A nineteen-millimetre aortic valve prosthesis: is this really a risk?

Aortic valve replacement in patients with a small aortic root is a subject of ongoing controversy. We summarised our clinical experience with aortic valve replacement with 19 mm valves and combined this with a review of literature.

Between January 1994 and December 1999, 603 patients underwent aortic valve replacement; 51 of these patients (8.3%) received a 19 mm heart valve prosthesis. The mean age was 72±9.7 years. Twenty-eight patients had concomitant coronary artery disease, six patients a combined mitral or tricupid valve disease. In four patients, the intervention was a reoperation. The mean EuroSCORE of the total group was 6.4±2.8, and 34 patients had a high operative risk.

Hospital mortality was 7.8% (4/51 patients). Follow-up of 47 hospital survivors was complete. At 12 months the survival was 90%, at 24 months 85% and at 48 months 60%. NYHA class improved at least one class in 35 patients (85%), and 34 patients declared that their quality of life had improved since the operation.

Aortic valve replacement with a small (19 mm) prosthesis can be performed with an acceptable operative mortality and results in excellent symptomatic improvement and quality of life.