الفهرس 
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Abstract
This is a prospective, non-randomised, non-blinded study that is
conducted between May 1997 and April 2000 to evaluate the outcome of the patients with isolated aortic valve
replacement using two types of cardiac prostheses. Fifity patients were devided into two groups, group I, 25 patients received bileaflet mechanical valves mostly St Jude Medical valves and CarboMedics valves, while group II; 25 patients received procine stentless bioprosthesis. Surgery was performed on elective basis. Fifity patients included in this study was divided into two groups,there was statistical difference between both groups as regard age, while no difference as regard other parameters in preoperative state. The mean of age in group I was 33.2 ± 10.4 years (range 18-52 years) and in group II, the mean was
45.3± 9.2years (range = 29- 59 years), female patients were 21 (42%) and males were 29 (58%).
All of patients were in sinus rhythum pre and postoperative. As regards NYHA functional class, in group I, 9 patients (36%) were in class II, 12 patients (48%) were in classIII and 4 patients (16%) were in class IV, while in group II, 7 patients (28%) were in class II, 11 patients (44%) were in class III, and 7 patients 28% were in class (IV). 22 patients 44% of both groups were in grade I left ventricular systolic (EF) and 28 patients (56%) were in grade II, left ventricular systolic function (EF). The majority of patients had aortic regurgitation ,they were 23 patients
(46%), Aortic stenosis was in 16 patients (32%) while the lesion was in 11 patients (22%).
Summary -145
Most of the patients in both groups received aortic valve prosthesis size 21mm (14 patients 28%), prosthesis size 25mm was implanted in 12 patients (24% ) ,size 27mm was used in 11 patients (22%), size 23mm was implanted in 8 patients (16%) and size 19mm was implanted in 5 patients (10%). There was no difference between both groups as regards the immediate postoperative complications.
Follow up was complete for all patients in this study at discharge, 3 months and on 6 months postoperatively, no valve thrombosis, endocarditis or any complications necessitated reoperation occurred, only 3 patients (6.1%) sustained thromboembolic manifestations without any residual after medical therapy , also, anticoagulation-related hemorrhage occurred in 9 patients (18.4%) in the form of epistaxis and hematuria, over dose was documented and only dose adjustement was enough to correct this problem. As regard non structural deterioration of the prosthesis, 3 patients (6.1%) had paravalvular leakage, they were two patients (8.3%) in group II, and one patient (4%) in group I, this leakage was diagnosed by physical examination and Doppler echocardiography, non of three patients had symptoms severe enough to necessitate surgical repair on the end time of follow up.
By the end of sixth month, there were 37 patients (75.5%) asymptomatic, 12 patients (24.4%) were in class I, there is a high significant differences among NYHA class in the same group (P. value < 0.0001) and no differences between both groups( P.value = 0.1) . Also by closing date for follow up, the survival was 100% for 49 patients
discharged from the hospital.
Summary -146
Our study among the numerous available studies, conclude that there is no gross difference between these two types of aortic valve presthesis apart from easily implantation technique, high durability of mechanical bileaflet valves in comparison with difficult technique of insertion of stetless bioprosthesis and liability to calcification especially with the main etiological factor in our countery is rheumatic fever so, its durability becomes unsatisfactory, but as regard anticoagulant with its clinical hazards, the stentless bioprosthesis solving this problem especially in presence of bleeding tendency disease, chronic diseases preventing uses of anticoagulant or any female in child bearing period to avoid social complications. Also remodeling of aortic root and regression of the left ventricular mass with excellent hemodynamic outcome were met very well with the stentless bioprosthsesis as well as pressure gradient across the valve especially with the small sized prosthesis where bileaflet mechnical valves exerted some resistance to flow.