Rapid-Deployment Aortic Valves for Patients With a Small Aortic Root: A Single-Center Experience

Background. Aortic valve replacement in patients with a small aortic root is a matter of concern in terms of prosthesis-patient mismatch. We evaluated the survival and hemodynamic performance after implantation of a small rapid-deployment aortic valve (EDWARDS INTUITY valve system sizes 19 and 21 mm). Methods. Between May 2010 and November 2018, 659 consecutive patients with severe aortic stenosis who received a rapid-deployment valve were included in a prospective and ongoing database. A small aortic bioprosthesis (sizes 19 mm and 21 mm) was implanted in 217 (32.9%) patients (mean age 74.9 +/- 7.9 years, 85.3% women). Preoperative characteristics, operative parameters, and postoperative outcomes were assessed. Results. Mean gradients at discharge and 1 year were 14.8 +/- 5.6 mm Hg and 13.6 +/- 4.9 mm Hg, respectively. Mean effective orifice area and the indexed effective orifice area at discharge were 1.55 +/- 0.36 cm(2) and 0.87 +/- 0.22 cm(2)/m(2), respectively, and prosthesis-patient mismatch occurred in 77 (35.5%) patients (25.8% moderate and 9.7% severe). Perioperative mortality was 1.8% (n = 4 of 217) and overall survival at 1 year and 5 years was 91% and 79%, respectively. The presence of any prosthesis-patient mismatch degree did not have a significant influence on overall survival (hazard ratio, 0.95; 95% confidence interval, 0.75-1.19; P = .638). At the last follow-up, mean New York Heart Association functional class was 1.5 +/- 0.7 vs 2.8 +/- 0.6 at baseline (P < .001). Conclusions. Surgical aortic valve replacement with rapid-deployment valves has shown improved results concerning hemodynamic performance, with decreased rates of prosthesis-patient mismatch. We observed excellent early-term and midterm survival and a significant improvement in functional class in this subgroup of patients with a small annulus. (C) 2020 by The Society of Thoracic Surgeons