title: An alternative option for elderly patients with a small aortic annulus: the 16 mm ATS valve.
abstract: OBJECTIVE
  The optimal procedure and prosthesis remains debatable for aortic valve replacement (AVR) in high-risk elderly patients in whom the aortic annulus is too small to allow a standard AVR procedure with even the smallest sized bioprosthetic valve available. Herein are reported the early and mid-term results of standard AVR using a 16 mm ATS Advanced Performance (AP) mechanical heart valve.
  
  
  METHODS
  The medical records of 10 patients (mean age 75 +/- 5 years; range: 64-79 years) in whom 16 mm ATS AP valves had been implanted in the supra-annular position were reviewed retrospectively. Preoperatively, the mean body surface area was 1.46 +/- 0.1 m2 (range: 1.21-1.69 m2); mean logistic EuroSCORE 16.1 +/- 14.6% (range: 4.32-53.2%); mean peak pressure gradient (peak PG) across the aortic valve 98 +/- 28 mmHg; mean diameter of the aortic annulus 19.3 +/- 1.2 mm; mean fractional shortening 37 +/- 10%; and mean left ventricular myocardial mass index (LVMI) 173 +/- 34 g/m2.
  
  
  RESULTS
  There were no hospital deaths, and one late death. The postoperative course was uneventful in all cases, except for one patient who developed respiratory failure. The NYHA functional class was improved from 3.0 +/- 0.7 before surgery to 1.4 +/- 0.5 postoperatively. A significant decrease in the peak PG was observed postoperatively compared to preoperative data (p < 0.01); mean values at two weeks, and at one and two years after surgery were 35 +/- 12, 35 +/- 10, and 33 +/- 10 mmHg, respectively. A significant decrease in the mean LVMI was also noted postoperatively (p < 0.01); mean values at two weeks, and at one and two years after surgery were 134 +/- 35, 110 +/- 17, and 114 +/- 22 g/m2, respectively. The mean effective orifice area index was 0.79 +/- 0.2 cm2/m2. During the mean follow up period of 56 +/- 23 months, all patients received oral anticoagulation with warfarin, and there were no cases of bleeding or thomboembolic complications.
  
  
  CONCLUSIONS
  Satisfactory early and mid-term outcomes were noted following AVR with the 16 mm ATS AP valve in high-risk elderly patients with a small aortic annulus.
authors.affiliation: Department of Cardiovascular Surgery, Kanto Medical Center NTT EC, Shinagawa-ku, Tokyo, Japan. yoshitsugu.nakamura@east.ntt.co.jp
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Kiyoharu
authors.initials: K
authors.lastname: Nakano
authors.forename: Osamu
authors.initials: O
authors.lastname: Tagusari
authors.forename: Go
authors.initials: G
authors.lastname: Kataoka
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Seike
authors.forename: Satoru
authors.initials: S
authors.lastname: Domoto
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Ito
mesh_terms: D000368:Aged; D001011:Aorta / Q000473:pathology*; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D012189:Retrospective Studies; D016896:Treatment Outcome