Small aortic root in the elderly: use of stentless bioprosthesis.

BACKGROUND AND AIMS OF THE STUDY

Aortic root enlargement in the elderly patient prolongs aortic valve replacement procedures and may be problematic if the root is calcified. Mechanical valves have superior hemodynamics compared to tissue valves in the smaller sizes but are often contraindicated in the older patient.

MATERIALS AND METHODS

Between January 1993 and November 1995, we implanted 80 Freestyle (Medtronic, Irvine, CA) stentless porcine valves using the freehand subcoronary technique. Twenty-seven of the patients had small aortic roots with an average age of 76.3 years (69-84). Seven patients received size 19 valves and 20 patients had size 21 valves.

RESULTS

The average echocardiographic gradient at hospital discharge was 17.9 mmHg (12.1-23.0) for size 19 valves and 15.3 mmHg (5.7-27.9) for size 21. At one year postoperative follow up the average gradient had decreased to 12.9 mmHg (9.3-17.5) for size 19 and 8.0 mmHg (2.2-19.3) for size 21 valves. Effective orifice areas increased from 1.09 cm2 at the time of discharge to 1.29 cm2 at one year follow up for size 19 valves, and from 1.30 cm2 to 1.56 cm2 for size 21. No patient had more than mild aortic insufficiency at most recent follow up.

CONCLUSION

This stentless porcine prosthesis has excellent hemodynamics in the smaller valve sizes which improve at least during the first year following surgery. We feel that it is the valve of choice in older patients with small aortic roots.