Implantation Of Aortic Prosthesis Research Articles

CONDUCTION DISORDERS AND PERMANENT CARDIAC PACEMAKER AFTER TRANSCATHETER AORTIC IMPLANTATION - AN UPDATE OVERVIEW

Aortic valve substitution is a standard technique with tolerable risk; nevertheless, the high mortality may be contraindicated. To reduce morbidity and mortality minimally invasive transcatheter aortic valve implantation (TAVI) may be an alternative approach. Although considered secure, after the method complications can occur, presenting as new-onset persistent left bundle branch block and demanding pacemaker implant. To establish how frequent this probability is, a systematic review from PUBMED (philters used were "15 years" and "free full texts") was achieved applying the terms "TAVI", "pacing" and "complications". For supporting literature, the other sources (SCIELO, Google Scholar and MEDLINE) were used and consulted for supporting literature. Catheter aortic prosthesis implantation is an effective modality for patients with high surgical risk and severe aortic stenosis. The review results suggest that the need for a pacemaker after endovascular treatment is neither inevitable nor easily predicted by known risk factors. Even though TAVI is considered a safe technique of selection, the implant position is near to functionally significant septal cardiac structures. Conduction disorders are frequent and need prudent checking after the procedure. Forthcoming studies must be necessary to validate the proposed algorithm and define the role of EP studies, ambulatory continuous electrocardiogram (Holter 24 hours) monitoring and preventive pacemaker in the management of conduction disturbances in patients undergoing transcatheter aortic valve replacement

A modified technique for aortic prosthesis implantation after prosthetic valve endocarditis complicated by complex paraannular aortic abscess.

The aim of this study is to describe a modified technique for aortic prosthesis implantation in the sinuses of Valsalva without the use of a patch for aortic annular reconstruction in patients with prosthetic valve endocarditis complicated by aortic abscess. From January 2008 to March 2021, 47 patients underwent aortic valve replacement due to prosthetic aortic valve endocarditis. The new aortic prosthesis was implanted into the sinuses of Valsalva above the abscess left open to drain. The first step consists in passing U-shaped stitches with pledgets through the aortic wall approximately 5-7 mm above the abscess involving the annulus. In the second step, the prosthesis is fixed to the aortic wall. In the third step, a 10 mm wide Teflon strip is positioned along the external course of the aortic wall and U-shaped stitches without pledgets are passed from the outside to the inside to definitively fix the prosthetic annulus to the sinuses of Valsalva. In-hospital mortality was 8.5% (4/47 patients). Mean follow-up was 62 ± 37.7 months. Four patients died (9.3%). Predicted probability of cardiac vs non-cardiac mortality was not statistically significant (p = 0.88). Overall survival probability (freedom from all-cause death) at 3, 7 and 9 years was 97%, 87.5% and 75%, respectively. No patients presented with grade 2 or 3 peri-prosthetic leak, nor had endocarditis. Prosthetic valve endocarditis complicated by complex paraannular aortic abscess can be successfully addressed with good long-term results by using our alternative technique.

Lipidomic signatures of aortic media from patients with atherosclerotic and nonatherosclerotic aneurysms

Aortic aneurysms are associated with fatal aortic rupture. Current therapeutic approaches are limited to implantation of aortic prostheses and stent-grafts; no effective drugs are available because the pathogenic mechanisms of aortic aneurysms remain unclear. Here, we aimed to elucidate the molecular mechanisms of the initiation and progression of aortic aneurysm by lipidomics. We performed lipidomics analyses of lipids in the aortic media of normal, border, and aneurysm areas from patients with thoracic atherosclerotic aortic aneurysm (N = 30), thoracic nonatherosclerotic aortic aneurysm (N = 19), and abdominal atherosclerotic aortic aneurysm (N = 11) and from controls (N = 8) using liquid chromatography and mass spectrometry. Significant alterations were observed in the lipid profiles of patients with atherosclerotic aortic aneurysms and to a lesser extent in those with nonatherosclerotic aneurysms. Increased triacylglycerols (TGs) and decreased ether-type phosphatidylethanolamines (ePEs) were observed throughout the normal, border, and aneurysm areas of thoracic and abdominal atherosclerotic aortic aneurysms. Prostaglandin D2 increased, but ePEs and TGs decreased in normal areas of thoracic atherosclerotic aortic aneurysms and thoracic nonatherosclerotic aortic aneurysms compared with the control tissues. These findings expand our knowledge of metabolic changes in aortic aneurysms and provide insights into the pathophysiology of aortic aneurysms.

