Abstract
Background: Aortic valve replacement (AVR) with a 21-mm sized bioprothesis is still discussed
controversially. Since better results have been reported for pericardial valves, the
aim of the current study was to analyze the hemodynamic performance as well as clinical
parameters in our patients and to compare pericardial and standard porcine valves
in particular. Methods: 342 patients underwent AVR with a bioprosthesis between 1987 and 2000. A 21 mm prosthesis
was used in 39 patients (group S), while 303 patients received at least a 23-mm sized
valve (group L). Group S was further divided into 19 patients with a pericardial valve
(group S1) and 20 patients with a standard porcine valve (group S2). The hemodynamic
and clinical parameters were studied in all three groups. Results: The peak and mean transprosthetic gradients were significantly lower in the pericardial
group than in the porcine group, particularly between patients with 21 mm valves (peak/mean:
S1: 24 ± 9/20.8 ± 6.5 mm Hg vs. S2: 38 ± 15/33 ± 9 mm Hg, p < 0.05) at discharge. We could also observe that the peak transprosthetic gradient
7 days postoperatively was not significantly higher in patients with a 21 mm pericardial
valve compared to group L patients. Comparing clinical parameters, we found significantly
more cerebral ischemic events, a prolonged mechanical ventilation, a higher mortality
and a longer stay in hospital in the group S2 compared to the group S1. Conclusion: The current study shows that pericardial valves perform well, particularly in patients
with small aortic roots. Postoperative hemodynamics and clinical results were better
than for comparable standard porcine valves. As the outcome of patients with a 21
mm pericardial valve was no worse than that in patients with bigger valves, enlarging
procedures for the aortic root are not necessary in the majority of these patients.
Key words
Aortic valve replacement - small aortic annulus - pericardial bioprosthesis
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1 The results of this paper were presented in part during the 34th annual meeting of
the German Society of Thoracic and Cardiovascular Surgery, February 13th - 16th, 2005
in Hamburg, Germany.
MD Jens Litmathe
Department of Thoracic and Cardiovascular Surgery
Moorenstraße 5
40225 Düsseldorf
Germany
Phone: + 492118118332
Fax: + 49 21 18 11 83 33
Email: litmathe@med.uni-duesseldorf.de