To study the preoperative and intraoperative variables influencing the mean post-operative transvalvular gradient across stentless porcine valves.
From 1995 to 2002, 84 patients underwent stentless valve insertion. The mean age was 73 years, and 63% were male. The valve pathology was aortic stenosis (AS) in 79%, aortic regurgitation (AR) in 12%, and mixed in 9%. Valve sizes ranged from 21 to 29 with size 27 being most frequent. 54% of patients had concomitant procedures. Patients had at least yearly clinical and echocardiographic follow-up.
There was no operative mortality. 9.5% of the patients had significant postoperative complications. The average echo interval was 18.6 months (range 1–88). The overall mean transvalvular gradient was 9.88 ± 5.67 (SD) mmHg. Variables associated with significantly reduced gradients were: larger valve sizes (p = 0.002), younger age (p = 0.05), pre-op AR (p = 0.008), and increasing post-operative interval (p = 0.05). The mean gradients decreased by 0.28 mmHg for each post-operative year. The method of implantation did not significantly affect gradients (p = 0.26).
Excellent mean transvalvular gradients were achieved with stentless valves studied, with a low operative risk. The gradients did not appear to be related to intra-operative factors, suggesting that insertion techniques can be tailored to suit patient conditions and surgeon preferences.
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