Long-term follow-up of small (size 20 and 21) medtronic-hall aortic valve prostheses

Background. Our goal was to study the long-term follow-up of patients having aortic valve replacement and to focus particularly on the patients receiving small prostheses. Methods. Four hundred twenty-eight Medtronic-Hall valves were implanted (156 size 20 or 21 mm, 149 size 22 or 23 mm, and 123 size 25 or 27 mm). Group 20–21 had a higher number of female patients, more associated coronary lesions, and more patients with aortic stenosis. Results. The actuarial survival rate at 8 years was 80% for group 20–21, 80% for group 22–23, and 76% for group 25–27 (p = not significant). In group 20–21, the actuarial event-free rates at 8 years were as follows: thromboembolic complications, 94%; prosthetic valve endocarditis, 99%; reoperation, 98%; and hemorrhagic complications, 78%. The only factors of prognostic value in this group were age and associated coronary lesions. Conclusions. The durable nature of the results obtained with the Medtronic-Hall 20- and 21-mm prostheses compared with large-diameter prostheses allows the use of a simple and reliable surgical technique and should mean that indications for ring enlargement become rare.