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Aortic valve replacement with patch enlargement of the aortic annulus
1Division of Cardiovascular Surgery, The Toronto Hospital and the University of Toronto, Ontario, Canada.
The Annals of Thoracic Surgery
|June 1, 1997
Summary
Aortic annulus enlargement for aortic valve replacement may increase operative mortality but offers comparable long-term survival and freedom from death, especially for patients with small aortic annuli.
Area of Science:
- Cardiac Surgery
- Bioprosthetic Valves
- Aortic Valve Replacement
Background:
- Aortic annulus enlargement is used to implant larger valve prostheses.
- Limited data exists on the outcomes of this procedure.
Purpose of the Study:
- To evaluate the short- and long-term outcomes of aortic annulus enlargement during aortic valve replacement.
Main Methods:
- Retrospective review of 530 patients undergoing aortic valve replacement with Hancock II bioprosthesis over 11 years.
- Aortic annulus enlargement was performed in 98 patients (18%) to avoid prosthetic valve-patient mismatch.
- Short- and long-term outcomes were analyzed, including a case-control study.
Main Results:
- Aortic annulus enlargement increased operative mortality (3.5% to 7.1%), but not statistically significant (p=0.10).
- Long-term survival was similar between patients with and without annulus enlargement.
- Case-control analysis showed comparable long-term survival and freedom from death endpoints.
Conclusions:
- Aortic annulus enlargement increases operative mortality in aortic valve replacement.
- However, it provides comparable long-term survival and freedom from cardiac/valve-related death for patients with small aortic annuli.