Mid-term evaluation of Sorin Soprano bioprostheses in patients with a small aortic annulus ≤20 mm

We set to examine the mid-term outcome after aortic valve replacement (AVR) with Soprano pericardial stented bioprosthesis measuring <or=20 mm. Sixty-eight patients underwent AVR between June 2003 and January 2006 (50 women; median age 77 years; range 60-89 years). Preoperatively, 60 patients (88.2%) were in New York Heart Association (NYHA) class III/IV. The mean EuroSCORE was 6.7+/-2.3. Supra-annular aortoplasty was performed in 21 patients (30.9%), out of which 11 patients received an 18 mm prosthesis (55%). The median follow-up was 45.5 months (0.1-62 months). The 30-day mortality was 4.4% (n=3) with no early valve-related deaths. No patient suffered a cerebrovascular accident and no patient required replacement of prosthesis for coronary malperfusion. Postoperatively, the mean gradient across the 18 mm bioprosthesis (n=20) was 25+/-8.9 mmHg and across the 20 mm bioprosthesis (n=48) was 25.5+/-7.3 mmHg (P=NS). During follow-up, there was no valve-related death, re-operation for structural valve degeneration, endocarditis or valve thrombosis. There were five late deaths and actuarial survival at three and five years was 92.7+/-3.1% and 81.0+/-6.9%, respectively. At last follow-up, 86.7% (n=52) of survivors were in NYHA class I/II. AVR with Soprano bioprosthesis measuring <or=20 mm is associated with excellent mid-term outcome. Continued follow-up is required to determine the long-term efficacy of the prosthesis.