Aortic root enlargement does not increase the surgical risk and short-term patient outcome?☆

Coutinho, Gonçalo F.; Correia, Pedro Miguel Alves Ribeiro; Paupério, Gonçalo; Oliveira, Ferrão de; Antunes, Manuel J.

doi:10.1016/j.ejcts.2010.11.064

Cited by 38 publications

(29 citation statements)

References 24 publications

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“…6 In a second series of 16 patients, there was no operative mortality with stability of aortic diameters at 30 months of follow-up, confirming the safety and effectiveness of this technique in allowing adequate EAA. 7 Large series of EAA associated with AVR have been reported [19][20][21][22][23][24] using a variety of techniques and materials, such as autologous or xenograft pericardium or synthetic patches, but reports on long-term follow-up are limited. Piehler and associates 19 reported on 96 patients undergoing EAA with the technique by Nicks and colleagues 2 with autologous pericardium and a maximum follow up of 15 years; 24 patients required reoperation, and in all of them the pericardium was found to be well healed, not dilated but thickened and often calcified.…”

Section: Discussionmentioning

confidence: 99%

Stability of aortic annulus enlargement during aortic valve replacement using a bovine pericardial patch: An 18-year clinical, echocardiographic, and angio–computed tomographic follow-up

Celiento¹,

Saccocci²,

Martino³

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Stability of aortic annulus enlargement during aortic valve replacement using a bovine pericardial patch: An 18-year clinical, echocardiographic, and angio–computed tomographic follow-up

Celiento¹,

Saccocci²,

Martino³

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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“…Aortic root enlargement is sometimes performed to avoid the PPM, but clinical results including increased surgical risks are controversial [21, 22]. Newly developed prosthetic valves with smaller sewing rings and supra-annular implantation techniques contribute to avoiding the PPM.…”

Section: Discussionmentioning

confidence: 99%

Patient-prosthesis mismatch in patients with aortic valve replacement

Kaminishi

Misawa

Kobayashi

et al. 2013

Gen Thorac Cardiovasc Surg

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ObjectivePatient-prosthesis mismatch (PPM) may affect clinical outcomes in patients with aortic valve replacement (AVR). We retrospectively examined the PPM in patients with isolated AVR in the Japan Adult Cardiovascular Surgery Database (JACVSD).MethodsWe examined all patients with isolated AVR between January 1, 2008 and December 31, 2009. The JACVSD data collection form has a total of 255 variables. We defined PPM as an effective orifice area index of ≤0.85 m2/cm2.ResultsPPM was observed in 306 of 3,609 cases analyzed, PPM rate was 8.5 %. Body surface area was larger and body mass index was higher in the PPM group than the non-PPM group (P < 0.001). Patients with PPM were older (P = 0.001) and had a higher prevalence of diabetes (P = 0.004), dyslipidemia (P < 0.001), hypertension (P < 0.001), cerebrovascular disease (P = 0.031), old myocardial infarction (P = 0.006), previous percutaneous coronary artery intervention (P = 0.001), coronary artery disease (P = 0.018), and aortic valve stenosis (P < 0.001). Perioperative blood transfusion (P < 0.001) and dialysis (P = 0.005) were more frequent in the PPM group. Postoperative ventilation (P = 0.004) and intensive care unit stay (P = 0.004) were significantly longer in the PPM group.ConclusionsAge, aortic valve stenosis, dyslipidemia, hypertension, old myocardial infarction, previous percutaneous coronary artery intervention, diabetes mellitus, cerebrovascular disease, and high body mass index were the risk factors for PPM. PPM was not an independent risk factor for short-term mortality.

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“…First, our patients presented with a relatively high-risk characteristics [high proportion of female patients (74.5%), NYHA class III/IV (50.9%), LVEF < 50% (55.7%), and concomitant coronary surgery (34.9%)], and therefore a “quick and simple” procedure was required to reduce myocardial ischemic time. It is clinically evident that a prolonged aortic cross-clamp time is one of the most important risk factors for post-AVR adverse events [3,4,6,7]. Although aortic root enlargement procedures or stentless prosthesis implantation are feasible options for patients with small aortic annulus, these procedures are technically more difficult and time consuming, and may result in higher morbidity than simple valve replacement, particularly in our patients who often have a severe calcified aortic root due to rheumatic and degenerative etiologies (81.1%).…”

Section: Discussionmentioning

confidence: 99%

“…a stentless bioprosthesis or a new generation of stented bioprosthesis) or modern bileaflet mechanical valve implanted in the supra-annular position. However, these strategies are technically more difficult, require longer cardiopulmonary bypass times, and fail to point uniformly toward an improved clinical outcome [2,3]. …”

Section: Introductionmentioning

confidence: 99%

Seventeen-millimeter St. Jude Medical Regent valve in patients with small aortic annulus: dose moderate prosthesis-patient mismatch matter?

Qian

et al. 2014

J Cardiothorac Surg

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BackgroundThe study was designed to evaluate the effects of moderate prosthesis-patient mismatch (defined as 0.65 cm2/m2 < indexed effective orifice area ≤ 0.85 cm2/m2) on midterm outcomes after isolated aortic valve replacement with a 17-mm St. Jude Medical Regent valve in a large series of patients, and to determine if these effects are influenced by patient confounding variables.MethodsOne-hundred and six patients with and without moderate prosthesis-patient mismatch early after implantation of a 17-mm Regent valve at aortic position were included. Both clinical and echocardiographic assessments were performed preoperatively, at discharge and during follow-up period (mean follow-up time 52.6 ± 11.9 months).ResultsThe prevalence of moderate prosthesis-patient mismatch was documented in 46 patients (43.4%) at discharge. During the follow-up period, no difference in the regression of left ventricular mass, decrease of transvalvular pressure gradients, mortality and prosthesis-related complications was observed between patients with and without moderate prosthesis-patient mismatch. After adjustment for several risk factors, moderate prosthesis-patient mismatch was associated with increased midterm mortality in patients with baseline left ventricular ejection fraction < 50% (HR: 1.80, p = 0.02), but with normal prognosis in those with preserved LV function. Younger age (cut off value = 65 years) was not an independent predictor of increased midterm mortality and valve-related complications in patients with moderate prosthesis-patient mismatch.ConclusionsModerate prosthesis-patient mismatch after aortic valve replacement with a small mechanical prosthesis is associated with increased mortality and adverse events in patients with pre-existing left ventricular dysfunction. Selected patients with small aortic annulus can experience satisfactory clinical improvements and midterm survival after aortic valve replacement with a 17-mm Regent valve.

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Aortic root enlargement does not increase the surgical risk and short-term patient outcome?☆

Cited by 38 publications

References 24 publications

Stability of aortic annulus enlargement during aortic valve replacement using a bovine pericardial patch: An 18-year clinical, echocardiographic, and angio–computed tomographic follow-up

Stability of aortic annulus enlargement during aortic valve replacement using a bovine pericardial patch: An 18-year clinical, echocardiographic, and angio–computed tomographic follow-up

Patient-prosthesis mismatch in patients with aortic valve replacement

Seventeen-millimeter St. Jude Medical Regent valve in patients with small aortic annulus: dose moderate prosthesis-patient mismatch matter?

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