Clinical Analysis Of Replacement Of Aortic Valve With Large Annulus With Inverted Carbomedics Orbis Mechanical Mitral Valve

Background:Different size of prosthetic aortic valve is available in foreign countries, especially in Europe and America. In the case of patient with large aortic annulus, aortic valve can be replaced by the corresponding prosthetic aortic valve. However, comparing to the patients in European and American countries, Chinese body surface area is smaller, therefore, the large size of prosthetic aortic valves (>25) are not supplied routinely, and the size of valves supplied in China is from19(valve external diameter19mm) to25(valve external diameter25mm). However if the mechanical aortic valve with smaller size (=25) is implanted in the patient with large aortic annulus(>25) of aortic valve, the prosthesis-patient mismatch (PPM) and other related complications after aortic valve replacement may be occurred. Mechanical aortic valves replacement are widely performed in our country, and how to treat with the patients with larger annulus of aortic valve during mechanical aortic valve replacement is an urgent problem.Objetive:To evaluate the feasibility and necessity of inverted Carbomedics Orbis mechanical mitral valve to replace aortic valve with large annulus, and analyze the characteristics of this method. Methods:From January2010to October2011,33patients who underwent aortic valve replacement with inverted Carbomedics Orbis mechanical mitral valve at the Department of Cardiothoracic Surgery were reviewed. The patients’preoperative and postoperative data of echocardiography, including left ventricular ejection fraction, left ventricular shortening fraction, interventricular septal thickness, peak of aortic transvalvular pressure gradient and valvular effective orifice area index were analyzed.Results:Of the33patients,17cases were performed aortic valve replacement with inverted Carbomedics Orbis mechanical mitral valve with size of27,13cases with size of29and three with size of31. There is no dead case during or after operation. Compared with preoperative data of echocardiography, the postoperative left ventricular ejection fraction increased from58.2%±7.2%to61.7%±7.3%(P＜0.01),left ventricular fractional shortening fraction increased from31.6%±4.8%to33.5%±4.9%(P<0.05), left ventricular end-diastolic diameter decreased from68.0±7.4mm to53.5±6.1mm(P<0.01), peak of aortic transvalvular pressure gradient decreased from41.1±38.0mmHg to17.7±7.3mmHg(P<0.01)and valvular effective orifice area index of all cases are greater than0.85cm2/m2, without PPM.Conclusion:In the absence of large size of mechanical aortic valve (>25),the replacement of aortic valve with larger annulus with inverted Carbomedics Orbis mechanical mitral valve is feasible and necessary.