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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Aortic annular enlargement during aortic valve replacement: improving results with time
Mark D Peterson1, Michael A Borger, Christopher M Feindel
1Division of Cardiac Surgery, Toronto General Hospital, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
The Annals of Thoracic Surgery
|May 29, 2007
Summary
Aortic annular enlargement during aortic valve replacement is safe in the modern era. This procedure, when performed in contemporary patients, shows reduced operative mortality compared to earlier periods, avoiding patient-prosthesis mismatch.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Surgery
- Aortic Valve Replacement
Background:
- Aortic annular enlargement allows for larger prosthetic valve insertion during aortic valve replacement.
- Historically, patch enlargement of the aortic annulus was associated with increased operative morbidity and mortality.
- Contemporary outcomes of aortic annular enlargement were compared to an earlier era.
Purpose of the Study:
- To evaluate if aortic annular enlargement is still associated with worse outcomes in contemporary patients undergoing aortic valve replacement.
- To compare the safety and efficacy of aortic annular enlargement in two distinct time periods.
Main Methods:
- A review of prospectively gathered data from 1995 to 2005 for patients undergoing aortic valve replacement with aortic annular enlargement (n = 669).
- Comparison of patient outcomes between two periods: 1995-2000 (n = 360) and 2001-2005 (n = 309).
- Propensity matching was utilized in a secondary analysis to adjust for baseline differences between the groups.
Main Results:
- Operative mortality was significantly lower in the more recent group (2001-2005) at 2.9% compared to the earlier group (1995-2000) at 7.2% (p = 0.013).
- Rates of perioperative myocardial infarction, stroke, and pacemaker implantation were similar between the two groups.
- After propensity matching, the risk of perioperative death remained significantly lower in the contemporary group (3% vs. 7.5%; p = 0.04).
Conclusions:
- Aortic annular enlargement is a safe adjunct to aortic valve replacement in the modern surgical era.
- The procedure should be considered in selected patients to prevent patient-prosthesis mismatch.
- Contemporary outcomes demonstrate improved safety compared to historical data.
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