Myalgies fébriles révélant une endocardite infectieuse à Propionibacterium acnes

IntroductionPropionibacterium acnes endocarditis is rare and difficult to diagnose. We report a case of Propioniacterium acnes endocarditis revealed by a lower limb fasciitis. Case reportA 54-year-old patient presented with recurrent febrile myalgia of the lower limbs, that appeared three years after an aortic surgery (aortic valve sparing reimplentation and ascending aortic prosthesis implantation). Computer tomography showed fasciitis of both legs. Positron emission tomography showed 18Fluorodeoxyglucose intake of the aortic prosthesis and in muscles of the lower limbs. Ten days after blood sample drawing, cultures showed the presence of Propionibacterium acnes. The aortic prosthesis was surgically removed, whose culture confirmed infection by Propionibacterium acnes. The diagnosis of infective endocarditis revealed by lower limb emboli was made. Evolution was favorable. ConclusionIn patients with vascular prostheses, Propionibacterium acnes infection must be evoked face to an atypical inflammatory process. Very prolonged blood culture incubation is needed to identify the pathogen.

Does Aortic Valve Replacement Surgery Improve Patients' Quality of Life?

Aortic valve replacement surgery is done to increase patients' life expectancy and improve their health-related quality of life. Several published studies have found improvement in health-related quality of life after this procedure, but none have involved patients in Portugal. This study sought to evaluate patients' health-related quality of life after the implantation of aortic prostheses and compare these values with preoperative health-related quality of life and the general Portuguese population's health-related quality of life. A retrospective study was done with elective patients who underwent implantation of an aortic prosthesis between August 2011 and April 2016. Health-related quality of life was evaluated using the Short Form 36 Health Survey and Short Form 6 Health Survey questionnaires in the preoperative period and 3, 6 and 12 months post-surgery. Descriptive and inferential analyses were conducted to process the data and compare preoperative health-related quality of life with postoperative values and the Portuguese population's norms. The sample included 506 patients with an average age of 70.6 years. The majority are male (53.6%). The postoperative results show a statistically significant improvement compared to preoperative health-related quality of life in all eight dimensions of the Short Form 36 Health Survey. When contrasted with the general Portuguese population, patients' health-related quality of life is lower in the preoperative period, improving postoperatively and reaching higher than average health-related quality of life levels in some subgroups of patients and in various dimensions. An analysis of the Short Form 6 Health Survey results revealed that the patients undergoing this surgery have a higher level of preoperative problems compared with the general population, but these patients' values approach those of the general population by the end of one year post-surgery. This is the first study in Portugal that compares health-related quality of life using a validated scale, before and after the aortic prosthesis implantation surgery. The results demonstrate a significant improvement in all dimensions, which is not consistently observed in other published studies. The results confirm that the implantation of aortic prostheses improves patients' health-related quality of life, over time bringing it close to the general population's levels.

Aims and expectations of a prospective multicenter study on aortic valve surgery: (E-AVR registry)

Background: Treatment of severe aortic valve stenosis (SAVS) is a hot topic due to improved life expectancy of general population, improvement of diagnostic tools, and consequent increased number of patients requiring aortic valve surgery. Traditional aortic valve replacement and recent transcatheter aortic prosthesis implantation have reported comparable or non-inferior mortality in randomised controlled trials (RCTs). However, RCTs have the limitation of the predefined inclusion/exclusion criteria, and cannot completely reflect the ‘real clinical world’. Recently sutureless prostheses, often implanted via minimally invasive approaches, have been reported as an alternative strategy. However, their definitive impact on clinical results is not yet completely evaluated because of the limited sample size of patients population of most of published studies, based on monocentric patients series. Methods: The aim of this prospective multicentre registry including all patients referred for aortic valve surgery and treated with all available techniques is to obtain a ‘real-world’ scenario of the clinical results arising from current surgical options. Results: The research protocol enrollment phase is ongoing. Therefore we have not yet results to publish. When available, the research findings deriving from E-AVR registry will be presented in the scientific community in international congresses and published in peer review international journals in the fields of cardiac surgery and cardiology. Conclusions: This multicenter, prospective, European registry has been designed with the aim to cast light on a lot of controversial issues, particularly those regarding the impact of patient baseline risk factors as well as treatment methods for SAVR, with or without coronary artery bypass grafting (CABG), on the prognosis after treatment. We believe that the information derived from this registry can provide deep knowledge on the causes that lead to adverse outcomes after SAVR, to avoid them, and finally to identify the best treatment option for SAVS for each patient.

