Rapid-Deployment Aortic Valves for Patients With a Small Aortic Root: A Single-Center Experience

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science
• Medical Devices

Background:

• Aortic valve replacement in patients with small aortic roots presents challenges regarding prosthesis-patient mismatch.
• The EDWARDS INTUITY valve system is a rapid-deployment aortic valve used in these cases.

Purpose of the Study:

• To evaluate the survival and hemodynamic performance of small rapid-deployment aortic valves (19 and 21 mm).
• To assess the impact of prosthesis-patient mismatch on outcomes in this patient group.

Main Methods:

• A prospective study included 659 patients with severe aortic stenosis receiving rapid-deployment valves.
• 217 patients (32.9%) received small bioprostheses (19 or 21 mm) and were analyzed for outcomes.

Main Results:

• Mean gradients were low (14.8 mmHg at discharge, 13.6 mmHg at 1 year).
• Prosthesis-patient mismatch occurred in 35.5% of patients, but did not significantly affect overall survival.
• Perioperative mortality was 1.8%, with 1-year and 5-year survival rates of 91% and 79%, respectively.
• Significant improvement in New York Heart Association functional class was observed.

Conclusions:

• Surgical aortic valve replacement with rapid-deployment valves demonstrates favorable hemodynamic performance and reduced prosthesis-patient mismatch.
• Excellent early- and midterm survival rates and improved functional class were noted in patients with small aortic annuli.