Hemodynamic performance
As mentioned above, we observed a significant reduction in the peak and mean gradients of the aortic valve both in the immediate postoperative period and in the follow-up (Figure2A, Table 3). In the follow up, the medians of the peak and mean gradients were 14mmHg, (CI95%=10.9-17.6) and 7mmHg (CI95%=5.2-9.1), respectively. Regarding this matter, Krane et al. report a mean pressure gradient of 8.9 ± 3.8mmHg at discharge, which remained stable within the first postoperative year, Ozaki et al. report a mean peak gradient of 15.2 ± 6.3 mmHg on average 8 years after surgery. Similar results have been observed in other series.10,18,21-23
This excellent hemodynamic performance is the result of preserving the natural motion of the aortic valve annulus and the coordination of the left ventricle, aortic annulus, sinus of Valsalva, and aorta. This is particularly important in patients with a small AV annulus.10,18,26