Does Aortic Root Enlargement Impair the Outcome of Patients With Small Aortic Root?

Authors: Ardal, Hasan; Toker, Mehmet Erdem; Rabuş, Murat Bülent; Uyar, İbrahim; Antal, Arzu; Şişmanoğlu, Mesut; Mansuroğlu, Denyan; Kırali, Kaan; Yakut, Cevat

Source: Journal of Cardiac Surgery, Volume 21, Number 5, September/October 2006 , pp. 449-453(5)

Publisher: Wiley-Blackwell

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Abstract:

Background: Posterior root enlargement procedures provide the implantation of suitable-sized prosthetic valves in patients with a small aortic root to prevent a high postoperative transvalvular gradient. The aim of this study was to evaluate long-term results of the posterior root enlargement. Methods: Between 1985 and 2002, 124 patients underwent aortic valve replacement with a posterior root enlargement. The main indication was a small aortic valve orifice area to patient body surface area (indexed valve area < 0.85 cm²/m²). Fifty-four (44%) patients were male, and 70 (56%) were female with a mean age 39.1 ± 14.3 years. Indications for operation were severe calcified aortic valve stenosis (37.1%), severe aortic insufficiency (25.8%), or combination (37.1%). Seventy-five (60%) patients received double-valve replacement. A pericardial patch was used in 100 patients (80.6%) and a Dacron patch was used in 24 patients. Results: Operative mortality was 6.4% (8 patients). The causes of hospital mortality were low cardiac output syndrome (LCOS) (in 6 patients), cerebrovascular events (in 1 patient) and multiple organ failure (in 1 patient). Multivariate analysis demonstrated concomitant coronary revascularization to be a significant (p = 0.03) predictor for early mortality. There were six (5.4%) late deaths. Cox proportional hazards regression analysis demonstrated LCOS (p = 0.013) and infective endocarditis (p = 0.003) to be significant predictors for late mortality. Atrioventricular block required a permanent pacemaker was observed in 4 patients (3.2%). Conclusions: Posterior aortic root enlargement techniques can be easily applied without additional risks. Long-term survival and freedoms from valve-related complications are satisfactory.

(J Card Surg 2006;21:449-453)

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1540-8191.2006.00274.x

Affiliations: 1: Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey

Publication date: 2006-09-01

Does Aortic Root Enlargement Impair the Outcome of Patients With Small Aortic Root?

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