Aortic Valve Replacement without Annular Enlargement in Patients with Small Aortic Roots

Use of small prostheses for aortic valve replacement eliminates the need for annular enlargement but may impair symptomatic resolution and long-term patient survival. We reviewed our experience with 105 consecutive patients who had isolated aortic valve replacement with small mechanical prostheses or bioprostheses (14 to 21 mm) without concurrent annular enlargement between August 1976 and November 1992. The mean age was 72 ± 10 years and 82% of patients were female. Valvular disease was primarily aortic stenosis in 61%, aortic regurgitation in 7%, and mixed aortic disease was present in 32% of patients. Mean preoperative ejection fraction was 64% ± 17% and the aortic valve area was 0.5 ± 0.2 cm 2 . Prior to surgery, 82% of patients were in New York Heart Association functional class III or IV. The mean duration of follow-up was 8.1 years. There were 7 early and 14 late deaths giving an overall survival of 80% and a 10-year Kaplan-Meier survival rate of 77%. Five patients developed thromboembolic complications (transient stroke) and 2 required repeat aortic valve replacement due to prosthetic valve endocarditis. Doppler echocardiography or cardiac catheterization was performed in 15 patients postoperatively but peak systolic gradient exceeded 50 mm Hg in only one individual with a 21-mm porcine valve. All surviving patients were in functional class I or II. We conclude that aortic valve replacement with small prostheses is associated with excellent long-term patient survival, improvement in clinical symptoms, and a low incidence of complications.