Aortic Valve Replacement with Pericardial Valves in Patients with Small Aortic Roots. Clinical Results in a Consecutive Series of Patients Receiving 19 and 21 mm Prostheses

Objective - To determine how second generation pericardial valves perform in patients with small aortic roots. Design - Ninety patients who underwent isolated aortic valve replacement (AVR) with 19 or 21 mm Mitroflow® or Carpentier-Edwards (Perimount®) valves between 1989 and 1996 were studied. Mean age was 78 years. Concomitant coronary bypass surgery was performed in 41%. Results - Thirty-day mortality was 5.6%. Ninety-seven percent had acceptable transprosthetic mean pressure gradients (25 mmHg or less) 1 week after surgery. Follow-up was 100% complete and 76% of the patients were alive after a mean of 5 years. There was no structural valve failure or valve thrombosis. One patient required reoperation for perivalvular leak. Four patients had transient ischemic attacks and seven had strokes. These figures are, however, within the expected range for the age. Conclusion - Second generation pericardial valves perform well in elderly patients with small aortic roots. Postoperative hemodynamics are acceptable, valve durability of up to 8 years adequate, and the clinical results good, considering the age of the patients.