The aortic Elan stentless aortic valve: excellent hemodynamics and ease of implantation

Abstract

The superior performance of stentless aortic valves with improved left ventricular hypertrophy regression and greater effective orifice area is proven. The Aortech Elan stentless valve (AESV) is a glutraldehyde preserved porcine valve with a pericardial reinforced inflow tract and a scalloped outflow to reduce bulk. We present the early results of AESV implantation at our institution. The first 41 consecutive recipients of the AESV at our unit, between November 1999 and December 2000, were studied. Mean preoperative New York Heart Association functional class (NYHA) status was 3.00 +/- 0.1. Patients requiring a bioprosthesis with suitable anatomy routinely received this implant. The AESV was implanted, either with an interrupted or continuous suture to the inflow tract and a continuous suture to the outflow tract. Transthoracic echocardiography was performed at 6 to 9 weeks after surgery, and aortic transvalvular gradients, flow velocities, and effective orifice areas (EOA) were calculated. In the early postoperative period, two patients with coronary artery disease died of low cardiac output. Echocardiography demonstrated competent valves. At follow-up, one patient was shown to have mild to moderate perivalvular leak with minimal symptoms. Two patients with aortic regurgitation secondary to bacterial endocarditis had no evidence of infection at 3 months after surgery. Mean transvalvular gradient was 6.91 +/- 0.87 mm Hg and mean effective orifice area was 1.18 +/- 0.04 cm(2)/m(2) at a mean of 8.4 weeks after surgery. AESV recipients for native aortic endocarditis were free from infection and regurgitation. The Elan stentless aortic valve demonstrates excellent early hemodynamic results, with very low transvalvular gradients, good flow characteristics and low regurgitation incidence. Ease of implantation is evidenced by favorable ischemic times. This valve may offer an option to homograft in acute aortic endocarditis. Long-term results are awaited.