title: Clinical and hemodynamic evaluation of small Perimount aortic valves in patients aged 75 years or older.
abstract: BACKGROUND
  There is the potential for iatrogenic aortic stenosis and poor quality of life when small aortic valve bioprostheses are used in elderly patients. The alternative is enlarging the aortic annulus to accommodate larger size prostheses, increasing operative mortality. It was hoped that bovine pericardial valves would improve hemodynamic performance in the smaller valve sizes.
  
  
  METHODS
  To determine long-term results and in vivo hemodynamic performance of small-size aortic Carpentier-Edwards bovine pericardial valves (Perimount) in elderly patients, we analyzed our follow-up and echocardiographic data from patients 75 years of age or older receiving isolated 19-mm and 21-mm Perimount valves. Ninety-four patients with a mean age of 77 +/- 2.2 years were followed for 12 years. Seventeen patients with 19-mm and 25 patients with 21-mm Perimount valves underwent transthoracic echocardiograms.
  
  
  RESULTS
  Operative mortality was 6.3% (6 of 94). Twelve-year survival was 82.7%. Freedom from thromboembolism was 86.9% at 12 years. Two patients had anticoagulation-related bleeding. Overall New York Heart Association class decreased from 3 +/- 1 to 1.6 +/- 0.7 at the end of follow-up. Hemodynamic performances were satisfactory in both 19-mm and 21-mm Perimount valves, with low peak and mean transvalvular gradients and good effective orifice areas, orifice area indices, and performance indices.
  
  
  CONCLUSIONS
  Perimount aortic valve in the small aortic annulus has yielded excellent long-term results and hemodynamic performances. Perimount is a very satisfactory option in elderly patients. Implantation of a Perimount bioprosthesis avoids enlargement of the small aortic annulus, reducing mortality and morbidity associated with this procedure.
authors.affiliation: Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom. nicola_vitale@lycos.co.uk
authors.forename: Nicola
authors.initials: N
authors.lastname: Vitale
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Clark
authors.forename: Alexander
authors.initials: A
authors.lastname: Ramsden
authors.forename: Asif
authors.initials: A
authors.lastname: Hasan
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Hilton
authors.forename: Michael P
authors.initials: MP
authors.lastname: Holden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D013923:Thromboembolism / Q000209:etiology