Aortic valve replacement with 17-mm mechanical prostheses: Is patientprosthesis mismatch a relevant phenomenon?

Andrea Garatti, Francesca Mori, Francesco Innocente, Alberto Canziani, Piervincenzo Gagliardotto, Eugenio Mossuto, Tiberio Santoro, Vincenzo Montericcio, Alessandro Frigiola, Lorenzo Menicanti

Research output: Contribution to journalArticlepeer-review

Abstract

Background We sought to evaluate the long-term performance of a consecutive cohort of patients implanted with a 17-mm bileaflet mechanical prosthesis. Methods Between January 1995 and December 2005, 78 patients (74 women, mean age = 71 ± 12 years) underwent aortic valve replacement with a 17-mm mechanical bileaflet prosthesis (Sorin Bicarbon-Slim and St. Jude Medical-HP). Preoperative mean body surface area and New York Heart Association class were 1.6 ± 0.2 m2 and 2.6 ± 0.8, respectively. Preoperative mean aortic annulus, indexed aortic valve area, and peak and mean gradients were 18 ± 1.6 mm, 0.42 cm2/m2, 89 ± 32 mm Hg, and 56 ± 21 mm Hg, respectively. Patients were divided into two groups, according to the presence (group A, 29 patients) or absence of patientprosthesis mismatch (group B, 49 patients). Patientprosthesis mismatch was defined by an indexed effective orifice area less than 0.85 cm2/m2. Results Overall hospital mortality was 8.8%. Follow-up time averaged 86 ± 44 months. Actuarial 5-year and 10-year survival rates were 83.7% and 65.3%, respectively. The mean postoperative New York Heart Association class was 1.3 ± 0.6 (p <0.001). Overall indexed left ventricular mass decreased from 163 ± 48 to 120 ± 42 g/m2 (p <0.001), whereas average peak and mean prosthesis gradients were 28 ± 9 mm Hg and 15 ± 6 mm Hg, respectively (p <0.001). Early and long-term mortality were similar between the two groups as well as long-term hemodynamic performance (mean peak gradient was 28 mm Hg and 27 mm Hg in group A and B, respectively, not significant); left ventricular mass regression occurred similarly in both groups (indexed left ventricular mass at follow-up was 136 ± 48 and 113 ± 40 in group A and B, respectively; not significant). Conclusions Selected patients with aortic stenosis experience satisfactory clinical improvement after aortic valve replacement with modern small-diameter bileaflet prostheses.

Original languageEnglish
Pages (from-to)71-77
Number of pages7
JournalAnnals of Thoracic Surgery
Volume91
Issue number1
DOIs
Publication statusPublished - Jan 2011

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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