title: Long-term Mortality Predictors in Patients with Small Aortic Annulus Undergoing Aortic Valve Replacement with a 19- or 21-mm Bioprosthesis.
abstract: Replacement of the aortic valve in patients with a small aortic annulus is associated with increased morbidity and mortality. A prosthesis-patient mismatch is one of the main problems associated with failed valves in this patient population.
  
  
  
  To evaluate the long-term mortality predictors in patients with a small aortic annulus undergoing aortic valve replacement with a bioprosthesis.
  
  
  
  In this retrospective observational study, a total of 101 patients undergoing aortic valve replacement from January 2000 to December 2010 were studied. There were 81 (80.19%) women with a mean age of 52.81±18.4 years. Severe aortic stenosis was the main indication for surgery in 54 (53.4%) patients. Posterior annulus enlargement was performed in 16 (15.8%) patients. Overall, 54 (53.41%) patients underwent concomitant surgery: 28 (27.5%) underwent mitral valve replacement, and 13 (12.7%) underwent coronary artery bypass graft surgery.
  
  
  
  Mean valve index was 0.82±0.08 cm(2)/m(2). Overall, 17 (16.83%) patients had a valve index lower than 0.75 cm(2)/m(2), without statistical significance for mortality (P=0.12). The overall 10-year survival rate was 83.17%. The rate for patients who underwent isolated aortic valve replacement was 91.3% and 73.1% (P=0.02) for patients who underwent concomitant surgery. In the univariate analysis, the main predictors of mortality were preoperative ejection fraction (P=0.02; HR 0.01) and EuroSCORE II results (P=0.00000042; HR 1.13). In the multivariate analysis, the main predictors of mortality were age (P=0.01, HR 1.04) and concomitant surgery (P=0.01, HR 5.04). Those relationships were statistically significant.
  
  
  
  A valve index of < 0.75 cm(2)/m(2) did not affect 10-year survival. However, concomitant surgery and age significantly affected mortality.
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors.forename: Jenny Lourdes Rivas
authors.initials: JLR
authors.lastname: de Oliveira
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors.forename: Renato Tambellini
authors.initials: RT
authors.lastname: Arnoni
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors.forename: Magaly Arrais
authors.initials: MA
authors.lastname: dos Santos
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors.forename: Antonio Flávio Sanchez
authors.initials: AF
authors.lastname: Almeida
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors.forename: Mário
authors.initials: M
authors.lastname: Issa
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors.forename: Antoninho Sanfins
authors.initials: AS
authors.lastname: Arnoni
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Chaccur
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil.
authors.forename: Luiz Carlos Bento
authors.initials: LCB
authors.lastname: de Souza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects; D002648:Child; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult