Aortic valve replacement in small aortic annulus with or without annular enlargement

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Disease
• Aortic Valve Repair and Replacement

Background:

• Surgical treatment for aortic valve disease with a small aortic annulus requires careful patient selection and prosthesis choice.
• This study addresses the need for optimal surgical strategies in this patient population.

Purpose of the Study:

• To compare the long-term outcomes of aortic annular enlargement versus standard aortic valve replacement using a small prosthesis.
• To evaluate mortality, reoperation rates, and valve-related events in both surgical approaches.

Main Methods:

• A retrospective analysis of 45 patients with small aortic annuli who underwent surgery since 1980.
• 28 patients had aortic annular enlargement (Nicks', Manouguian's, or apico-aortic bypass).
• 17 patients underwent standard aortic valve replacement with a small prosthesis (19 mm St. Jude Medical).

Main Results:

• 10-year actuarial survival was higher in the enlargement group (85.7%) compared to the standard group (62.7%).
• Freedom from valve-related events at 10 years was significantly better in the enlargement group (81.0%) versus the standard group (58.8%).
• No significant difference in early mortality or freedom from reoperation was observed between the groups.

Conclusions:

• Aortic annular enlargement may provide superior long-term survival and reduced morbidity compared to standard aortic valve replacement with a small prosthesis.
• This approach is a viable option for managing aortic valve disease in patients with small aortic annuli.