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

Lookup NU author(s): Stephen Clark, Colin Hilton, Michael Holden


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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-min 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-min 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. (C) 2003 by The Society of Thoracic Surgeons.

Publication metadata

Author(s): Vitale N, Clark SC, Ramsden A, Hasan A, Hilton CJ, Holden MP

Publication type: Article

Publication status: Published

Journal: Annals of Thoracic Surgery

Year: 2003

Volume: 75

Issue: 1

Pages: 35-39

ISSN (print): 0003-4975

ISSN (electronic): 1552-6259

Publisher: Elsevier


DOI: 10.1016/S0003-4975(02)04165-6


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