[Long-term results of the 19 mm low-profile bileaflet valve prosthesis in the small aortic anulus]

Between April, 1979, and November, 1986, 20 patients underwent aortic valve replacement (AVR) in the small aortic anulus with either 19 mm St. Jude Medical valve prosthesis or 19 mm Duro-Medics valve prosthesis, which are relatively new, low-profile bileaflet valve prostheses. There were two male and 18 female patients ranging from 35 to 69 years old (mean, 54.7 years). Average body surface area was 1.37 +/- 0.11 m2 (range 1.20 to 1.55 m2). One patient died of arrhythmia at 22 postoperative day. The 19 survivors have been followed up for as long as 61 months (mean, 31.2 months). There were two late complications, cerebral infarctions, and event free ratio was 0.85 at five years. All long-term survivors were in New York Heart Association Functional Class I (15 patients) and Class II (three patients). Preoperative and postoperative echocardiograms demonstrated significant decreases in mean left ventricular end-diastolic diameter (LVDd) (48.9 +/- 8.3 mm vs 42.2 +/- 5.7 mm; p less than 0.01) and in left ventricular end-systolic diameter (LVDs) (32.2 +/- 8.2 mm vs 25.7 +/- 4.9 mm; p less than 0.01). Mean left ventricular wall thickness was decreased to 24.5 +/- 3.7 mm from 25.8 +/- 6.4 mm. The average peak systolic gradient at rest with Doppler ultrasound was 26.0 +/- 9.3 mmHg (range nine to 36 mmHg). Though transprosthetic gradient did occur in patients who received 19 mm low-profile bileaflet valves in narrow aortic roots, progressive prosthetic stenosis was not observed and small aortic prostheses provide acceptable palliation for long-term results clinically.