Prosthesis Size in Aortic Valve Replacement: Surgeon-Related Variable

Abstract

A retrospective analysis was performed to determine the surgeon's impact on the selection of the size of prosthesis in aortic valve replacement. From January 1993 through December 1997, 748 patients underwent either isolated aortic valve replacement (530) or double valve replacement (218) with bileaflet valves. Depending on the operating surgeon, patients were divided into group A (367) or group B (381). Preoperative, intraoperative, and postoperative variables in both groups were compared. Groups A and B were identical in demographic and clinical profiles. Cardiopulmonary bypass time, ischemic time, and early and late results in both groups were similar. Significantly more patients undergoing isolated aortic valve replacement in group A (169; 67.9%) received a large (≥ 25 mm) prosthesis compared with group B (69; 24.5%). Compared with group B, a large prosthesis was used in a significantly greater proportion of all patients in group A, irrespective of etiology, predominant aortic valve lesion, and age of the patient. Overall, the operating surgeon was identified as the most important predictor (odds ratio 3.5; p < 0.0001) of use of a large valve.

Aortic valve replacement in predominant aortic stenosis: What is an appropriate size valve?

“…In contrast, 80% of our patients receieved valves 23 mm or larger in size. Aortic valve dimension in the Indian population is similar to that in the West 23,24 Observations of aortic root dimensions in cadavers in India has shown that the mean aortic annulus diameter in adult Indian males aged 16-60 years is 23.2±1.9 mm and in the adult Indian females aged 16-65 years is 21.2±2.5 mm which corresponds to valve areas of 4.2 cm 2 (range 3.6-4.9 cm 2 ) and 3.5 cm 2 (range 2.8-4.4 cm 2 ) respectively 24 . Therefore valve prosthesis of 25-31 mm diameter are considered to match the native valves in terms of area 24 .…”

“…Though implantation of small prosthesis may result in significant symptomatic relief, this may produce patient-prosthesis mismatch with resultant transvalvuar gradients at rest which are increased during exercise 19 . Large size valves have favourable hemodynamics and low gradients with resultant good exercise performance 24 . Valve size is therefore a significant determinant of postoperative exercise capacity 16 .…”

“…Larger prosthesis are associated with a better prognosis than replacement with small prosthetic valves [20][21][22] . The size of the prosthesis should match as closely as possible the native valve area for best hemodynamic performance and prognosis 9,23,24 . Size of prosthesis implanted has been shown to be a surgeonrelated variable 24 and large sized prosthesis have been placed in the aortic position 11,25 .…”

“…The size of the prosthesis should match as closely as possible the native valve area for best hemodynamic performance and prognosis 9,23,24 . Size of prosthesis implanted has been shown to be a surgeonrelated variable 24 and large sized prosthesis have been placed in the aortic position 11,25 . In this study we evaluated if an adequately large size prosthesis could be implanted in the aortic position in patients with predominant aortic stenosis.…”

Valve prosthesis-patient mismatch: A surgeon’s solution

“…We have also published our observation on the surgeon as a variable for implantation of a larger prosthesis. 9 It was clear from this study that the actual size of prosthesis implanted was primarily determined by the surgeon and not always by the measured aortic annulus diameter.…”