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Ann Thorac Surg 1997;63:933-934
© 1997 The Society of Thoracic Surgeons

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Editorial

Do Small Aortic Valves Influence Long-Term Survival?

Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada

The first 20% of the full text of this article appears below.

The study by Sawant and colleagues in this issue of The Annals [1] addresses the influence of small valves on long-term survival. Sawant and colleagues followed up 104 patients who received 19-mm St. Jude mechanical aortic valve replacements (mean of 5.48 ± 3.73 years), and demonstrated 5- and 10-year survival rates of 80.6% ± 8.3% and 61.6% ± 15.0%, respectively, similar to other reports of larger mechanical aortic valve prostheses. They also demonstrated that a body surface area of 1.7 m² or greater was not a determinant of long-term mortality, suggesting that patient-prosthesis mismatch does not influence long-term outcome. Sawant and colleagues concluded that implantation of a 19-mm St. Jude mechanical prosthesis in small aortic roots is a reasonable alternative to other more complex procedures for inserting larger valves. Initially, their results and conclusions appear counterintuitive. However, the paucity of studies examining these issues requires that this report be more closely scrutinized.

As with most studies, review of the data by different investigators may lead to different conclusions. The 104 patients with 19-mm valves were selected from a population of 593 patients undergoing aortic valve replacement, a "small valve" prevalence of 18%. This extremely high rate is inconsistent with other previously reported series, suggesting a selection bias or an unusual patient population, and that the conclusions are not generalizable.

See also page 964.

On close examination of the data, the reader will in fact discover significant selection bias and an inhomogeneous study group: the patients in this study are elderly (42% 70 years old), female (89%), and with . . . [Full Text of this Article]

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Nineteen-Millimeter Aortic St. Jude Medical Heart Valve Prosthesis: Up to Sixteen Years' Follow-up

Dilip Sawant, Arun K. Singh, William C. Feng, Arthur A. Bert, and Fred Rotenberg
Ann. Thorac. Surg. 1997 63: 964-970. [Abstract] [Full Text]

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