Early clinical evaluation after aortic valve replacement with the St. Jude Medical valve in patients with a small aortic root.

Forty-three patients, nine men and 34 women, mean age 60 years (range 23-81 years), who had small aortic roots underwent aortic valve replacement with a St. Jude Medical valve. Preoperatively, five patients were in New York Heart Association (NYHA) class I, 19 were in class II, 15 were in class III and four were in class IV. In 30 of 36 patients with aortic stenosis, the mean gradient was 102 mm Hg (range 52-175 mm Hg; in six patients with aortic stenosis, the gradient was not measured. Seven patients underwent surgery for aortic regurgitation. Ten patients received a 19-mm valve, 29 a 21-mm valve and nine a 23-mm valve. Two patients (4.6%) died in the hospital, one immediately postoperatively and the other from low cardiac output 9 days postoperatively. There are 670 patient-months of follow-up (mean 17 months). Thirty-six patients are NYHA class I and two patients are in class II. There have been no thromboembolic episodes in 605 months of follow-up for patients maintained on warfarin. There was one partial valve thrombosis among eight patients being managed without warfarin. No mechanical valve failures have occurred. The St. Jude Medical valve provides a satisfactory early result when used to replace the aortic valve of patients who have a small aortic root.