Nineteen-Millimeter Bioprosthetic Aortic Valves Are Safe and Effective for Elderly Patients With Aortic Stenosis

Zain Khalpey, Patrick O. Myers, Siobhan McGurk, Jan D. Schmitto, Foeke Nauta, Wernerd Borstlap, Esther Wiegerinck, Justina Wu, Lawrence H. Cohn

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Replacing a stenotic aortic valve with 19-mm bioprostheses remains controversial owing to potential patient-prosthesis mismatch concerns. We report a single-center 10 year experience with 19-mm bioprosthetic valves implanted in elderly patients. We hypothesized patients would have acceptable in-hospital and long-term outcomes.

METHODS: Between January 2002 and December 2011, 257 patients underwent aortic valve replacement with a 19-mm prosthesis, of whom 182 had available follow-up echocardiographic studies. Mean age was 77.4 ± 8.4 years, and 10 of 257 (4%) were male. Outcomes of interest included early and late mortality, peak and mean aortic valve gradients, and left ventricular mass regression.

RESULTS: Operative mortality was 3.5% (9 of 257). Median postoperative echocardiographic time was 16 months. On follow-up echocardiography, mean peak aortic valve gradient decreased from 76 ± 27 mm Hg preoperatively to 32 ± 13 mm Hg and the mean gradient decreased from 46 ± 17 mm Hg to 18 ± 8 mm Hg (both p <0.001) Mean left ventricular mass decreased from 191 g to 162 g (p <0.001). Postoperative survival did not differ significantly between patients who met the criteria for patient-prosthesis mismatch and those who did not (p = 0.607).

CONCLUSIONS: In a series of elderly patients with aortic stenosis who were implanted with 19-mm bioprosthetic valves, long-term follow-up showed significant left ventricular mass regression and peak and mean aortic valve gradient reductions. The use of 19-mm aortic valves is safe and efficacious for elderly patients with a small aortic root.

Original languageEnglish
Pages (from-to)650-657
Number of pages8
JournalAnnals of Thoracic Surgery
Issue number2
Publication statusPublished - Feb 1 2016

ASJC Scopus subject areas

  • Medicine(all)


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