[CarboMedics "Top Hat" supraannular prosthesis in the small aortic root with severe calcification: a case report]

A 71-year-old man with aortic stenosis due to calcification successfully underwent aortic valve replacement with a 21-mm CarboMedics "Top Hat" supraannular prosthesis. We were able to implant a "Top Hat" valve one size larger than would have been possible using a standard bileaflet valve. The postoperative recovery was uneventful, and echocardiography showed a peak gradient of 23 mmHg for this prosthesis. The CarboMedics supraannular valve allowed a gain in size over standard prostheses, resulting in favorable hemodynamics. This valve may be useful in difficult or unsuitable cases to enlarge the narrow aortic valve ring, such as patients with severe calcification of aortic root, elderly patients with less activity, or patients who can tolerate only short cardiopulmonary bypass time due to cardiac dysfunction.