Objective: Small-sized biological prostheses for aortic valve replacement (AVR) increase the propensity for residual left ventricular outflow obstruction (iatrogenic aortic stenosis) and subsequent poor quality of life. The alternative is root enlargement or extended root procedures. We aimed to determine the long-term performance of implanted label-size 19 mm supraanular pericardial prostheses.
Methods: 53 consecutive patients underwent AVR with 19-mm biological prosthesis (2007-2013). Additional coronary artery grafting or valve procedure was performed in 45% of the patients. Serial postoperative echocardiographic data and the respective clinical status were analyzed.
Results: Patient's age ranged between 62 and 88 years (mean, 71 ± 2) and 72% were female gender. Average BSA was 1.7 ± 0.3 m2 (range, 1.3-2.3). Implantation failure-rate (prosthesis conversion) was 1.8% (1/54). Overall, 30-day mortality was 3.7% (2 of 53). Follow-up averaged 34 ± 5.1 months (range, 1 to 78). Overall mortality rate at 6.5 years was 7.5%. At 5 years, freedom from thromboembolism and freedom from anticoagulation-related bleeding was 100%. Late endocarditis was documented in 5.6%. The mean postoperative New York Heart Association class was 1.4 ± 0.5 (p=0.05). Postoperative average mean and peak transvalvular gradients were 18 ± 2.4 mmHg and 32 ± 3.5 mmHg, respectively. These indices remained stable during serial echocardiographic examinations (p=NS) at median follow-up duration of 33 months (range, 4 to 67).
Conclusions: 19-mm biological valves confers acceptable hemodynamic performance in recipients assigned for biological prostheses. This study defines the range of postoperative gradients across this valve. Recipients may achieve functional improvement and acceptable event-free survival.
