Surgical management of the small aortic annulus. Hemodynamic evaluation

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Surgery
• Aortic Valve Replacement

Background:

• Small aortic roots pose a challenge for aortic valve replacement, leading to higher gradients with standard mechanical and tissue valves.
• Implantation of appropriately sized valves is crucial for optimal hemodynamic function post-aortic valve replacement.

Purpose of the Study:

• To describe a surgical technique for enlarging the aortic annulus to accommodate larger prosthetic valves.
• To evaluate the safety and efficacy of aortic annulus enlargement in patients undergoing aortic valve replacement.

Main Methods:

• A cohort of 253 patients undergoing aortic valve replacement was studied, with 22 requiring aortic annulus enlargement.
• The technique involves dividing the aortic annulus, extending the incision to the mitral valve, and closing the defect with a Dacron patch.
• Hancock porcine heterografts were used in patients with annular diameters < 25 mm.

Main Results:

• Aortic annulus enlargement allowed for the implantation of larger valves in 22 patients.
• Postoperative recatheterization in 12 patients showed an average resting transvalvular gradient of 13.5 mm Hg.
• The procedure was successful in combined aortic and mitral valve replacement without instances of heart block.

Conclusions:

• Aortic annulus enlargement is a necessary and effective technique for a significant number of patients with small aortic roots undergoing aortic valve replacement.
• This approach improves valve implantation and hemodynamic outcomes.
• The technique is safe and can be combined with other cardiac procedures.