CONCOMITANT PROCEDURES IN THE SMALL VERSUS STANDARD AORTIC ROOT

Background and aims of the study: Aortic valve replacement (AVR) in th e small aortic root (SAR) has always been a severe challenge with an u ncertain surgicaI outcome. The purpose of this study was to assess the surgical and clinical performance of 19 mm and 21 mm CarboMedics valv es (CPHV) based on a review of valve-related morbidity and mortality o ver a period of six years. Methods: A total of 361 patients undergoing aortic valve replacement (AVR) with the CPHV between January 1989 and August 1995 was subdivided and studied. (i) Group A patients (n = 137 ) received 19 mm or 21 mm prostheses; subgroup AI (n = 85) underwent i solated AVR and subgroup AII (n = 52) underwent AVR with associated ca rdiac procedures. (ii) Group B patients (n = 224) were given 23 mm or larger prostheses; subgroup BI (n = 147) underwent isolated AVR and su bgroup BII (n = 77) underwent AVR with concomitant cardiac procedures. Results: Hospital mortality was group A 7.3% versus group B 4.9%. Cum ulative survival after six years was 83.7% in Al and 76.9% in All vers us 72.1% in BI and 77.4% in BII. There were no significant statistical differences between the subgroups concerning cardiac mortality. Throm boembolic events occurred with a linearized rate of 1.41%/pty in group A versus 1.03%/pty in group B, the incidence of anticoagulant-related major hemorrhage was 1.4l%/pty in group A versus 1.20%/pty in group B and that of periprosthetic leakage 1.69%/pty in group A versus 1.89%/ pty in group B, Conclusion: Our results demonstrate that this bileafle t prosthesis is highly efficient in patients with small aortic roots u ndergoing AVR with or without associated procedures.