Midterm, multicenter clinical and hemodynamic results for the Trifecta aortic pericardial valve

ObjectiveTo evaluate the midterm hemodynamic performance and clinical outcomes of the Trifecta aortic pericardial valve. MethodsIn a multicenter, prospective, nonrandomized, follow-up study, 710 patients underwent surgical implantation of a pericardial stented aortic prosthesis (Trifecta valve; St Jude Medical, St. Paul, Minn). The valve is constructed from bovine pericardium mounted externally onto a titanium stent. Subjects were followed on an annual basis over 6 years. ResultsOperations were performed from 2007 to 2009, and mean age was 72.4 ± 9.3 years; 471 of 710 (66.3%) were men. Preoperatively, 361 of 710 (50.8%) of patients were in New York Heart Association class III or IV, and at 6 years postoperatively, 92 of 96 (95.8%) were New York Heart Association class I or II. Six years postoperatively, average mean gradient across all valve sizes was 11.0 mm Hg, and the average effective orifice area index was 0.80 cm2/m2. The proportion of patients without moderate-to-severe valvular regurgitation at 6 years was 95.2% (80/84). Six years postoperatively, freedom from valve-related mortality, nonstructural dysfunction, and paravalvular leak were 98.3%, 98.6%, and 98.9%, respectively, and freedom from reoperation due to structural valve deterioration was 97.3% (95% confidence limits, 98.6-94.7). ConclusionThese midterm results demonstrate that the Trifecta valve is a safe and effective valve substitute with excellent hemodynamic performance and durability that is maintained through the 6-year follow-up period.

Sutureless Aortic Valve Replacement in a Patient with Transfemoral Aortic Valve Replacement and Left Ventricular Hypertrophy.

Background Transarterial valve intervention (TAVI) is valuable in high-risk patients, however, in case of left ventricular outflow tract (LVOT) obstruction, conventional surgery, including partial myectomy, is indicated. Case Description An 84-year-old female patient presented with increasing fatigue after TAVI in 2012, demonstrated a narrowed LVOT. Conventional surgery was performed, including removal of the transcathether valve, partial septal myectomy, and implantation of a sutureless valve. The postoperative course was uncomplicated. Conclusion Aortic valve stenosis combined with severe left-ventricular hypertrophy is not ideal for TAVI. Conventional surgery, performing partial septal myectomy and implantation of sutureless aortic prosthesis, seems more appropriate.

Reduced anticoagulation is safe in high-risk patients with the On-X mechanical aortic valve.

The goal of anticoagulation in patients with mechanical aortic valve replacement (AVR) is to maintain an optimal international normalized ratio (INR) that minimizes both the risk of bleeding and thromboembolic events. Here, we review the published data on anticoagulation with bileaflet mechanical prostheses, with a focus on the On-X valve (On-X Life Technologies, Austin, TX), which was designed to function with less anticoagulation or, in some cases, antiplatelet therapy only. Several long-term follow-up studies with the On-X valve demonstrate low rates of bleeding and thromboembolism with standard and low-dose anticoagulation. The Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT) compared the safety of less aggressive anticoagulation (INR 1.5-2.0) with standard anticoagulation (INR 2.0-3.0) after implantation of On-X aortic prostheses for patients at high risk of thromboembolic events. The updated 5-year data confirm that low-dose warfarin is associated with lower major bleeding (1.6 vs. 3.9%/patient-year; P = 0.007) with no difference in thromboembolic events (0.11 vs. 0.52%/patient-year; P = 0.2). Nonrandomized studies and the PROACT data support the safety and efficacy of maintaining the On-X bileaflet mechanical aortic valve prosthesis at a lower target INR than current guideline recommendations for patients at high risk of thromboembolic events. These results offer the promise of a valve prosthesis with excellent durability combined with reduced anticoagulation-related complications.

