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Routine enlargement of the small aortic root: a preventive strategy to minimize mismatch
Luis J Castro1, Joseph M Arcidi, Audrey L Fisher
1Department of Cardiovascular Surgery, Sequoia Hospital, Redwood City, California, USA.
The Annals of Thoracic Surgery
|July 18, 2002
Summary
Aortic root enlargement (ARE) is a safe and effective strategy to prevent prosthesis-patient mismatch during aortic valve replacement (AVR), especially in patients with small aortic roots. This procedure enhances the benefits of AVR with minimal added risk.
Area of Science:
- Cardiac Surgery
- Cardiovascular Research
- Prosthetic Valve Surgery
Background:
- Aortic root enlargement (ARE) is employed to mitigate prosthesis-patient mismatch in aortic valve replacement (AVR) for patients with small aortic roots.
- Prosthesis-patient mismatch can lead to suboptimal outcomes after AVR.
Purpose of the Study:
- To evaluate the safety and efficacy of ARE as a strategy to prevent prosthesis-patient mismatch.
- To assess the impact of ARE on patient outcomes and procedural risks.
Main Methods:
- Retrospective review of 657 stented AVR patients (1995-2001).
- ARE performed in 114 patients identified at risk for mismatch (iEOA < 0.85 cm²/m²).
- ARE involved aortotomy extension, valve implantation, and Dacron patch closure.
Main Results:
- ARE was performed in 17% of AVR patients, primarily those at risk for mismatch.
- Prevalence of mismatch was <3% in ARE patients.
- ARE added an average of 19 minutes to aortic clamp time, with 30-day mortality at 0.9%.
Conclusions:
- ARE is readily performed with minimal added risk compared to standard AVR.
- ARE is a valuable preventive strategy to minimize predicted mismatch.
- This technique enhances the potential benefits of AVR by ensuring appropriate valve sizing.