scholarly journals Management of Small Aortic Root during Aortic Valve Replacement

2020 ◽  
Vol 2 (1) ◽  
pp. 1-7
Author(s):  
Ahmed Nabil Malek ◽  
Mohamed A.K. Salama Ayyad ◽  
Hussein Elkhayat ◽  
Ahmed El-Minshawy
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Aortic Annulus ◽  
Early Results ◽  
Significant Difference ◽  
Small Aortic Root ◽  
Group A ◽  
Aortic Root Enlargement

Background: Concomitant aortic root enlargement (ARE) increases the risk of aortic valve replacement (AVR). The objectives of this study were to identify the patients who needed aortic root enlargement and compare the outcomes and the risk of adding ARE to AVR. Methods: We retrospectively reviewed 62 patients who underwent isolated mechanical aortic valve replacement between 2017 and 2019. We divided the patients into two groups: group A included patients with small aortic root who had AVR with one of the different surgical strategies for small aortic annulus (n= 32) and group B, which included patients with a normal aortic annulus and underwent conventional AVR (n= 30). Group A was further sub-divided based on the surgical strategy into 4 categories; patients who had supra-annular implantation of size 19 mm St. Jude prosthetic valve (n= 11; 34.4%), Nicks procedure (n= 13 40.6%), Manougian procedure (n= 4; 12.5%), Konno procedure (n= 4; 12.5%).  Results: Group A patients were significantly younger (26.16 ± 11.49 vs. 34.63 ± 8.9 years; p< 0.001) and had lower body weight (55.09 ± 21.41 vs. 69.80 ± 19.20; p= 0.01). Group A had significantly smaller valves (p = 0.03), and total cardiopulmonary bypass (148.65 ± 44.09 vs. 97.46 ± 20.90 minutes; p<0.001) and aortic cross-clamp times (118.13 ± 36.70 vs. 78.06 ± 16.01 minutes; p < 0.001) were significantly longer in group A. There was no significant difference in operative complications between groups. Among patients with small aortic root; Konno procedure had the longest bypass time (236.3 ± 19.70 minutes; p<0.001); cross-clamp time (192.5 ± 22.2 minutes; p <0.001); mechanical ventilation (4.75 ± 0.50 hours; p<0.001) and intensive care unit stay (6.50 ± 0.57 days; p <0.001). Patients with supra-annular implantation of the St. Jude valve had a significantly higher postoperative pressure gradient (14.64 ± 6.84 mmHg; p= 0.02). No difference in procedure complications was observed among aortic root enlargement procedures. Conclusion: Patients who had aortic root enlargement procedure were younger, with lower weight and body surface area. Surgical procedures used to manage small aortic root had comparable early results, and no technique was superior to the others.

scholarly journals Aortic Valve Replacement in Patients with Small Aortic Annulus: New Pericardial Stented Valves vs Aortic Root Enlargement Procedures.

2021 ◽  
Author(s):  
Ahmed Fouad ◽  
ehab elshihy ◽  
Mohammed Hassan ◽  
Mohammed Maged ◽  
Ashraf Mostafa Abd Raboh
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Mechanical Valve ◽  
Aortic Annulus ◽  
University Hospitals ◽  
Small Aortic Annulus ◽  
Postoperative Drainage ◽  
Aortic Root Enlargement

Objectives: Newer generations of stented pericardial valves may offer hemodynamic benefit in patients with small aortic annulus. The aim of this study was to determine the effectiveness of isolated aortic valve replacement with one such valve, the Trifecta valve, when compared to Aortic root enlargement surgery in reducing postoperative gradients and the severity of PPM in patients with small aortic annulus. Patients and methods: A prospective observational study of 100 patients with SAA who underwent AVR from March 2020 to October 2021 in Cairo university hospitals and other centers. The cohort was divided into two groups based on surgical technique: Isolated AVR using Trifecta valve or ARE and mechanical valve placement. Preoperative characteristics, intraoperative times and postoperative outcomes were recorded and compared in all patients, including a pre-discharge echocardiography. Results: Increased operative times, increased ICU stay and need for blood products were observed in the ARE group and operative time was determined as an independent risk factor. Higher rate of complications such as need for permanent pacemaker as well increased postoperative drainage was also recorded in ARE group, with no difference between groups in in-hospital mortality. Higher incidence of PPM was recorded in the Trifecta group (24%) compared to the ARE group (8%). but, the severity of PPM within the Trifecta group was reduced compared to the ARE group, and no degree of PPM was observed in Trifecta valves sized 21. Conclusion The Trifecta valve offers excellent postoperative hemodynamics and significant reduction in severity of PPM in patients with SAA undergoing AVR, with gradients and iEOA almost comparable to larger sized valves implanted after ARE, making the increased surgical burden of ARE unnecessary in most patients.