Repercusión de la enfermedad coronaria en pacientes con estenosis aórtica severa tratados con la prótesis aórtica percutánea CoreValve

BackgroundA third of patients with severe aortic stenosis undergoing valve replacement surgery is associated with coronary heart disease, increasing the risk of surgery. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment for patients with severe aortic stenosis and high surgical risk. However, little is known about the effect of coronary artery disease in these patients. The objective was to determine the prevalence and impact having coronary artery disease in patients undergoing percutaneous valve implantation. MethodsBetween April 2008 and December 2011, 230 patients with severe symptomatic aortic stenosis were treated with high surgical risk, with the CoreValve aortic prosthesis. All patients underwent a previous coronary angiography. Results36.1% had coronary artery disease, predominantly male (60%) and greater ventricular dysfunction than patients without coronary disease (24% vs. 12%, P=.02). There was no difference in hospital mortality (4.1% vs. 7.2%, P=.303) when comparing patients with and without coronary disease. Survival at 12 and 24months was slightly lower in patients with coronary artery disease (80.9% vs. 91.4% and 72.6% vs. 86.5%, P=.048, respectively). The revascularized coronary patients previously had a slightly higher survival non-revascularized patients, 82.9% vs. 78.6% at 12 months and 67.2% vs. 61.15% at 24 months, P=.63. ConclusionsThe treatment of coronary artery disease in patients with severe aortic stenosis prior to percutaneous implantation of CoreValve aortic prosthesis improves the prognosis of these short and medium term.

TCT-707 Impact of Area Cover Index on the Incidence of Conduction Abnormalities after Implantation of Balloon-Expandable Aortic Prosthesis

TCT-707 Impact of Area Cover Index on the Incidence of Conduction Abnormalities after Implantation of Balloon-Expandable Aortic Prosthesis

Adrenal cortical carcinoma with extension into the inferior vena cava – case report and literature review

Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with an incidence rate of 1 to 2 per million person-years. ACC most commonly arises sporadically, but may be associated with familial tumour syndromes. Clinical symptoms are mainly related to an excess of steroid hormones. We present an unusual case of adrenocortical carcinoma in a 27-year-old male who complained of non specific mass-effect related symptoms of slowly growing intensity differing from others described in literature because of the patient’s age and the sudden deterioration of the clinical course. The tumour was resected with the left kidney with an extension into the inferior vena cava. Histological examination revealed morphological features characteristic of an adrenal cortical tumour. The immunohistochemical results (positive reactions for vimentin, CD56, inhibin, melan A, synaptophysin, bcl-2, calretinin) confirmed the diagnosis. According to the most widely used modified Weiss criteria and the Van Slooten system, a diagnosis of adrenal cortical carcinoma was strongly confirmed. The postoperative condition was poor. Reoperation was conducted, including abdominal aorta thrombectomy and aortic prosthesis implantation. The patient died two days after the second operation. Autopsy revealed a metastatic tumour in the left lung and morphological symptoms of acute circulatory collapse due to a massive haemorrhage into the abdominal cavity, which was the direct cause of death.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1602226377106882.

PM120 Sex influence on the results of the self expanding aortic prosthesis implantation according the criteria of the valve academic research consortium

O ST E R A B ST R A C T S Methods: A cohort of 8 patients with severe aortic stennosis underwent 9 BAV procedures. Intra-cardiac echocardiography (ICE) guided trans-septal puncture and BAV using Inoue balloon were performed antegradely. Clinical, hemodynamin, and follow-up mortality data were collected. Results: The mean age was 81.0 9.2 years, and the vast majority of patients had comorbidities and high-risk features including 4 hemodialysis patients(50%). The mean Society of Thoracic Surgeons and EuroSCOREII (European System for Cardiac Operative Risk Evaluation) was 10.6 5.2 and 16.0 7.8, respectively. BAV was performed for symptom relief in all patients (100%). The mean aortic valve area (AVA) increased from 0.69 0.32 cm(2) to 1.17 0.4 cm(2) (p 1 cm(2), and in 7 patients (88%), AVA increased by >50%. There was no death, stroke, coronary occlusion, severe aortic regurgitation, cardiac tamponade. One patient developed sepsis and worsening of renal failure. During median follow-up of 194 days, the mortality rate was 25% (n 1⁄4 2). Conclusion: In severe AS patients who have high risk for surgical AVR, antegrade BAV using Inoue balloon may be feasible with good initial and mid-term outcomes. Disclosure of Interest: None Declared

Is heart team fundamental to aortic stenosis transcatheter treatment?

