The Journal of Thoracic and Cardiovascular Surgery, Vol 88, 234-237, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
The Ionescu-Shiley valve: a solution for the small aortic root
JM Revuelta, R Garcia-Rinaldi, RH Johnston Jr, L Bonnington, JL Ubago and CG Duran
Valve replacement in patients with a small aortic anulus can cause
difficult technical problems or leave the patient with a significant
residual transvalvular gradient. Between August, 1977, and June, 1983, 35
patients with a small aortic root (21 mm or less) underwent aortic valve
replacement with Ionescu-Shiley pericardial xenograft valves. They ranged
in age from 29 to 76 years (mean 52.8 years) and in weight from 64 to 91 kg
(mean 76.3 +/- 3.6 kg). Preoperatively, 26 patients were in New York Heart
Association Functional Class III-IV. The valve sizes used were 17 mm in
three cases, 19 mm in 16 cases, and 21 mm in 16 cases. There were four
hospital deaths (11.4%) resulting from sepsis or low cardiac output. There
were no late deaths. Cumulative duration of follow-up was 819.4
patient-months. Twenty-four (78%) of the 31 surviving patients are
asymptomatic. Up to the time of review, there have been no episodes of
thromboembolism, infective endocarditis, perivalvular leak, valve
thrombosis, or primary tissue valve failure. Fifteen patients were
hemodynamically evaluated 2 to 47 months (mean 14.3 months) after
operation. The average resting transvalvular gradients for 19 and 21 mm
valves were 15.1 and 10.8 mm Hg, respectively. Our experience suggests that
the Ionescu-Shiley pericardial xenograft valve is a valid alternative in
the surgical treatment of patients with a small aortic root.
