Key result
Autopericardial neocuspidization yielded similar in-hospital mortality (2.1% vs 7.1%, p=0.321) but higher survival (96% vs 74%, p=0.04) compared to aortic root enlargement.
Why the study?
In patients with aortic valve disease, a small aortic annulus can lead to prosthesis-patient mismatch after aortic valve replacement.
Does autopericardial neocuspidization improve survival and reduce MACE compared to aortic root enlargement with standard valve replacement in patients with aortic valve disease and small aortic annulus?
Cohort (n=77)
Does autopericardial neocuspidization improve survival and reduce MACE compared to aortic root enlargement with standard valve replacement in patients with aortic valve disease and small aortic annulus?
Autopericardial neocuspidization in patients with a small aortic annulus is associated with better mid-term survival, lower MACE, and improved hemodynamics compared to aortic root enlargement with standard valve replacement.
Answers are grounded in this paper and cite their sources.
AVNeo may be feasible for small annuli; leaves open need for randomized trials versus root enlargement.
Introduction. Some patients with aortic valve (AV) disease have small aortic annulus. This anatomical feature can lead to prosthesis-patient mismatch after AV replacement. Objective. To improve postoperative outcomes in patients with AV disease and small aortic annulus. Material and methods. We retrospectively analyzed 77 patients with small aortic annulus divided into 2 groups: group 1 (n=49) — autopericardial neocuspidization (AVNeo) of the aortic valve, group 2 (n=28) — aortic root enlargement and standard aortic valve replacement using mechanical or biological prostheses. Analysis of comorbidities found no differences between groups. Results. In-hospital mortality was similar (2.1% (n=1) and 7.1% (n=2), respectively, p=0.321). Survival rate was 96% and 74%, respectively (p=0.04), cumulative freedom from MACE — 95% and 53% (p=0.03), freedom from redo surgery — 95% and 80%, respectively (p=0.381). Duration of cardiopulmonary bypass and myocardial ischemia was similar: 113.84±36.03 vs 116.61±25.01 min, (p=0.71); 86.74±23.19 vs 91.04±22.71 min, respectively (p=0.404). The incidence of permanent pacemaker implantations was significantly higher in group 2: 6 (21.4%) vs 2 (4.1%) cases (p=0.039). In early postoperative period, transvalvular peak blood flow velocity (p<0.01) and pressure gradient (p<0.01) significantly decreased in the 1st group compared to the 2nd group. Mean transvalvular pressure gradient in mid-term period was significantly lower in the AVNeo group (p=0.001). Conclusion. AVNeo in patients with small annulus demonstrates the advantages over aortic root enlargement regarding mid-term results due to better hemodynamic parameters after surgery.
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Курасов et al. (2024) conducted a cohort in Aortic valve disease with small aortic annulus (n=77). Autopericardial neocuspidization (AVNeo) vs. Aortic root enlargement and standard aortic valve replacement was evaluated on In-hospital mortality (p=0.321). Autopericardial neocuspidization yielded similar in-hospital mortality (2.1% vs 7.1%, p=0.321) but higher survival (96% vs 74%, p=0.04) compared to aortic root enlargement.
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