Performance of 21-mm size perimount aortic bioprosthesis in the elderly

Background. Aortic valve replacement in elderly patients with a small aorti c annulus may pose difficult problems in terms of prosthesis selection. We have evaluated the hemodynamic performance of the 21-mm Carpentier-Edwards Perimount bioprosthesis implanted in elderly patients. Methods. From July 1996 to June 1998, 19 patients (17 women acid 2 men, mea n age 76 +/- 4 years and mean body surface area 1.73 +/- 0.13 m(2)), had ao rtic valve replacement with a 21-mm Carpentier-Edwards Perimount bioprosthe sis. The hemodynamic performance of the valve was evaluated in 16 patients, who completed at least a 6-month follow-up interval, with transthoracic co lor; Doppler echocardiography with particular reference to peak and mean tr ansprosthetic gradients, effective orifice area index, and regression of le ft ventricular mass index. Results. There were no late deaths and no major postoperative complications . At a mean follow-up of 12 +/- 7 months, compared to discharge, all patien ts showed clinical improvement with a significant reduction of Beak gradien t (from 23 +/- 4 to 21 +/- 6 mm Hg, p = 0.04) and left ventricular mass ind ex (from 181 +/- 23 to 153 +/- 20 g/m(2); p < 0.001), whereas mean gradient (from 13 +/- 3 to 13 +/- 4 mm Hg, p = not significant) and effective orifi ce area index (from 1.12 +/- 0.34 to 1.13 +/- 0.28 cm(2)/m(2), p = not sign ificant) remained substantially unchanged. Conclusions. The use of a 21-mm Carpentier-Edwards Perimount bioprosthesis is associated with low transprosthetic gradients and significant reduction in left ventricular hypertrophy after aortic valve replacement. The results of our study suggest that a 21-m Carpentier-Edwards Perimount bioprosthesi s should be considered a valid option in elderly patients with aortic valve disease and a small aortic annulus. (C) 2000 by The Society of Thoracic Su rgeons.