LONG TERM EFFECTS OF 19MM-SIZE BILEAFLET AORTIC VALVE PROSTHESIS

Abstract

OBJECTIVES. 19mm-size aortic prostheses still raises concerns about long term effects of residual transprosthetic gradient, left ventricular mass, and patient's activity. We reviewed our experience with SJM 19 mm standard® and 17 mm supra-annular (SJM-HP® and Solin Bicarbon®) aortic valve prostheses for small aortic annulus. METHOD. Forty-six patients (2 men and 44 women, age 71 ± 8 years) operated on between April 1990 and August 2002 were enrolled in this study. The mean body surface area was 1.40±0.12 m2. Clinical late assessment was performed to evaluate the incidence of valve related complications, residual transprosthetic gradient, left ventricular mass index (LVMI), and NYHA functional class. Postoperative echocardiography was performed to evaluate hemodynamic performance of the prostheses. Follow up was 1 to 12.7 (mean 7.5) years. RESULTS. There was no hospital mortality (0%). Actuarial survival rates at 5 and 10 years were 97.4±2.5% and 97.4±2.5%. Actuarial freedom from valve-related events rates at 5 and 10 years were 89.4±5.9% and 89.4%. Late postoperative peak gradient was 24±12mmHg. LVMI was significantly reduced in late phase (preope vs. late, 189±49 vs. 138±57g/m2, p=0.004). NYHA functional class was significantly improved in late period. CONCLUSIONS. Although 19 mm size aortic valve prosthesis remains small transprosthetic pressure gradient, LVMI was significantly reduced and patients' activity was satisfactory maintained in late period.