SMALL AORTIC ROOT IN THE ELDERLY - USE OF STENTLESS BIOPROSTHESIS

Background and aims of the study: Aortic root enlargement in the elder ly patient prolongs aortic valve replacement procedures and may be pro blematic if the root is calcified. Mechanical valves have superior hem odynamics compared to tissue valves in the smaller sizes but are often contraindicated in the older patient. Materials and methods: Between January 1993 and November 1995, we implanted 80 Freestyle (Medtronic, Irvine, CA) stentless porcine valves using the freehand subcoronary te chnique. Twenty-seven of the patients had small aortic roots with an a verage age of 76.3 years (69-84). Seven patients received size 19 valv es and 20 patients had size 21 valves. Results: The average echocardio graphic gradient at hospital discharge was 17.9 mmHg (12.1-23.0) for s ize 19 valves and 15.3 mmHg (5.7-27.9) for size 21. At one year postop erative follow up the average gradient had decreased to 12.9 mmHg (9.3 -17.5) for size 19 and 8.0 mmHg (2.2-19.3) for size 21 valves. Effecti ve orifice areas increased from 1.09 cm(2) at the time of discharge to 1.29 cm(2) at one year follow up for size 19 valves, and from 1.30 cm (2) to 1.56 cm(2) for size 21. No patient had more than mild aortic in sufficiency at most recent follow up. Conclusion: This stentless porci ne prosthesis has excellent hemodynamics in the smaller valve sizes wh ich improve at least during the first year following surgery. We feel that it is the valve of choice in older patients with small aortic roo ts.