Aortic Valve Replacement With Carpentier-Edwards: Hemodynamic Outcomes for the 19-mm Valve

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Clinical Outcomes Research

Background:

• Aortic stenosis necessitates aortic valve replacement (AVR).
• The Carpentier-Edwards pericardial bioprosthesis is a common AVR option.
• Comparisons between smaller (19-mm) and larger bioprostheses are crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the hemodynamic performance and clinical outcomes of the 19-mm Carpentier-Edwards pericardial bioprosthesis against larger valves in patients with aortic stenosis.
• To evaluate the impact of patient-prosthesis mismatch on outcomes.

Main Methods:

• A retrospective study of 447 patients undergoing AVR for aortic stenosis between 1998 and 2013.
• Patients were grouped by implanted valve size: 19-mm (n=54), 21-mm (n=154), and 23-27 mm (n=239).
• Transthoracic echocardiography assessed in vivo effective orifice area index at 12 months; mean follow-up was 4.9 years.

Main Results:

• Overall survival at 10 years was 84.1%, unaffected by patient-prosthesis mismatch.
• The 19-mm group, despite being older and having more mismatch, showed no significant differences in early outcomes, survival, or cardiac mortality compared to larger valves.
• Independent mortality risk factors included age, male gender, coronary artery bypass graft, and low hemoglobin.

Conclusions:

• The Carpentier-Edwards pericardial bioprosthesis, including the 19-mm size, demonstrates acceptable clinical outcomes and hemodynamic function.
• Smaller bioprostheses can be safely used in selected patients with aortic stenosis.
• Further research may explore long-term durability and specific patient selection criteria.