Is heart team fundamental to aortic stenosis transcatheter treatment?

Initial experience of two national centers in transcatheter aortic prosthesis implantation.

BackgroundTranscatheter aortic valve implantation is an effective alternative to surgical treatment of severe aortic stenosis in patients who are inoperable or at high surgical risk.ObjectivesTo report the immediate and follow-up clinical and echocardiographic results of the initial experience of transcatheter aortic valve implantation.MethodsFrom 2009 June to 2013 February, 112 patients underwent transcatheter aortic valve implantation.ResultsMean age was 82.5 ± 6.5 years, and the logistic EuroSCORE was 23.6 ± 13.5. Procedural success was 84%. After the intervention, a reduction in the mean systolic gradient was observed (pre: 54.7 ± 15.3 vs. post: 11.7 ± 4.0 mmHg; p < 0.01). Cerebrovascular accidents occurred in 3.6%, vascular complications in 19% and permanent pacemaker was required by 13% of the patients. Thirty-day mortality and at follow-up of 16 ± 11 months was 14% and 8.9% respectively. The presence of chronic obstructive pulmonary disease was the only predictor of mortality at 30 days and at follow-up. During follow up, aortic valve area and mean systolic gradient did not change significantly.ConclusionsTranscatheter aortic valve implantation is an effective and safe procedure for the treatment of aortic stenosis in high-surgical risk or inoperable patients. The presence of chronic obstructive pulmonary disease was the only independent predictor of mortality identified both in the first month post-intervention and at follow-up.

Obesity and the risk of late mortality after aortic valve replacement with small prosthesis.

BackgroundWhether obesity is related to late mortality with implantation of small aortic prosthesis remains to be clarified. This study was aimed to evaluate the effect of obesity on late survival of patients after aortic valve replacement (AVR) with implantation of small aortic prosthesis (size ≤ 21 mm).MethodsFrom January 1998 to December 2008, 307 patients in our institution who underwent primary AVR with smaller prostheses survived the 30 days after surgery. Patients were defined as normal if body mass index (BMI) was < 24 kg/m2, as overweight if BMI 24–27.9 kg/m2, and as obese if BMI ≥ 28 kg/m2. Data of New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF), effective orifice area index (EOAI), and left ventricular mass index (LVMI) of the patients collected at the 3rd month (M), 6th M, 1st year (Y), 3rd Y, 5th Y, 8th Y after operation respectively.ResultsBy multivariable analysis, obesity was an independent factor of late mortality (hazard ratio [HR]: 1.62; P = 0.01). The obesity and overweight group had more poor survival (p < 0.001) and higher proportion of NYHA class III/IV (p < 0.01) compared with the normal group. Lower EOAI and higher LVMI were found in obesity and overweight group, but we saw no significant difference about LVEF among the three groups.ConclusionsObesity was associated with increased late mortality of patients after AVR with implantation of small aortic prosthesis. Being obese or and overweight may also affect the NYHA classification, even in the longer term. EOAI should be improved where possible, as it may reduce late mortality and improve quality of life in obese or overweight patients.

Obesity is Associated with Higher Long-term Mortality After Aortic Valve Replacement with Small Prosthesis

ObjectiveAlthough many studies have evaluated the impacts of obesity on various medical treatments, it is not known whether obesity is related to late mortality with implantation of small aortic prosthesis. This study evaluated the effect of obesity on late survival of patients after aortic valve replacement (AVR) with implantation of small aortic prosthesis (size ≤21mm). MethodsFrom January 1998 to December 2008, 536 patients in our institution who underwent primary AVR (307 patients with smaller prostheses) survived the 30 days after surgery. Patients were categorised as normal weight if body mass index (BMI) was ≤25kg/m2, as overweight if BMI 25–30kg/m2, and as obese if BMI ≥30kg/m2. Data were collected at the third-month (M), sixth-M, first-year (Y), third-Y, fifth-Y, and eighth-Y after operation. ResultsBy multivariable analysis, obesity was a significant independent factor of late mortality (hazard ratio [HR]: 1.59; p=0.006). The obese and overweight groups of patients exhibited lower survival (p<0.001) and a higher proportion in NYHA class III/IV (p<0.01) compared with the normal group. Lower EOAI and higher left ventricular mass index were found in the obese and overweight groups, but we saw no significant variance in LVEF among the three groups. ConclusionsObesity was associated with increased late mortality of patients after AVR with implantation of small aortic prosthesis. Being obese or and overweight may also affect the NYHA classification, even in the longer term.

