Nineteen-Millimeter Bioprosthetic Aortic Valves Are Safe and Effective for Elderly Patients With Aortic Stenosis

Zain I Khalpey, Patrick O. Myers, Siobhan McGurk, Jan D. Schmitto, Foeke Nauta, Wernerd Borstlap, Esther Wiegerinck, Justina Wu, Lawrence H. Cohn

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Abstract

BACKGROUND: Replacing a stenotic aortic valve with 19-mm bioprostheses remains controversial owing to potential patient-prosthesis mismatch concerns. We report a single-center 10 year experience with 19-mm bioprosthetic valves implanted in elderly patients. We hypothesized patients would have acceptable in-hospital and long-term outcomes.

METHODS: Between January 2002 and December 2011, 257 patients underwent aortic valve replacement with a 19-mm prosthesis, of whom 182 had available follow-up echocardiographic studies. Mean age was 77.4 ± 8.4 years, and 10 of 257 (4%) were male. Outcomes of interest included early and late mortality, peak and mean aortic valve gradients, and left ventricular mass regression.

RESULTS: Operative mortality was 3.5% (9 of 257). Median postoperative echocardiographic time was 16 months. On follow-up echocardiography, mean peak aortic valve gradient decreased from 76 ± 27 mm Hg preoperatively to 32 ± 13 mm Hg and the mean gradient decreased from 46 ± 17 mm Hg to 18 ± 8 mm Hg (both p <0.001) Mean left ventricular mass decreased from 191 g to 162 g (p <0.001). Postoperative survival did not differ significantly between patients who met the criteria for patient-prosthesis mismatch and those who did not (p = 0.607).

CONCLUSIONS: In a series of elderly patients with aortic stenosis who were implanted with 19-mm bioprosthetic valves, long-term follow-up showed significant left ventricular mass regression and peak and mean aortic valve gradient reductions. The use of 19-mm aortic valves is safe and efficacious for elderly patients with a small aortic root.

Original languageEnglish (US)
Pages (from-to)650-657
Number of pages8
JournalAnnals of Thoracic Surgery
Volume101
Issue number2
DOIs
StatePublished - Feb 1 2016

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ASJC Scopus subject areas

  • Medicine(all)

Cite this

Khalpey, Z. I., Myers, P. O., McGurk, S., Schmitto, J. D., Nauta, F., Borstlap, W., Wiegerinck, E., Wu, J., & Cohn, L. H. (2016). Nineteen-Millimeter Bioprosthetic Aortic Valves Are Safe and Effective for Elderly Patients With Aortic Stenosis. Annals of Thoracic Surgery, 101(2), 650-657. https://doi.org/10.1016/j.athoracsur.2015.07.081