Multicenter study of stentless valve replacement in the small aortic root

Objective: A clinical study was conducted to evaluate the results of stentless porcine valves in patients with a small aortic root (19- and 21-mm aortic anulus), Methods: Of 567 patients, from 4 surgical institutions, 171 patients (30.1%) had a small aortic root, comprising 163 cases with calcified aortic stenosis and 8 cases with predominant valvular insufficiency. Sixty patients had associated mitral or coronary lesions. Mean age was 72 +/- 4.2 years. Forty-seven patients with a small aortic root had a 19-mm anulus, and 124 patients had a 21-mm anulus. The body surface area was, respectively, 1.55 +/- 0.2 m(2) and 1.78 +/- 0.45 m(2). Hemodynamic evaluation of the stentless valve comprised serial measures of mean gradients, effective orifice area, and left ventricular mass reduction. Complication rates for secondary events were evaluated over a 6-year period. Results: The hospital mortality rate was 3.5%, The mean gradients after the first year were 9 +/- 2 mm Hg and 6 +/- 1.7 mm Hg in patients with a 19-mm and a 21-mm anulus, respectively, Effective orifice area was 1.45 +/- 0.3 cm(2) and 1.72 +/- 0.4 cm(2). Gradients and surfaces remained stable throughout the study period. Aortic regurgitation was zero to trace. Left ventricular mass at discharge and at 1 year were, respectively, 296 +/- 127 g and 215 +/- 102 g for patients with a 19-mm anulus and 281 +/- 75 g and 236 +/- 15 g for patients with a 21-mm anulus, Conclusions: Stentless valves are a suitable device for elderly patients with small aortic roots, which leave only mild residual obstruction.