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CLINICAL STUDY

Usefulness of the cryolife o’brien stentless suprannular aortic valve to prevent prosthesis-patient mismatch in the small aortic root

^* Department of Cardiovascular Sciences, General Hospital "S. Maria Della Misericordia," Udine, Italy

Manuscript received September 17, 2001; revised manuscript received March 4, 2002, accepted March 6, 2002.

^* Reprint requests and correspondence: Dr. Sandro Gelsomino, U. O. Cardiotoracica, Azienda Ospedaliera S. Maria della Misericordia, Piazzale S. Maria Della Misericordia 11.33100 Udine, Italy.
sandrogelsomino{at}virgilio.it

OBJECTIVES: This study evaluated the occurrence of prosthesis-patient mismatch (PPM) after Cryolife O’Brien (CLOB) suprannular stentless valve replacement in patients with a small aortic root and its repercussions on the patient’s hemodynamic status and left ventricular mass regression.

BACKGROUND: The correct management of the small aortic annulus is still controversial. Small aortic prostheses can lead to a PPM, which results in high gradients with important repercussions on the hemodynamic status.

METHODS: Seventy-two patients (mean age: 72.5 ± 6.2 years, 73.6% women) with a small aortic root (21 mm intraoperatively measured aortic annulus) had a CLOB valve implanted in the aortic position between November 1993 and July 2001 at our institution. Mean prosthesis size was 22.0 ± 0.8 mm. Patients underwent echocardiography preoperatively, at discharge, six months, one year and yearly thereafter.

RESULTS: The incidence of PPM at discharge was 22.2% (16/72); 18.7% were severe (effective orifice area index [EOAI] 0.65 cm/m²), 43.7% were moderate (EOAI = 0.66 to 0.75 cm/m²) and 37.6% were mild (0.76 to 0.85 cm/m²). At multivariable analysis, gender (p < 0.001), age (p = 0.015), body surface area (p < 0.001) and patient’s annulus index (p < 0.001) were significant factors influencing the occurrence of "transient" PPM. At one year the incidence of PPM was 0%.

CONCLUSIONS: Suprannular CLOB valve yielded excellent hemodynamic results in patients with small aortic roots. This study demonstrates that PPM can be completely avoided when using the CLOB valve. The superior hemodynamics of this stentless valve are likely to be related to its suprannular design.

Abbreviations and Acronyms   ANOVA   analysis of variance   AV   aortic valve   AVR   aortic valve replacement   BSA   body surface area   CI   confidence interval   CLOB   Cryolife O’Brien   CSA   cross-sectional area   EOAI   effective orifice area index   LVM   left ventricular mass   LVMI   left ventricular mass index   LVOT   left ventricular outflow tract   MG   mean gradient   NYHA   New York Heart Association   PAI   patient annulus index   PPM   prosthesis-patient mismatch   RR   relative risk   RWT   relative wall thickness   VTI   velocity-time integral

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