Aortic Valve Replacement with Sutured Valves in the Elderly: Does the Absolute Valve Size Matter?

Abstract

Background: The objective during Sutured aortic valve replacement (AVR) is to implant the largest possible valve. Root enlargement to allow implantation of larger valves is not without risks in the elderly. This study investigates the influence of small-size sutured valves on medium and long-term outcomes in the elderly in this era where sutureless valves could be an alternative based on their design. Methods: We retrospectively collected and verified data for 1,097 patients who were ≥65 years old and underwent Isolated AVR at our institution from January 2010 to January 2022. Patients who underwent concomitant procedures or root enlargements were excluded. Based on implanted valve sizes, patients were divided into: Group A (19-21mm) and Group B (23- 29mm). Results: Most patients were in Group B 739 (67%) compared to Group A which had 358 (33%) patients. Group A patients were younger, predominantly female, with smaller body surface area, and higher mean Logistic EuroSCORE. Biological valves were implanted in most patients. Although, there was no significant difference in in-hospital mortality between the groups. The Kaplan Meier 5- and 10-year survival rates were 77 % and 49% for group A versus 81% and 62% for group B (p=0.002), which was significant. Conclusions: Our study shows that sutured aortic valve sizes ≤21mm adversely affect medium and long-term outcomes after AVR in the elderly, with women affected disproportionately.