Comparison of Heavier Versus Lighter Operatively Excised Stenotic Aortic Valves in Adults With Aortic Stenosis and Implications for Percutaneous Aortic Valve Implantation Without Replacement

To better understand aortic valves amenable to percutaneous aortic valve implantation, operatively excised stenotic aortic valves were examined and divided into 2 groups: heavier and lighter valves. Among 2,247 operatively excised stenotic aortic valves in adults aged >20 years without associated mitral stenosis or mitral valve replacement, 1,608 valves were weighed; 1,241 (77%) weighed <4 g, and 367 (23%) weighed ≥4 g. Of the valves from 1,038 men, 717 (69%) weighed <4 g, and 321 (31%) weighed ≥4 g; of the valves from 570 women, 524 (92%) weighed <4 g, and 46 (8%) weighed ≥4 g. The patients with heavier (≥4 g) valves had higher transvalvular peak gradients (78 ± 28 vs 55 ± 27 mm Hg, p <0.0001), smaller valve areas (0.69 ± 0.30 vs 0.75 ± 0.27 cm2, p <0.0001), and more often congenitally malformed valves (327 of 367 [89%] vs 638 of 1,241 [51%], p <0.0001). In patients aged 81 to 90 years, 44 of the 195 valves (23%) were congenitally unicuspid or bicuspid; in those aged 41 to 50 years, 112 of 128 valves (88%) were congenitally malformed. In conclusion, compared with patients whose stenotic aortic valves weighed <4 g, those with valves weighing ≥4 g were younger, had higher transvalvular peak systolic pressure gradients, had smaller valve areas, and usually (about 90%) had congenitally unicuspid or bicuspid valves. It seems reasonable to avoid percutaneous aortic valve implantation in patients with heavily calcified stenotic aortic valves, most of which are either congenitally unicuspid or bicuspid.