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The New Generation Of Stented Aortic Pericardial Tissue Valves In Patients With Small Aortic Roots: Single Center Experience In 572 Patients
Reinhard Moidl, David Santer, Harald Pisarik, Sandra Folkmann, Gabriel Weiss, Martin Grabenwoeger.
General Hospital Hietzing, Vienna, Austria.

OBJECTIVE: The aim of our study was to compare the hemodynamic and clinical performances between different stented aortic tissue valves in patients with small aortic roots. M
ETHODS: Between 2005 and 2012, 572 consecutive patients with small aortic roots (mean age 74.6+/-9.0 years, additional procedures 47.2%, logistic predicted mortality LPM=10.8+/-9.3%; 1.3-78.5), received different types of size 19 (n=171) and 21 (n=401) tissue valves in our institution: Sorin Mitroflow®(MF) 149, , CE Magna Ease® (ME) 119, CE Perimount Magna® (PM) 98, SJM Trifecta® (TF) 90, Medtronic Mosaic® (M) 47, SJM Epic® (E) 42, CE Perimount® (P) 27. Patient prosthesis mismatch (PPM) was calculated and defined as mismatch if EOAI≤0.85cm²/m² (PPM) and severe mismatch if EOAI≤0.65cm²/m² (sPPM). Statistical analysis was performed with IBM SPSS statistics (Version21.0; Pearson's Chi-Square test).
RESULTS: Moderate and severe PPM was present in porcine aortic valves (PPM/sPPM: M:55%/43%; E:74%/37%) and in bovine pericardial tissue valves (MF:49%/44%, CEP:26%/0%, PM:45%/1%, TF:21%/0%, ME:16%/0%). In patients received size 19 valves without PPM, the perioperative mortality was statistically significant decreased in isolated procedures (0%, LPM 9.97%; p<0.01). In contrast the mortality in patients with severe PPM is high and not statistically significant different between isolated and combined procedures (7.4 vs. 10%; ns). In our experience the new generation of bovine pericardial tissue valves (CE Perimount®, CE Perimount Magna®, CE Magna Ease® and SJM Trifecta®) showed the lowest incidence of moderate and severe PPM in the small sizes. With the use of these pericardial tissue valves, we further improved perioperative mortality in patients with small aortic roots (2.9% vs. 4.3%, p=0.029; LPM 8.5%, p=0.031).
CONCLUSIONS: In our experience with aortic valve replacement in patients with small aortic roots, the use of pericardial tissue valves has further improved the perioperative outcome and hemodynamic performances; in particular the latest generation of pericardial tissues valves showed the lowest incidence of PPM in the cohort. We recommend pericardial tissue valves as the aortic valve substitute of choice in patients with small aortic roots.

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