Author + information
- Received June 6, 2003
- Revision received November 17, 2003
- Accepted December 9, 2003
- Published online October 6, 2004.
- Victor G. Dávila-Román, MD, FACC*,* (, )
- Alan D. Waggoner, RDCS, MHS*,
- Elizabeth D. Kennard, PhD†,
- Richard Holubkov, PhD‡,
- W.R.Eric Jamieson, MD§,
- Lars Englberger, MD∥,
- Thierry P. Carrel, MD∥ and
- Hartzell V. Schaff, MD¶
- ↵*Reprint requests and correspondence:
Dr. Victor G. Dávila-Román, Director, Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Box 8086, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110
Objectives The purpose of this study was to determine the prevalence and severity of paravalvular regurgitation (PVR) in the Artificial Valve Endocarditis Reduction Trial (AVERT) cohort.
Background The initial AVERT cohort consisted of 807 patients randomized to receive either a Silzone-coated prosthetic valve or a conventional prosthetic valve; early clinical reports showed higher rates of valve explant caused by PVR for Silzone-coated prosthetic valve.
Methods Of the 678 eligible patients, 575 (85%) underwent postoperative transthoracic echocardiograms. The presence and severity of PVR were identified by color flow Doppler. Reviewers were blinded to the type of prosthetic valve and the demographic and clinical variables.
Results Among those who underwent echocardiography (Silzone-coated prosthetic valve, n = 285 and conventional prosthetic valve, n = 290), 59% had prosthetic aortic valves, 32% prosthetic mitral valves, and 9% had both; demographic and clinical findings (i.e., prosthetic valve endocarditis, thromboembolism, bleeding, and all-cause death) were similar for the two groups. Echocardiographically determined PVR was present in 50 valves: Silzone-coated prosthetic valve, 29 of 285 (10%) and conventional prosthetic valve, 21 of 290 (7%, p = NS); the severity of PVR was similar in both groups. Kaplan-Meier analysis showed no significant differences in PVR at 24 months from valve implantation between the two groups (24-month event-free rate: 93% Silzone-coated prosthetic valve vs. 94% conventional prosthetic valve, p = NS).
Conclusions Excluding those patients who had initial prosthetic valve explant, the two-year echocardiographic follow-up of the AVERT cohort shows no statistically significant differences in the prevalence or severity of PVR in the Silzone-coated prosthetic valve compared with the conventional prosthetic valve. Further monitoring is warranted to determine whether these clinical outcomes remain similar on long-term follow-up.
The AVERT study was funded by St. Jude Medical, St. Paul, Minnesota.
- Received June 6, 2003.
- Revision received November 17, 2003.
- Accepted December 9, 2003.
- American College of Cardiology Foundation