Clinical and hemodynamic evaluation of the 19-mm Carpentier-Edwards supraannular aortic valve

Abstract The clinical and hemodynamic performance of the 19-mm Carpentier-Edwards supraannular aortic valve is largely unknown compared with that of the larger valves. Over 4 years we implanted the 19-mm Carpentier-Edwards supraannular aortic valve into 21 patients (20 female) with a mean age of 75 ± 1.2 years (range, 59 to 86 years) and a mean body surface area of 1.6 ±0.03 m 2 (range, 1.3 to 1.7 m 2 ). There were four deaths, one operative and three late noncardiac deaths. Follow-up of the 17 survivors for a mean of 20 ±3.1 months (range, 2 to 42 months) demonstrated symptomatic improvement in all 17 (all are now in New York Heart Association functional class I or II). There were no valve-related complications and no patient required long-term anticoagulation. Doppler echocardiographic studies were used to assess the in vivo hemodynamic profile of the valve. Mean postoperative aortic valve gradient was 34.1 ±2.7 mm Hg (range, 19 to 52 mm Hg). Functional valve orifice area was 1.1 ±0.09 cm 2 (range, 0.6 to 1.8 cm 2 ). Mean cardiac output was 3.92 ±0.17 L/min (range, 3.2 to 5.1 L/min) with a mean cardiac index of 2.5 ±0.11 L · min −1 · m −2 (range, 2.1 to 3.2 L · min −1 · m −2 ). In conclusion, we have demonstrated that aortic valve replacement with the 19-mm Carpentier-Edwards supraannular aortic valve has a low operative mortality and offers major clinical benefits despite moderate transprosthetic gradients. This approach provides an alternative management strategy in elderly patients who would otherwise require low-profile mechanical valves or aortic root enlargement.