Aortic Valve Replacement With 17-mm St. Jude Medical Prostheses for a Small Aortic Root in Elderly Patients

Background: There are few reports about the optimal prosthesis for elderly patients who have small aortic roots with an aortic annular size of less than 19 mm. Methods: From October 2004 to October 2006, 11 women aged 70 years or older (mean age, 74.9 ± 3.5 years) underwent aortic valve replacement with a 17-mm Regent prosthesis (St. Jude Medical, St. Paul, MN), with the size determined using the manufacturer's sizer. Clinical status and the results of preoperative and postoperative echocardiography were evaluated. Results: The patients had a mean body surface area of 1.33 ± 0.13 m². Preoperative average New York Heart Association (NYHA) functional class was 2.5 ± 0.7. Preoperative echocardiography showed a mean indexed effective orifice area of 0.33 ± 0.14 cm²/m² and a left ventricular mass index of 175 ± 63 g/m². Seven patients underwent associated procedures. Postoperative ventilation time was 14 ± 5.6 hours, and the intensive care unit stay was 1.0 ± 0.4 days. No patients died perioperatively. The NYHA functional class improved to class I in 9 patients. No obstruction of valve opening was observed. A significant increase in the mean indexed effective orifice area (0.87 ± 0.10 cm²/m²) and regression of left ventricular mass index were found (114 ± 46 cm²/m²) on postoperative echocardiography. Conclusions: Aortic valve replacement in elderly patients with small aortic roots (less than 19 mm) using a 17-mm Regent prosthesis showed satisfactory clinical and hemodynamic results.