Clinical outcomes
No in-hospital mortality occurred among the patients in this study. No neurological events, low output syndrome, respiratory complications, or renal failure occurred. We had only one case of an early bleeding event that needed revision; however, no late major bleeding events occurred. New pacemaker implantation was required in only one patient (2.6%) during the first 30 postoperative days (Table 3).
The most common size implanted was 23 mm (42%), followed by 25 mm (26%), 21 mm (21%), and 19 mm (11%). We evaluated patient preoperative baseline values for each valve. An increased proportion of bicuspid valves was associated with large valves, the body surface area of such valves, and male gender. At sizes of 19 mm and 21 mm, valve sizes were almost the same as the measured value on echocardiography, but in cases where the artificial valve used was large, sizes were underestimated, and a difference occurred. In such cases, the diameter of the sinotubular junction is expanded, and the overall image of aortic root showed that the root is dilated. The value measured by 3D-CT was larger and more accurate than that by ultrasonic echocardiography(UCG). (Table 4)
We reported the follow-up clinical outcomes for each implanted valve size (Table 5). The mean gradients, effective orifice area, and effective orifice area index at the 1-year follow-up were excellent in all cases. No prosthesis-patient mismatch (PPM) was observed during follow-up. However, postoperative PVL was found in four patients (10.5%); of these patients, three PVLs were only mild, and only one was moderate.
The PVL did not disappear even after a year. All four cases with regurgitation were large in prosthetic valve size, and one patient had a type 1 bicuspid aortic valve. One patient had a small gap and had hemolytic anemia; therefore, he underwent reoperation one year later (Figure 3). A case of regurgitation around the prosthetic valve was examined using 3D-CT. The valve-annulus gap was associated with a larger annulus, regardless of whether it was a perfect circle or an ellipse (Table 6).
There were no complications or PVL and no complete AV block during hospitalization because we performed the aforementioned extra stitch (Table 7). Consequently, almost all patients were discharged without any complications.