Abstract
IntroductionReplacement of the aortic valve in patients with a small aortic annulus is associated with increased morbidity and mortality. A prosthesis-patient mismatch is one of the main problems associated with failed valves in this patient population.ObjectiveTo evaluate the long-term mortality predictors in patients with a small aortic annulus undergoing aortic valve replacement with a bioprosthesis.MethodsIn this retrospective observational study, a total of 101 patients undergoing aortic valve replacement from January 2000 to December 2010 were studied. There were 81 (80.19%) women with a mean age of 52.81±18.4 years. Severe aortic stenosis was the main indication for surgery in 54 (53.4%) patients. Posterior annulus enlargement was performed in 16 (15.8%) patients. Overall, 54 (53.41%) patients underwent concomitant surgery: 28 (27.5%) underwent mitral valve replacement, and 13 (12.7%) underwent coronary artery bypass graft surgery.ResultsMean valve index was 0.82±0.08 cm2/m2. Overall, 17 (16.83%) patients had a valve index lower than 0.75 cm2/m2, without statistical significance for mortality (P=0.12). The overall 10-year survival rate was 83.17%. The rate for patients who underwent isolated aortic valve replacement was 91.3% and 73.1% (P=0.02) for patients who underwent concomitant surgery. In the univariate analysis, the main predictors of mortality were preoperative ejection fraction (P=0.02; HR 0.01) and EuroSCORE II results (P=0.00000042; HR 1.13). In the multivariate analysis, the main predictors of mortality were age (P=0.01, HR 1.04) and concomitant surgery (P=0.01, HR 5.04). Those relationships were statistically significant.ConclusionA valve index of < 0.75 cm2/m2 did not affect 10-year survival. However, concomitant surgery and age significantly affected mortality.
Highlights
Replacement of the aortic valve in patients with a small aortic annulus is associated with increased morbidity and mortality
Patients with aortic stenosis benefit from aortic valve replacement because this procedure reduces left ventricular afterload, which leads to a significant reduction in left ventricular muscle hypertrophy and marked clinical improvement[1]
Aortic valve replacement with a 19- or 21-mm bioprosthesis was performed without annulus enlargement in 85 (84.15%) patients and with aortic annulus enlargement using the Manouguian technique in 16 (15.84%) patients
Summary
Replacement of the aortic valve in patients with a small aortic annulus is associated with increased morbidity and mortality. A prosthesis-patient mismatch is one of the main problems associated with failed valves in this patient population. Prosthetic aortic valve replacement is a therapeutic option for patients with symptomatic aortic valve disease. Patients with aortic stenosis benefit from aortic valve replacement because this procedure reduces left ventricular afterload, which leads to a significant reduction in left ventricular muscle hypertrophy and marked clinical improvement[1]. In the late 1970s, Rahimtoola[2] suggested that the main complications from valve replacement surgery were thromboembolism, bleeding from anticoagulation therapy, prosthetic dysfunction, the need for valve re-replacement, and prosthesis-patient mismatch (PPM). This study was carried out at Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
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