Aortic Valve Replacement With 17-mm St. Jude Medical Prostheses for a Small Aortic Root in Elderly Patients

Background There are few reports about the optimal prosthesis for elderly patients who have small aortic roots with an aortic annular size of less than 19 mm. Methods From October 2004 to October 2006, 11 women aged 70 years or older (mean age, 74.9 ± 3.5 years) underwent aortic valve replacement with a 17-mm Regent prosthesis (St. Jude Medical, St. Paul, MN), with the size determined using the manufacturer’s sizer. Clinical status and the results of preoperative and postoperative echocardiography were evaluated. Results The patients had a mean body surface area of 1.33 ± 0.13 m2 . Preoperative average New York Heart Association (NYHA) functional class was 2.5 ± 0.7. Preoperative echocardiography showed a mean indexed effective orifice area of 0.33 ± 0.14 cm2 /m2 and a left ventricular mass index of 175 ± 63 g/m2 . Seven patients underwent associated procedures. Postoperative ventilation time was 14 ± 5.6 hours, and the intensive care unit stay was 1.0 ± 0.4 days. No patients died perioperatively. The NYHA functional class improved to class I in 9 patients. No obstruction of valve opening was observed. A significant increase in the mean indexed effective orifice area (0.87 ± 0.10 cm2 /m2 ) and regression of left ventricular mass index were found (114 ± 46 cm2 /m2 ) on postoperative echocardiography. Conclusions Aortic valve replacement in elderly patients with small aortic roots (less than 19 mm) using a 17-mm Regent prosthesis showed satisfactory clinical and hemodynamic results.