Rapid-Deployment Aortic Valves for Patients with a Small Aortic Root: A single-center experience.

Abstract Background Aortic valve replacement in patients with a small aortic root is a matter of concern in terms of prosthesis-patient mismatch. We evaluated the survival and hemodynamic performance after implantation of a small rapid-deployment aortic valve (Edwards Intuity Valve System sizes 19 and 21 mm). Methods Between May 2010 and November 2018, 659 consecutive patients with severe aortic stenosis who received a rapid-deployment valve were included in a prospective and ongoing database. A small aortic bioprosthesis (sizes 19 and 21 mm) was implanted in 217 patients (32.9%), mean age 74.9±7.9 years, 85.3% female. Preoperative characteristics, operative parameters and postoperative outcomes were assessed. Results Mean gradients at discharge and one year were 14.8±5.6 and 13.6±4.9 mmHg. Mean effective orifice area (EAO) and the indexed EAO at discharge were 1.55 cm2±0.36 and 0.87±0.22 cm2/m2, patient-prosthesis mismatch (PPM) occurring in 77 (35.5%) patients, 25.8% moderate and 9.7% severe. Perioperative mortality was 1.8% (4/217) and overall survival at one and five years was 91% and 79%. The presence of any PPM degree did not have a significant influence on overall survival (HR: 0.95; 95% CI 0.75 to 1.19; p=0.638). At the last follow-up, mean New York Heart Association classification was 1.5±0.7 versus 2.8±0.6, at baseline (p Conclusions Surgical aortic valve replacement with rapid-deployment valves has shown improved results concerning hemodynamic performance with decreased rates of prosthesis-patient mismatch. We observed excellent early and mid-term survival and a significant improvement in functional class in this subgroup of patients with a small annulus.