Performance of 21-mm size perimount aortic bioprosthesis in the elderly

Background. Aortic valve replacement in elderly patients with a small aortic annulus may pose difficult problems in terms of prosthesis selection. We have evaluated the hemodynamic performance of the 21-mm Carpentier-Edwards Perimount bioprosthesis implanted in elderly patients. Methods. From July 1996 to June 1998, 19 patients (17 women and 2 men, mean age 76 ± 4 years and mean body surface area 1.73 ± 0.13 m2), had aortic valve replacement with a 21-mm Carpentier-Edwards Perimount bioprosthesis. The hemodynamic performance of the valve was evaluated in 16 patients, who completed at least a 6-month follow-up interval, with transthoracic color-Doppler echocardiography with particular reference to peak and mean transprosthetic gradients, effective orifice area index, and regression of left ventricular mass index. Results. There were no late deaths and no major postoperative complications. At a mean follow-up of 12 ± 7 months, compared to discharge, all patients showed clinical improvement with a significant reduction of peak gradient (from 23 ± 4 to 21 ± 6 mm Hg, p = 0.04) and left ventricular mass index (from 181 ± 23 to 153 ± 20 g/m2; p < 0.001), whereas mean gradient (from 13 ± 3 to 13 ± 4 mm Hg, p = not significant) and effective orifice area index (from 1.12 ± 0.34 to 1.13 ± 0.28 cm2/m2, p = not significant) remained substantially unchanged. Conclusions. The use of a 21-mm Carpentier-Edwards Perimount bioprosthesis is associated with low transprosthetic gradients and significant reduction in left ventricular hypertrophy after aortic valve replacement. The results of our study suggest that a 21-m Carpentier-Edwards Perimount bioprosthesis should be considered a valid option in elderly patients with aortic valve disease and a small aortic annulus. (C) 2000 by The Society of Thoracic Surgeons.