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Ann Thorac Surg 2005;79:1915-1920
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Small "Functional" Size after Mechanical Aortic Valve Replacement: No Risk in Young to Middle-Age Patients

^a Department of Cardiac Surgery, Second University of Naples, Naples, Italy
^b Department of Cardiac Surgery, University of Rome Tor Vergata, Rome, Italy

Accepted for publication December 10, 2004.

^_* Address reprint requests to Dr Zeitani, Department of Cardiac Surgery, Università di Roma Tor Vergata, European Hospital, Via Portuense 700, Rome, 00149 Italy (E-mail: zeitani{at}hotmail.com).

BACKGROUND: The impact of a valve prosthesis-patient size mismatch is still controversial. In most studies, the inclusion of a large proportion of poorly active old patients with low cardiac output requirements may be misleading, due to the close correlation between trans-prosthetic gradients and cardiac output. The aim of this study was to assess the impact of small "functional" prosthesis sizes in active young to middle-age patients.

METHODS: Eighty-three active patients with a mean age of 46 ± 8 years and a high health survey questionnaire score were followed for 80 ± 34 months after isolated aortic valve replacement with a mechanical prosthesis.

RESULTS: Patients with an indexed, Doppler derived, effective orifice area index less than 0.85 cm²/m² (0.77 ± 0.1 cm²/m²) showed higher early trans-prosthetic gradients (peak, 34 ± 11 vs 26 ± 8 mm Hg; P = 0.001) than patients with a larger effective orifice area index. However, significant regression of the left ventricular mass index and improvement of the left ventricular ejection fraction were observed in both groups at follow-up (119.8 ± 26 vs 165.2 ± 38 g/m² and 128.5 ± 25 vs 181.8 ± 5 0 g/m²; P < 0.001; 58 ± 6 vs 52 ± 11% and 58 ± 7 vs 53 ± 10%; P < 0.001), with no differences between groups (P = 0.4 and P = 0.7, respectively). At multiple linear regression, the final left ventricular mass index was positively related to the preoperative left ventricular mass index (P = 0.004) and was unaffected by the effective orifice area index (P = 0.4). Symptomatic improvement (New York Heart Association class 1.3 ± 0.4 vs 2.4 ± 0.8 and 1.2 ± 0.4 vs 2.2 ± 0.8; P < 0.001) and freedom from late cardiac death (93 ± 3% and 95 ± 6%) were comparable between groups (P = 0.6 and P = 0.7, respectively).

CONCLUSIONS: Our findings indicate that small "functional" prosthesis sizes with modern mechanical valves may not adversely affect outcomes of aortic valve replacement in young patients with high cardiac output requirements.

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				A. Roscitano, U. Benedetto, A. Sciangula, E. Merico, F. Barberi, R. Bianchini, E. Tonelli, and R. Sinatra Indexed effective orifice area after mechanical aortic valve replacement does not affect left ventricular mass regression in elderly Eur. J. Cardiothorac. Surg., February 1, 2006; 29(2): 139 - 143. [Abstract] [Full Text] [PDF]