Clinical and hemodynamic evaluation of small perimount aortic valves in patients aged 75 years or older

Vitale, Nicola, Clark, Stephen, Ramsden, Alexander, Hasan, Asif, Hilton, Colin and Holden, Michael (2003) Clinical and hemodynamic evaluation of small perimount aortic valves in patients aged 75 years or older. Annals of Thoracic Surgery, 75 (1). pp. 35-39. ISSN 0003-4975

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Official URL: http://dx.doi.org/10.1016/S0003-4975(02)04165-6

Abstract

Background
There is the potential for iatrogenic aortic stenosis and poor quality of life when small aortic valve bioprostheses are used in elderly patients. The alternative is enlarging the aortic annulus to accommodate larger size prostheses, increasing operative mortality. It was hoped that bovine pericardial valves would improve hemodynamic performance in the smaller valve sizes.

Methods
To determine long-term results and in vivo hemodynamic performance of small-size aortic Carpentier-Edwards bovine pericardial valves (Perimount) in elderly patients, we analyzed our follow-up and echocardiographic data from patients 75 years of age or older receiving isolated 19-mm and 21-mm Perimount valves. Ninety-four patients with a mean age of 77 ± 2.2 years were followed for 12 years. Seventeen patients with 19-mm and 25 patients with 21-mm Perimount valves underwent transthoracic echocardiograms.

Results
Operative mortality was 6.3% (6 of 94). Twelve-year survival was 82.7%. Freedom from thromboembolism was 86.9% at 12 years. Two patients had anticoagulation-related bleeding. Overall New York Heart Association class decreased from 3 ± 1 to 1.6 ± 0.7 at the end of follow-up. Hemodynamic performances were satisfactory in both 19-mm and 21-mm Perimount valves, with low peak and mean transvalvular gradients and good effective orifice areas, orifice area indices, and performance indices.

Conclusions
Perimount aortic valve in the small aortic annulus has yielded excellent long-term results and hemodynamic performances. Perimount is a very satisfactory option in elderly patients. Implantation of a Perimount bioprosthesis avoids enlargement of the small aortic annulus, reducing mortality and morbidity associated with this procedure.

Item Type: Article
Uncontrolled Keywords: bioprostheses; small aortic annulus; elderly patients
Subjects: B100 Anatomy, Physiology and Pathology
Department: Faculties > Health and Life Sciences > Applied Sciences
Depositing User: Becky Skoyles
Date Deposited: 22 Apr 2015 08:43
Last Modified: 24 Oct 2017 11:28
URI: http://nrl.northumbria.ac.uk/id/eprint/22165

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