Original article
Adult cardiac
Clinical Outcome of Aortic Valve Replacement With 16-mm ATS-Advanced Performance Valve for Small Aortic Annulus

https://doi.org/10.1016/j.athoracsur.2009.12.074Get rights and content

Background

Various surgical techniques have been proposed to treat small aortic annulus. We have used small-diameter mechanical valves for small aortic annulus. The present study examined aortic valve replacement with small diameter mechanical valves to determine their effectiveness.

Methods

The study included 67 patients who underwent elective, isolated aortic valve replacement with ATS-Advanced Performance (AP) valves (ATS Medical, Inc, Minneapolis, MN) within our department. The patients were divided into two groups; patients receiving the 16-mm AP valve (16-mm group) and those receiving valves 18-mm AP or larger (>16-mm group).

Results

The mean age of the 16-mm group was significantly higher than that of the >16-mm group. Body surface area was significantly smaller in the 16-mm group than the >16-mm group. We found no significant differences in preoperative conditions between the groups. The effective orifice area index of the mechanical valve was lower in the 16-mm group (0.87 ± 0.06 vs 1.12 ± 0.13 cm2/m2, p < 0.0001). Six patients (40%) in the 16-mm group fell into the category of prosthesis-patient mismatch cases. Although the postoperative pressure gradient was higher in the 16-mm group (33.7 ± 12.5 vs 23.16 ± 8.78, p < 0.01), left ventricular mass index and left ventricular ejection fraction at early and at late follow-up improved from the preoperative period in both groups. We found no significant differences in incidence of postoperative complications, including death.

Conclusions

We believe aortic valve replacement with small-diameter mechanical valves (the ATS-AP valves) in patients with a small annulus provides satisfactory remote prognosis. The use of mechanical valves in elderly patients is considered acceptable with strict clinical monitoring to prevent thromboembolism and anticoagulation therapy-induced complications.

Section snippets

Patients and Methods

This study is a retrospective cohort study from our institution. Patient's data were obtained by retrospective review of clinical and operative records. The study included 67 patients who underwent elective, isolated, and consecutive aortic valve replacement with ATS-Advanced Performance (AP) valves (ATS Medical, Inc, Minneapolis, MN) within our department between June 2002 and January 2008. Valve replacement entailed a 16-mm valve in 15 cases, an 18-mm valve in 17 cases, a 20-mm valve in 24

Results

All patients in the 16-mm group were female. The >16-mm group consisted of 29 male and 23 female patients. The mean age of the 16-mm group was 71.5 ± 7.1 years, significantly higher than for the >16-mm group (66.3 ± 11.1 years; p = 0.04). Body surface areas were significantly smaller in the 16-mm group (1.38 ± 0.09 vs 1.55 ± 0.19; p < 0.0001). The following parameters did not differ in a statistically significantly manner between the groups before the procedure: LVEF, aortic valve pressure

Comment

With the aging of Japanese society, the number of patients in Japan with aortic valve conditions (particularly aortic stenosis) associated with age-related degeneration has increased each year. Previous guidelines suggested adding annular enlargement to aortic valve replacement procedures to prevent PPM in patients with a small aortic annulus [4]. However, reports indicate certain drawbacks with annular enlargement, including prolonged duration of aorta cross-clamp time, increase in

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