Comparison of the Early Results of Supra-Annular and IntraAnnular Aortic Valve Replacement in Isolated Aortic Valve Replacement

Comparison of the Early Results of Supra-Annular and Intra-Annular Aortic Valve Replacement in Isolated Aortic Valve ReplacementS urgical aortic valve replacement (AVR) is the gold stan- dard for the treatment of aortic stenosis and regurgitation. [1,2]In AVR, the location where the valve is placed is as important as the features of the prosthetic valve.The implanted valve orifice area is important in the regression of left ventricular (LV) hypertrophy.The smaller effective orifice area (EOA) resulting from small prosthesis implantation may be associated with higher patient-prosthesis mismatch (PPM) and less regression of LV hypertrophy. [3]Instead of intra-annular valve implantation in patients with small an-Objectives: This study aims to compare the early results of patients who underwent isolated aortic valve replacement (AVR) with supra-annular and intra-annular AVR.Methods: Between 2013 and 2019, 113 patients (77 males; mean age 57.816.36years) who underwent isolated AVR were evaluated.The patients were divided into two groups those who underwent supra-annular (n=59) and intra-annular (n=54) AVR.The most commonly used valves in surgeries St Jude Medical Masters (St.Jude Medical, Minneapolis, MN, USA), (n=35, 30.9%),Sorin Mitroflow (Sorin Group Inc., Mitroflow Division, Canada), (n=32, 28.3%, and Carbomedics Top Hat (Sulzer, Carbomedics, Austin, TX), (n=31, 27.4%). Results:The cross-clamp (XCL) and cardiopulmonary bypass (CPB) times of the patients who underwent supra-annular AVR were found to be significantly higher than the patients who underwent intra-annular AVR.However, there was no significant difference between the two groups in terms of postoperative adverse events.There was no significant difference between the two groups in the postoperative first-week transthoracic echocardiographic (TTE) findings.Conclusion: When comparing supra-annular and intra-annular valve positioning results in patients undergoing isolated AVR, no significant difference was found between the groups in terms of postoperative complications, gradient differences in postoperative TTE, and ejection fractions.Supra-annular valve positioning should be considered, especially in patients with small annulus, in the presence of suitable anatomical features.However, this issue needs to be investigated in future prospective studies with more patients.