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Established surgical treatment of aortic stenosis, especially nowadays using a minimally invasive approach through ministernotomy, is still the gold standard in the treatment of the calcifying degenerative disease of aortic stenosis. Considering of the choice of artificial aortic valves, regarding the size and type of prosthesis, available today, it is crucial to monitoring their impact on hemodynamics, to avoid the prosthesis patient mismatch (PPT). Prosthesis patient mismatch occurs when the effective orifice area (EOA) of the inserted prosthetic valve is too small in relation to body size. It is necessary the calculate the patient’s body surface area (BSA) from weight and height and determined of the minimal valve EOA required to ensure an indexed EOA >0.85 cm²/m², select the type and size of prosthesis that has reference values for EOA greater or equal to the minimal EOA value.1,2 Aim: To present hemodynamic impact of different aortic valve prosthesis in a cohort of patients treated with surgical aortic valve repair in our institution, to avoid prothesis-patient mismatch, which may have a significant impact on the long-term results of valve surgery. Study included 115 patients (75 male, 40 female) who underwent isolated aortic valve replacement surgery in our center in the period of January 2022 until January 2023. Patient’s ages ranged from 32 to 81 (M=67.7), average BSA 1.96 m². Average EuroScore logistic was 6.15%. Biological prosthesis was implanted at 108 patients, while a mechanical prosthesis was used in 7 patients. Biological prosthesis that are used are Carpentier-Edwards Magna Ease, Edwards Inspiris Resilia, Medtronic Avalus, in range of 19-29 mm, and mechanical prosthesis St Jude Mechanical, CarboMedics Mechanical TopHat, On-X valves in range of 21-27 mm. The average velocity V max was 2.57 m/s±0.39, and average PPG was 26.92 mmHg±8.34. 17 patients (15.6%) who underwent surgical replacement had postprocedural velocity over the valve >3m/s. [ABSTRACT FROM AUTHOR]

In patients with an implanted aortic valve, the importance of obtaining the maximum values of velocity and flow over the valve is extremely important to obtain adequate data on hemodynamics. However, the variability between the obtained values of ultrasound measurements in the same patients and among different ultrasound specialists has been known for a long time. Also, differences in hemodynamics between different manufacturers of heart valves are known, with a note that the larger the valve, the more favorable the hemodynamic effect on the valve is. By measuring the average internal diameter (ID) of the biological aortic valve in comparison with the body surface area (BSA) and the body mass index (BMI), an adequate instrument can be obtained for the comparison of different cardiac surgical centers. ID could also be a parameter that would allow us to compare different manufacturers of prosthetic aortic valves.1,2 The aim is to show the results of one center over a year, the average ID of the aortic valve and its relationship with body surface area and body mass index. The study included patients from University Hospital Centre Osijek, who were treated for severe isolated aortic valve stenosis from January to December 2022, and who have had a biological aortic valve implanted. Patients who had dilatation of the ascending part of the aorta, who had an implanted mechanical aortic valve, and who had significant aortic regurgitation in addition to aortic stenosis were excluded from data analysis. For adequate assessment and comparison with other centers, the average UP is expressed in relation to body surface area and body mass index. Patient’s data and measured values are shown in Table 1. Data are shown as average ± standard deviation. The presence of a bicuspid aortic valve, the left ventricular ejection fraction, and the presence of postoperative aortic regurgitation were not examined in the presentation of the results. The above should be examined in more detail in future research. Due to the different sizes of biological aortic valves used in clinical practice, we believe that the average internal diameter of the valve (the part through which blood passes) indexed by body surface area or body mass index would be adequate data for comparing different types of aortic valves. Also, it could become one of the parameters for comparison with different cardiac surgery centers. [ABSTRACT FROM AUTHOR]