Aortic Valve Replacement With 17-mm St. Jude Medical Prostheses for a Small Aortic Root in Elderly Patients

2007 ◽  
Vol 83 (6) ◽  
pp. 2050-2053 ◽  
Author(s):  
Tohru Takaseya ◽  
Takemi Kawara ◽  
Shigehiko Tokunaga ◽  
Michitaka Kohno ◽  
Yasuhisa Oishi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Elderly Patients ◽  
Valve Replacement ◽  
Aortic Root ◽  
Jude Medical ◽  
Small Aortic Root

scholarly journals Tanned xenograft pericardium for aortic root enlargement during aortic valve replacement

1991 ◽  
Vol 17 (2) ◽  
pp. A361
Author(s):  
Donato Sisto ◽  
Sylvia Fernandes ◽  
Antonio Palma ◽  
Michele Nanna ◽  
Robert Frater
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Aortic Root Enlargement

Enlargement of the Small Aortic Root During Aortic Valve Replacement: Is There a Benefit?

2008 ◽  
Vol 85 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Alexander Kulik ◽  
Manal Al-Saigh ◽  
Vincent Chan ◽  
Roy G. Masters ◽  
Pierre Bédard ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Small Aortic Root

scholarly journals Rupture of equine pericardial aortic-root patch after aortic valve replacement with aortic annulus enlargement: a case report

2014 ◽  
Vol 9 (1) ◽  
Author(s):  
Akimasa Morisaki ◽  
Yasuyuki Kato ◽  
Manabu Motoki ◽  
Yosuke Takahashi ◽  
Shinsuke Nishimura ◽  
...  
Keyword(s):  
Case Report ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Aortic Annulus

scholarly journals Predicting the Ideal Valve Size During Aortic Valve Replacement with Rapid Deployement Bioprosthetic Valves. Is Intraoperative Transesophageal Echocardiogram Reliable?

2021 ◽  
Author(s):  
Ali Al-Alameri ◽  
Alejandro Macias ◽  
Daniel Buitrago ◽  
Alvaro Montoya ◽  
Evan Markell ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transesophageal Echocardiography ◽  
Valve Replacement ◽  
Aortic Annulus ◽  
Significant Difference ◽  
Valve Size ◽  
The Mean ◽  
Rapid Deployment ◽  
Bioprosthetic Valves

Objective: To describe experience with using intraoperative Transesophageal Echocardiography to reliably predict the size of the rapid deployment prosthetic valve by measuring the native aortic annulus Methods: Retrospective review of single institution series of patients undergoing Aortic Valve Replacement with Rapid Deployement Bioprosthetic Valves. Included were patients that had their native aortic valve replaced either isolated or as part of any additional procedure. Aortic annulus was measured prior to initiation of the operation using transesophageal echocardiography (TEE). Correlation analysis was conducted between Echocardiographic annular measurements and actual implanted valve sizes. Results: Twenty five patients underwent rapid deployment valve implantation in the aortic position. Of these, 36% of patients had the same size valve as the measured aortic annulus, 48% of patients had a valve implanted that was 1 mm different, and 16% of patients had 2 mm difference. The mean annular size based was 22.4 mm (range: 21-28 mm). The mean valve size implanted was 23.3 mm (range: 21-27 mm). There was no statistically significant difference between the mean annular measurement and the valve size selected (0.9 mm , p = 0.8). Conclusion: TEE can further enhance valve sizing and guidance through a proper and safe deployment. Although evident in our experience, larger scale studies are needed to further elucidate conclusions on the importance of avoiding under-sizing valves.

scholarly journals Aortic Root Enlargement during Aortic Valve Replacement in Adults

2021 ◽  
pp. 56-62
Author(s):  
Miroslav M. Furman ◽  
Sergey V. Varbanets ◽  
Oleksandr M. Dovgan
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Severe Aortic Stenosis ◽  
Aortic Root Replacement ◽  
Safe Procedure ◽  
Aortic Pathology ◽  
Aortic Root Enlargement

Aortic valve replacement is a gold standard in the treatment of patients with severe aortic stenosis or combined aortic pathology. However, aortic valve pathology is often associated with a narrow aortic orifice, particularly in patients with severe aortic stenosis. In 1978, Rahimtoola first described the term of prosthesis-patient mismatch. He noted that effective orifice area of the prosthesis is smaller than that of the native valve. To minimize this complication, there are several surgical strategies: aortic root enlargement (ARE), implantation of a frameless biological prosthesis in the native position, neocuspidalization procedure, Ross procedure, aortic root replacement with xenograft or homograft. ARE is an excellent option, however, some authors outline additional perioperative risks. The aim. To analyze immediate results of ARE during isolated aortic valve replacement and in cases when it is combined with other heart pathologies. Materials and methods. Our study included 63 patients who underwent ARE. Isolated aortic valve replacement was performed in the majority of cases, but often aortic root replacement procedure was combined with coronary artery bypass grafting. Results and discussion. One of 63 patients died (hospital mortality 1.6%) at an early hospital stage (30 postoperative days). Measurement of the aortic valve ring was performed by two methods, through preoperative echocardiography and perioperative measurement using a valve sizer. However, perioperative dimension was chosen as the basis for the calculations. In 62 patients, the perioperative diameter of the aortic valve ring ranged from 19 to 23 mm, only one patient had a diameter of 24 mm. According to our findings, ARE enabled to achieve an average aortic ring size increase of 2.68 cm2 (from 1.5 to 3.4 cm2) and to prevent prosthesis-patient mismatch in 42 (66.7%) cases. Conclusions. Prosthesis-patient mismatch is considered a serious complication in the postoperative period. Narrow aortic root is a common pathology that should be considered during surgery. ARE is a safe procedure and is not associated with an increased risk of mortality and complications.

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