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Prosthesis Size in Aortic Valve Replacement: Surgeon-Related Variable

Department of Cardiothoracic and Vascular Surgery Cardiothoracic Sciences Centre All India Institute of Medical Sciences New Delhi, India

For reprint information contact: Arkalgud Sampath Kumar, MCh Tel: 91 11 686 4851 Ext. 4843 Fax: 91 11 686 2663 email: askumar{at}medinst.ernet.in Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.

A retrospective analysis was performed to determine the surgeon's impact on the selection of the size of prosthesis in aortic valve replacement. From January 1993 through December 1997, 748 patients underwent either isolated aortic valve replacement (530) or double valve replacement (218) with bileaflet valves. Depending on the operating surgeon, patients were divided into group A (367) or group B (381). Preoperative, intraoperative, and postoperative variables in both groups were compared. Groups A and B were identical in demographic and clinical profiles. Cardiopulmonary bypass time, ischemic time, and early and late results in both groups were similar. Significantly more patients undergoing isolated aortic valve replacement in group A (169; 67.9%) received a large (25 mm) prosthesis compared with group B (69; 24.5%). Compared with group B, a large prosthesis was used in a significantly greater proportion of all patients in group A, irrespective of etiology, predominant aortic valve lesion, and age of the patient. Overall, the operating surgeon was identified as the most important predictor (odds ratio 3.5; p < 0.0001) of use of a large valve.