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Original Articles: Adult Cardiac

Aortic Valve Replacement With 17-mm Mechanical Prostheses: Is Patient–Prosthesis Mismatch a Relevant Phenomenon?

^a I Division of Cardiac Surgery, IRCCS Policlinico San Donato Hospital, San Donato Milanese, Milan, Italy
^b II Division of Cardiac Surgery, IRCCS Policlinico San Donato Hospital, San Donato Milanese, Milan, Italy
^c Echocardiography, IRCCS Policlinico San Donato Hospital, San Donato Milanese, Milan, Italy
^d Division of Cardiology, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy

Accepted for publication August 19, 2010.

^_* Address correspondence to Dr Garatti, Department of Cardiovascular Disease "E. Malan," Cardiac Surgery Unit, Policlinico S. Donato Hospital, Via Morandi 30, S. Donato Milanese, Milan, 20097 Italy (Email: agaratti{at}tiscali.it).

Background: We sought to evaluate the long-term performance of a consecutive cohort of patients implanted with a 17-mm bileaflet mechanical prosthesis.

Methods: Between January 1995 and December 2005, 78 patients (74 women, mean age = 71 ± 12 years) underwent aortic valve replacement with a 17-mm mechanical bileaflet prosthesis (Sorin Bicarbon-Slim and St. Jude Medical-HP). Preoperative mean body surface area and New York Heart Association class were 1.6 ± 0.2 m² and 2.6 ± 0.8, respectively. Preoperative mean aortic annulus, indexed aortic valve area, and peak and mean gradients were 18 ± 1.6 mm, 0.42 cm²/m², 89 ± 32 mm Hg, and 56 ± 21 mm Hg, respectively. Patients were divided into two groups, according to the presence (group A, 29 patients) or absence of patient–prosthesis mismatch (group B, 49 patients). Patient–prosthesis mismatch was defined by an indexed effective orifice area less than 0.85 cm²/m².

Results: Overall hospital mortality was 8.8%. Follow-up time averaged 86 ± 44 months. Actuarial 5-year and 10-year survival rates were 83.7% and 65.3%, respectively. The mean postoperative New York Heart Association class was 1.3 ± 0.6 (p < 0.001). Overall indexed left ventricular mass decreased from 163 ± 48 to 120 ± 42 g/m² (p < 0.001), whereas average peak and mean prosthesis gradients were 28 ± 9 mm Hg and 15 ± 6 mm Hg, respectively (p < 0.001). Early and long-term mortality were similar between the two groups as well as long-term hemodynamic performance (mean peak gradient was 28 mm Hg and 27 mm Hg in group A and B, respectively, not significant); left ventricular mass regression occurred similarly in both groups (indexed left ventricular mass at follow-up was 136 ± 48 and 113 ± 40 in group A and B, respectively; not significant).

Conclusions: Selected patients with aortic stenosis experience satisfactory clinical improvement after aortic valve replacement with modern small-diameter bileaflet prostheses.

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