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Aortic valve replacement for aortic stenosis in patients with small aortic root
S F Franzen1, I E Huljebrant, I E Konstantinov
1Department of Cardiothoracic Surgery, Linköping Heart Center, University Hospital, Sweden.
The Journal of Heart Valve Disease
|November 1, 1996
Summary
Aortic stenosis in elderly women with small annuli is common. Surgical techniques like annulus enlargement and supra-annular valve placement can prevent prosthesis-patient mismatch.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Biomaterials in Medicine
Background:
- Increasing prevalence of aortic stenosis (AS) in patients with small aortic annuli.
- Elderly women with small heart and body dimensions present challenges for aortic valve replacement (AVR).
- Small aortic ostia necessitate careful prosthesis selection and implantation techniques.
Purpose of the Study:
- To evaluate outcomes of AVR in patients with small aortic annuli.
- To identify strategies to avoid prosthesis-patient mismatch in this population.
- To analyze the use of different prosthetic valves and surgical techniques.
Main Methods:
- Retrospective analysis of 254 patients undergoing AVR for small aortic annulus (19-21 mm prostheses) between 1989-1995.
- Inclusion of patients with concomitant coronary artery bypass grafting (CABG).
- Use of pericardial patch enlargement for aortic root augmentation in 23% of cases.
Main Results:
- Operative mortality was 3.1%, with no mortality in isolated AVR cases.
- Late mortality was 4.9% after a mean two-year follow-up.
- 95% of patients achieved acceptable transprosthetic gradients, indicating successful management of mismatch.
Conclusions:
- Choosing prostheses with large effective orifice areas is crucial.
- Optimal valve implantation techniques, including supra-annular placement, can mitigate mismatch.
- Annulus enlargement with an outflow patch is a viable option when necessary.