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Related Experiment Videos

Small aortic annulus: a functional definition

P Ghosh1, S Kumar, S Pandey

  • 1Cardiac Sciences Center, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
|November 26, 1998
PubMed
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Aortic valve replacement (AVR) with small prostheses does not always indicate poor outcomes. Patient-prosthesis mismatch is identified by specific valve size indices (VSI) and valve area indices (VAI), not just prosthesis size.

Area of Science:

  • Cardiovascular Surgery
  • Biomedical Engineering
  • Clinical Cardiology

Background:

  • Small aortic annulus is traditionally linked to adverse outcomes following aortic valve replacement (AVR).
  • However, some patients exhibit favorable outcomes despite AVR with smaller Medtronic Hall (MH) or Sorin Carbocast (SC) prostheses (sizes 19, 20, or 21).
  • This observation necessitates a re-evaluation of the definition of a small aortic annulus.

Purpose of the Study:

  • To investigate the discrepancy between predicted and implanted prosthetic valve sizes in patients undergoing AVR.
  • To assess the hemodynamic performance and functional outcomes in patients with AVR using smaller prostheses.
  • To refine the criteria for identifying patient-prosthesis mismatch in the context of aortic annulus size.

Main Methods:

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  • A retrospective study of survivors who underwent isolated AVR with MH or SC prostheses (sizes 19, 20, 21).
  • Analysis of the disparity between implanted and predicted prosthetic sizes using established nomograms (Rowlatt et al., NIH Plehn, Kishimoto, Sievers).
  • Preoperative and follow-up echocardiographic assessments to evaluate hemodynamic parameters and prosthetic function.

Main Results:

  • No significant differences in baseline demographics or preoperative hemodynamic parameters between groups with different valve sizes.
  • Discrepancies were observed in annulus size classification across different nomograms; Sievers criteria indicated undersizing by echocardiography.
  • Implanted valves were larger than Plehn-predicted sizes; Valve Size Index (VSI) and Valve Area Index (VAI) were acceptable, with improved postoperative gradients and regression of left ventricular dimensions and mass.

Conclusions:

  • Implanted prosthesis size alone does not define an inadequate aortic annulus.
  • Patient-prosthesis mismatch should be considered when predicted prosthesis size results in a VSI <12 mm/m2, VAI <1.31 cm2/m2, or an orifice diameter <19 mm.
  • These indices may suggest the need for annular enlargement during AVR.