title: Rapid Deployment of Aortic Bioprosthesis in Elderly Patients With Small Aortic Annulus.
abstract: BACKGROUND
  Aortic valve replacement in elderly patients with a small aortic annulus remains challenging. Patient-prosthesis mismatch (PPM) should be prevented without impacting operative mortality. Hemodynamic benefits resulting from rapid-deployment aortic valve replacement with the Edwards Intuity bioprosthesis for this indication were evaluated.
  
  
  METHODS
  Elective patients with severe aortic stenosis who required an Edwards Intuity bioprosthesis, size 19 mm and 21 mm, were prospectively included between July 2012 and July 2014. Transthoracic echocardiography was performed preoperatively and at 1-month follow-up.
  
  
  RESULTS
  Sixty-six consecutive patients (mean age, 78 ± 6.4 years; 54.5% women) were included. The Intuity 19 mm was inserted in 29 patients, and the Intuity 21 mm was inserted in 37 patients. No deaths or aortic annulus ruptures occurred. Mean aortic cross-clamp time was 42.7 ± 18.2 minutes. At the 1-month follow-up, mean New York Heart Association classification was 1.6 ± 0.5 versus 2.2 ± 0.8 (p < 0.001). The mean gradient decreased from 59 ± 17.6 mm Hg to 13.7 ± 4.4 mm Hg (p < 0.001). Mean indexed effective orifice area was 0.77 ± 0.17 cm(2)/m(2) for the Intuity 19 mm and 1.01 ± 0.32 cm(2)/m(2) for the Intuity 21 mm. Twenty-one patients (32%) had a moderate PPM (indexed effective orifice area < 0.85 cm(2)/m(2)), and 10 patients (15%) had a severe PPM (indexed effective orifice area < 0.65 cm(2)/m(2)). The mean gradient was 15.1 ± 3.5 mm Hg and 16.9 ± 4.9 mm Hg in the moderate PPM group and severe PPM group, respectively (p = 0.3). The left ventricular mass index dramatically decreased from 153.2 ± 32.7 g/m(2) to 118.4 ± 20.2 g/m(2) (p < 0.001), and only 1 patient (1.5%) had a periprosthetic regurgitation greater than 1.
  
  
  CONCLUSIONS
  Regarding the low rate of severe PPM and the early regression of left ventricular mass, these preliminary studies indicate the potential benefit of the Intuity bioprosthesis in patients with a small aortic annulus. Midterm results should be evaluated.
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, Marseille, France. Electronic address: alexis.theron@ap-hm.fr.
authors.forename: Alexis
authors.initials: A
authors.lastname: Theron
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, Marseille, France.
authors.forename: Vlad
authors.initials: V
authors.lastname: Gariboldi
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, Marseille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Grisoli
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, Marseille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Jaussaud
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, Marseille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Morera
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, Marseille, France.
authors.forename: David
authors.initials: D
authors.lastname: Lagier
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, Marseille, France.
authors.forename: Severine
authors.initials: S
authors.lastname: Leroux
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, Marseille, France.
authors.forename: Cecile
authors.initials: C
authors.lastname: Amanatiou
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, Marseille, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Guidon
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, Marseille, France.
authors.forename: Alberto
authors.initials: A
authors.lastname: Riberi
authors.affiliation: Department of Cardiac Surgery, La Timone Hospital, Marseille, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Collart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000473:pathology* / Q000628:therapy*; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D016896:Treatment Outcome