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Long-term follow up in patients receiving a small aortic valve prosthesis
Ken-Ichi Arata1, Yoshifumi Iguro, Hiroshi Masuda
1Second Department of Surgery, Faculty of Medicine, Kagoshima University, Sakuragaoka, Japan.
Background And Aims Of The Study:
Concern persists regarding the long-term effects of aortic valve replacement (AVR) in the small aortic root.
Methods:
Twenty-eight patients (21 females, seven males; mean age 54.1+/-11.7 years; mean body surface area (BSA) 1.39+/-0.07 m2) who underwent AVR with a 19 mm mechanical valve more than 10 years previously at the authors' institute, were followed up. Long-term echocardiographic evaluations were performed in 18 of 21 survivors.
Results:
Follow up in the 28 patients was complete for up to 19.2 years (mean 11.4 years); cumulative follow up was 318.1 patient-years. Actuarial survival rates at 5, 10 and 15 years were 88.5+/-6.3%, 72.0+/-9.0% and 72.0+/-9.0%, respectively. In general, NYHA class showed satisfactory improvement. Long-term echocardiography showed significant reductions in left ventricular (LV) wall thickness and mass index compared with preoperative values, despite the existence of pressure gradients. A negative correlation was found between the rate of reduction of LV wall thickness and BSA.
Conclusion:
Implantation of the 19 mm aortic mechanical prosthesis was viable in patients with a small aortic annulus, especially if their BSA was <1.45 m2.