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J Thorac Cardiovasc Surg 1999;117:267-272
© 1999 Mosby, Inc.

SURGERY FOR ADULT CARDIOVASCULAR DISEASE

MULTICENTER STUDY OF STENTLESS VALVE REPLACEMENT IN THE SMALL AORTIC ROOT

From the Hopital Bichat, Paris, France,^a Onassis Center, Athens, Greece,^b Ospedale S. Maria Della Misericordia, Udine, Italy,^c and Prince Charles Hospital, Brisbane, Queensland, Australia.^d

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication May 8, 1998. Revisions requested June 16, 1998. Revisions received Sept 17, 1998. Accepted for publication Sept 18, 1998. Address for reprints: Ulrik Hvass, MD, Hopital Bichat, 46 rue Henri Huchard, Paris 75018, France.

Objective: A clinical study was conducted to evaluate the results of stentless porcine valves in patients with a small aortic root (19- and 21-mm aortic anulus).
Methods: Of 567 patients, from 4 surgical institutions, 171 patients (30.1%) had a small aortic root, comprising 163 cases with calcified aortic stenosis and 8 cases with predominant valvular insufficiency. Sixty patients had associated mitral or coronary lesions. Mean age was 72 ± 4.2 years. Forty-seven patients with a small aortic root had a 19-mm anulus, and 124 patients had a 21-mm anulus. The body surface area was, respectively, 1.55 ± 0.2 m² and 1.78 ± 0.45 m². Hemodynamic evaluation of the stentless valve comprised serial measures of mean gradients, effective orifice area, and left ventricular mass reduction. Complication rates for secondary events were evaluated over a 6-year period.
Results: The hospital mortality rate was 3.5%. The mean gradients after the first year were 9 ± 2 mm Hg and 6 ± 1.7 mm Hg in patients with a 19-mm and a 21-mm anulus, respectively. Effective orifice area was 1.45 ± 0.3 cm² and 1.72 ± 0.4 cm². Gradients and surfaces remained stable throughout the study period. Aortic regurgitation was zero to trace. Left ventricular mass at discharge and at 1 year were, respectively, 296 ± 127 g and 215 ± 102 g for patients with a 19-mm anulus and 281 ± 75 g and 236 ± 15 g for patients with a 21-mm anulus.
Conclusions: Stentless valves are a suitable device for elderly patients with small aortic roots, which leave only mild residual obstruction.

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