Aortic Annular Enlargement vs Isolated Aortic Valve Replacement in Patients With Matched Annulus

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Surgery
• Aortic Valve Replacement

Background:

• Small native aortic annuli (≤23 mm) pose challenges in aortic valve replacement (AVR).
• The impact of aortic annular enlargement (AAE) on midterm outcomes in these patients is not fully understood.

Purpose of the Study:

• To evaluate the effect of AAE on midterm outcomes in patients undergoing isolated AVR with small native aortic annuli.
• To compare outcomes between AVR with and without AAE using propensity score matching.

Main Methods:

• Retrospective analysis of 1328 patients undergoing isolated AVR from 2011-2022.
• 1163 patients without AAE (AVR group) and 165 with AAE (AVR+AAE group).
• Propensity score matching created 112 pairs to control for baseline characteristics and annulus size.

Main Results:

• Median annulus size was 23 mm in both groups; prosthesis size was larger in the AVR+AAE group (25 mm vs 23 mm).
• The AVR+AAE group showed significantly improved 6-year survival (98% vs 74%) and was independently associated with reduced mortality (HR 0.19).
• Operative mortality and moderate/severe patient-prosthesis mismatch rates were similar between groups.

Conclusions:

• Aortic annular enlargement may be beneficial for patients with small native aortic annuli undergoing isolated AVR.
• AAE is an independent protective factor for midterm mortality in this patient cohort.
• Further research may explore optimal patient selection for AAE.