title: Concomitant procedures in the small versus standard aortic root.
abstract: OBJECTIVE
  Aortic valve replacement (AVR) in the small aortic root (SAR) has always been a severe challenge with an uncertain surgical outcome. The purpose of this study was to assess the surgical and clinical performance of 19 mm and 21 mm CarboMedics valves (CPHV) based on a review of valve-related morbidity and mortality over a period of six years.
  
  
  METHODS
  A total of 361 patients undergoing aortic valve replacement (AVR) with the CPHV between January 1989 and August 1995 was subdivided and studied. (i) Group A patients (n = 137) received 19 mm or 21 mm prostheses; subgroup AI (n = 85) underwent isolated AVR and subgroup AII (n = 52) underwent AVR with associated cardiac procedures. (ii) Group B patients (n = 224) were given 23 mm or larger prostheses; subgroup BI (n = 147) underwent isolated AVR and subgroup BII (n = 77) underwent AVR with concomitant cardiac procedures.
  
  
  RESULTS
  Hospital mortality was group A 7.3% versus group B 4.9%. Cumulative survival after six years was 83.7% in AI and 76.9% in AII versus 72.1% in BI and 77.4% in BII. There were no significant statistical differences between the subgroups concerning cardiac mortality. Thromboembolic events occurred with a linearized rate of 1.41%/pty in group A versus 1.03%/pty in group B, the incidence of anticoagulant-related major hemorrhage was 1.41%/pty in group A versus 1.20%/pty in group B and that of periprosthetic leakage 1.69%/pty in group A versus 1.89%/pty in group B.
  
  
  CONCLUSIONS
  Our results demonstrate that this bileaflet prosthesis is highly efficient in patients with small aortic roots undergoing AVR with or without associated procedures.
authors.affiliation: Clinical Department for Cardiac Surgery, Karl Franzens University, Graz, Austria.
authors.forename: I
authors.initials: I
authors.lastname: Knez
authors.forename: H
authors.initials: H
authors.lastname: Mächler
authors.forename: P
authors.initials: P
authors.lastname: Rehak
authors.forename: P
authors.initials: P
authors.lastname: Oberwalder
authors.forename: M
authors.initials: M
authors.lastname: Anelli-Monti
authors.forename: D
authors.initials: D
authors.lastname: Dacar
authors.forename: B
authors.initials: B
authors.lastname: Rigler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D006350:Heart Valve Prosthesis / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D011379:Prognosis; D011474:Prosthesis Design; D015996:Survival Rate