Impact of obesity on long-term survival after aortic valve replacement with a small prosthesis

Although many studies have evaluated the impact of obesity on various medical treatments, it is not known whether obesity is related to late mortality with implantation of small aortic prostheses. This study evaluated the effect of obesity on the late survival of patients after aortic valve replacement (AVR) with implantation of a small aortic prosthesis (size ≤ 21 mm). From January 1998 to December 2008, 307 patients in our institution who underwent primary AVR with smaller prostheses survived 30 days after surgery. Patients were categorized as normal weight if body mass index (BMI) was <24 kg/m(2), overweight if BMI 24-27.9 kg/m(2) and obese if BMI ≥ 28 kg/m(2). Data of the New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF), effective orifice area index (EOAI) and left ventricular mass index of the patients were collected at the third month, sixth month, first year, third year, fifth year and eighth year after operation. By multivariable analysis, obesity was a significant independent factor of late mortality (hazard ratio: 1.62; P = 0.01). The obese and overweight groups of patients exhibited lower survival (P < 0.001) and a higher proportion in NYHA Class III/IV (P < 0.01) compared with the normal group. A lower EOAI and higher left ventricular mass index were found in the obese and overweight groups, but we saw no significant variance in LVEF among the three groups. Obesity is associated with increased late mortality of patients after AVR with implantation of small aortic prosthesis. Obesity or/and overweight may also affect the NYHA classification, even in the longer term. EOAI should be improved where possible, as it may reduce late mortality and improve quality of life in obese or overweight patients.

Implantación de prótesis aórtica transcatéter por vía transaórtica. Experiencia inicial

A significant number of patients suffering from severe symptomatic aortic stenosis are not candidates for conventional surgical aortic valve replacement because of their high operative risk, or due to important technical difficulties. This group of patients may benefit from recently developed techniques of trans-catheter implantation of aortic prostheses, most commonly via femoral artery or through the left ventricular apex. We report the use of a trans-aortic approach for implanting such devices in three patients not suitable for conventional open surgery or for trans-femoral or trans-apical approach. We describe the surgical technique via a partial median sternotomy and direct puncture of the ascending aorta, and we comment on its pros and cons. We concluded that this is an efficient and reliable technique that may help to prevent some of the complications inherent to the trans-apical approach. We believe that this could be the technique of choice in patients with respiratory disease, low ejection fraction, or with previous left thoracotomy not suitable for a transfemoral approach.

Clinical outcome of double valve repalcement with or without small aortic prosthesis.

To determine the effect of aortic prosthesis size on clinical outcome of patients undergoing double cardiac valve replacement (DVR). A quasi-experimental study. Cardiac Surgery Department, Punjab Institute of Cardiology, Lahore, Pakistan, from February 1996 to December 2008. One hundred and forty patients undergoing double cardiac valve replacement were divided into 2 groups. Group I, 75 (53.6%) receiving aortic prosthesis size of ² 21 mm. Group II, 65 (46.4%) having aortic prosthesis of > 21 mm size. All patients were prospectively followed-up for 12 years in order to study mortality and valve related complications. There were 94 males (67.1%) and 46 females (32.9%) with a mean age of 25.5 ± 10 years. In Group I, 21 patients (28%) had aortic valve replacement (AVR) with 19 mm valve size and 54 patients (72%) had 21 mm size valves implanted. In Group II, 39 patients (60%) had AVR with 23 mm size valves implanted followed by 16 (24.6%) who received 25 mm size valves. Posterior mitral leaflet was preserved in 15 patients (20%) in Group I and 14 (21.5%) in Group II. Mortality was seen in 13 patients (9.3%); of these 5 (3.6%) were in Group I and 8 (5.7%) were in Group II. Nine patients (6.4%) had incomplete follow-up (In Group I, 2 patients died in ICU, 2 died within 30 days of admission and one was a late death. In Group II, 1 patient died in ICU, 1 within 30 days of admission and 6 within 1 year of operation). Double valve replacement with implantation of small aortic prosthesis has similar overall mortality as compared to patients having larger sized aortic valves.