[Advantage of supra-annular patch enlargement in aortic stenosis with a small aortic annulus]

We routinely perform supra-annular patch enlargement as a strategy to avoid patient-prosthesis mismatch (PPM) in patients with a small aortic annulus who are undergoing aortic valve replacement (AVR).

We performed a retrospective review of 128 consecutive single AVR patients from 1999 to 2005. Of these, 34 patients underwent supra-annular patch enlargement. The enlargement was selectively performed in patients at risk of PPM. This involved patch extension of the aortotomy just above the annulus of noncoronary sinus, and valve implantation with stitches placed directly on the patch. Along with this procedure, AVR with a valve size appropriate to body surface area (BSA) was performed.

Of these patients, 74% were female and the mean BSA was less than 1.50 m2. The enlargement required an average of 33 minutes of additional aortic clamp time. The 30-day mortality was 0%. A favorable hemodynamic outcome was achieved.

Our results show that supra-annular patch enlargement can be performed with minimal added risk, relative to standard root enlargement and a satisfactory hemodynamic status can be achieved by employing this procedure.