Key result
Aortic root enlargement during DVR appears safe, with ~1% complication rates seen exclusively in DVR alone.
Why the study?
Despite small aortic valve prostheses causing prosthesis-patient mismatch during double valve replacement for small aortic annulus, reluctance persists regarding aortic root enlargement due to fear of morbidity and mortality.
Does aortic root enlargement improve clinical and echocardiographic outcomes in patients with small aortic annulus undergoing double valve replacement?
Cohort (n=100)
Does aortic root enlargement improve clinical and echocardiographic outcomes in patients with small aortic annulus undergoing double valve replacement?
Aortic root enlargement is a safe and effective adjunct to double valve replacement in patients with small aortic annuli, potentially reducing valve-related complications compared to double valve replacement alone.
Aortic root enlargement may be safe with double valve replacement; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Small Aortic Annulus (AA) is big issue during Aortic Valve Replacement (AVR) necessitating replacement of an undersized prosthetic valve especially with Double Valve Replacement (DVR). Despite that small aortic valve prostheses can lead to Prosthesis-Patient Mismatch (PPM), there remains reluctance to perform aortic root enlargement (ARE) procedures fearing from morbidity and mortality. OBJECTIVE: To evaluate clinical and echocardiographic outcomes in patients with small aortic annulus undergoing double valve replacement. METHODS: The study included 100 consecutive patients underwent DVR for combined rheumatic aortic and mitral valve diseases, between Jan. 2016 and Sept. 2020. Only (50) patients had ARE with DVR. ARE was performed using an autologous or bovine pericardium or Dacron patch by Nick¢s or Manouguian procedures. The estimated postoperative end-points were mortality, effective orifice areas (EOA), mean aortic pressure gradient and valve-related complications. The least postoperative follow-up period was 6 months. RESULTS: The study included 30 male and 70 female patients with mean age of 35±20 years, body surface area (BSA) of 1.5 ±0.20 m2, aortic annulus diameter was 20±1.4 mm, aortic orifice area was 0.80±0.50 cm2, and aortic peak gradient (PG) 80±40 mm Hg. During follow-up period, there was a mild to moderate paravalvular leak (1%) with, (1%) heart block, and residual PG on prosthetic aortic valve; that was all in DVR alone. CONCLUSION: Enlargement of aortic root by Nick¢s or Manouguian technique is safe and effective in patients with small aortic annulus undergoing double valve replacements.
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Mubarak et al. (2021) conducted a cohort in Combined rheumatic aortic and mitral valve diseases with small aortic annulus (n=100). Aortic root enlargement with double valve replacement vs. Double valve replacement alone was evaluated on Mortality, effective orifice areas, mean aortic pressure gradient and valve-related complications. Aortic root enlargement during double valve replacement was safe, with paravalvular leak (1%) and heart block (1%) occurring exclusively in patients undergoing double valve replacement alone.
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