Performance of Edwards Magna in aortic position for small size patient population.
Department of cardiac surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
Yuta kume, Tomoyuki Fujita, Hiroki Hata, Yusuke Shimahara, Junjiro Kobayashi.
Few reports presented the efficacy of Edwards Magna valve in small size patient population. Thus, we analyzed the efficacy of Magna valve in aortic position for small size patient population.
Between June 2008 and April 2015, 282 consecutive patients (113 female, mean age, 69.9±9.9 years, mean body surface area (BSA), 1.59±0.19 m2 ) underwent AVR with a Magna (n=139) and Magna Ease (n=143). We divided the patients into 3 groups (Very Small group (n=49, VS): BSA ≦1.40, Relatively Small group (n=103, RS): BSA 1.40-1.60, Standard group (n=130, ST): BSA>1.60). The average valve size were 20.0±1.5 mm in VS group, 20.5±1.6 mm in RS group, and 23.1±2.1 mm in ST group (p<0.05 between VS and ST, RS and ST). The average EuroScore II was 3.4±4.6% (VS: 4.0±5.5%, RS: 3.3±3.9%, ST: 3.1±4.8% ). The hemodynamic performance was evaluated by echocardiography pre- and post-operatively and during the follow-up.
The mean follow-up time was 3.1±2.1 years with a 95.4% completion rate. Overall hospital mortality was 0.4%. There were 5 explant due to infectious endocarditis and no explant due to structural valve deterioration. The measured effective orifice area (EOA) for each sizes were 1.25±0.27 cm2 for 19mm, 1.38±0.33 cm2 for 21mm, 1.65±0.29 cm2 for 23mm and 1.75±0.33 cm2 for 25mm. The trans-valvular mean pressure gradients (mPG) were 13.9±4.6 mmHg for 19mm, 13.0±5.4 mmHg for 21mm, 11.9±4.5 mmHg for 23mm and 10.7±4.3 mmHg for 25mm. The follow up indexed EOA were 0.92±0.23 cm2/m2 in VS group, 0.90±0.21 cm2/m2 in RS group and 0.92±0.21 cm2/m2 in ST group, and the follow up trans-valvular mPG were 12.4±5.1 mmHg in VS group, 13.6±5.1 mmHg in RS group and 11.9±4.7 mmHg in ST group, and there were no significant difference between the groups. Follow-up echocardiography (3.0±2.3 years after surgery) revealed Left ventricular (LV) mass was significantly (p<0.05) reduced postoperatively with regression rate of 27.7% in VS group, 26.9% in RS group, and 30.9% in ST group.
Implantation of Magna valve in aortic position was safe and effective procedure for small size patients, with low operative risks and similar hemodynamics and left ventricular mass regression with standard size patients.