Aortic Root Enlargement In Case of Double Valve Replacement

Ahsan, Mahbub; Rahman, Lutfur; Islam, Asm Shariful; Rahman, Mohammad Arifur

doi:10.3329/kyamcj.v11i2.48426

Cited by 5 publications

(10 citation statements)

References 10 publications

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“…With an undersized prosthetic valve, a patient cannot maintain normal activity and may produce symptoms of aortic stenosis (AS) and PPM. Rahimtola first described the issue of PPM, if the EOA of prosthetic valve is very small, in relation to a patient's BSA [Ahsan 2020;Ankit 2020]. Nick and colleagues first proposed posterior root enlargement in 1970.…”

Section: Introductionmentioning

confidence: 99%

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Aortic Root Enlargement in Patients With Small Aortic Annulus Undergoing Double Valve Replacement: A Retrospective Comparative Cohort Study

Mubarak

Jawad

2021

HSF

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Background: Small aortic annulus (AA) is a big issue during aortic valve replacement (AVR), necessitating replacement of an undersized prosthetic valve especially with double valve replacement (DVR). Despite the fact that small aortic valve prostheses can lead to prosthesis-patient mismatch (PPM), there remains reluctance to perform aortic root enlargement (ARE) procedures, fearing morbidity and mortality. Objective: To evaluate clinical and echocardiographic outcomes in patients with small aortic annulus (<18 mm) undergoing double valve replacement. Methods: The study included 100 consecutive patients who underwent DVR for combined rheumatic aortic and mitral valve diseases, between January 2016 and September 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 endpoints were mortality, effective orifice areas (EOA), mean aortic pressure gradient (PG), and valve-related complications. The shortest 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 1.7 ± 0.3 m2, aortic annulus diameter was 1.4 ± 0.4 mm, aortic orifice area was 0.8 ± 0.1 cm2, and mean pressure gradient 85 ± 2.5 mmHg. During the follow-up period, there was a mild to moderate paravalvular leak (1%) with 1% heart block and residual gradient on prosthetic aortic valve; this was all in DVR alone. Conclusion: Enlargement of the 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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Section: Introductionmentioning

confidence: 99%

“…When ARE was performed properly by an experienced cardiac surgeon, the technique is safe and reproducible [Feindel 2006]. So, nowadays surgeons prefer to do ARE to get rid of PPM and to obtain optimum hemodynamics [Ahsan 2020;Ankit 2020].…”

Section: Introductionmentioning

confidence: 99%

Aortic Root Enlargement in Patients With Small Aortic Annulus Undergoing Double Valve Replacement: A Retrospective Comparative Cohort Study

Mubarak

Jawad

2021

HSF

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“…With undersized prosthetic valve, patient can't maintain normal activity; produce symptoms of aortic stenosis (AS) and PPM. Rahimtola rst described the issue of PPM, if the EOA of prosthetic valve is very small in relation to patient′s BSA [1][2]. Nicks and colleagues rst proposed posterior root enlargement in 1970.…”

Section: Introductionmentioning

confidence: 99%

“…When ARE is performed properly by an experienced cardiac surgeon, it is safe and reproducible [8]. So, nowadays surgeons prefer to do ARE to get rid of PPM and to obtain optimum hemodynamics [1][2].…”

Section: Introductionmentioning

confidence: 99%

Aortic Root Enlargement in patients with small aortic annulus undergoing double valve replacement. A retrospective Comparative cohort study

Mubarak¹,

Abdeljawad

2020

Preprint

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Objectives Small Aortic Annulus (AA) is big issue during Aortic Valve Replacement (AVR) necessitating replacement of inappropriate-sized prostheses especially during 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. We evaluate clinical and echocardiographic outcomes in patients with small AA undergoing DVR. Methods The study included 100 consecutive patients underwent DVR for combined rheumatic aortic and mitral valve diseases, between June 2016 and November 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 post-operative end-points were mortality, effective orifice areas (EOA), mean aortic pressure gradient and valve-related complications. The least post-operative follow-up period was 6 months. Results The study included 30 male and 70 female patients with mean age of 45 ± 10 years, body surface area (BSA) of 1.6 ± 0.50 m2, aortic annulus diameter was 20 ± 0.4 mm, EOAi was 0.80 ± 0.50 cm2/m2, and aortic mean gradient (PG) 80 ± 40 mm Hg. During follow-up period, there was a mild paravalvular leak (1%) with, (1%) heart block, and residual mean PG on prosthetic aortic valve with all cases of 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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“…MV repair with a downsized complete rigid annuloplasty ring is the procedure of choice for IMR. 8 , 9 A complete annuloplasty ring decreases mitral leaflet strain, improves leaflet coaptation geometry, and enhances repair durability. The Cosgrove flexible band is designed to preserve mitral annular dynamics.…”

Section: Introductionmentioning

confidence: 99%

Multicenter experience: early outcome of mitral valve repair in patients with ischemic mitral regurgitation

Hussein¹,

Abdelrehim

Mubarak

2020

Asian Cardiovasc Thorac Ann

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Background Ischemic mitral regurgitation is associated with poor outcomes. The optimal surgical strategy for management of ischemic mitral regurgitation is still debated. The objective of this study was to evaluate the early mortality and morbidity of mitral valve repair in patients with ischemic mitral regurgitation undergoing coronary artery bypass grafting. Methods We performed a retrospective, observational, cohort study on prospectively collected data on 136 consecutive coronary artery bypass graft patients with ischemic mitral regurgitation undergoing mitral valve repair between January 2016 and January 2020. Perioperative echocardiogram findings, operative procedures, and outcomes were analyzed. Results The overall mortality rate was 4.4%. Mitral valve repair with a low ejection fraction had a 4-fold increase in the risk of death compared to mitral valve repair with preserved ejection fraction > 30%. However, after adjusting for preoperative risk factors, the number of grafts was not an independent risk factor for mortality (odds ratio = 0.18, 95% confidence interval: 0.03–2.81, p = 0.84). Multivariable analysis showed that preoperative ejection fraction (odds ratio = 1.14, 95% confidence interval: 0.82–4.86, p < 0.01), preoperative left ventricular end-systolic dimension (odds ratio = 1.03, 95% confidence interval: 0.65–3.51, p < 0.01) and preoperative left ventricular end-diastolic dimension (odds ratio = 0.99, 95% confidence interval: 0.64–3.28, p = 0.04) were independent risk factors for mortality. Conclusions Mitral valve repair can be performed safely concomitantly with coronary artery bypass grafting in patients with moderate, moderately severe, and severe ischemic mitral regurgitation.

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Aortic Root Enlargement In Case of Double Valve Replacement

Cited by 5 publications

References 10 publications

Aortic Root Enlargement in Patients With Small Aortic Annulus Undergoing Double Valve Replacement: A Retrospective Comparative Cohort Study

Aortic Root Enlargement in Patients With Small Aortic Annulus Undergoing Double Valve Replacement: A Retrospective Comparative Cohort Study

Aortic Root Enlargement in patients with small aortic annulus undergoing double valve replacement. A retrospective Comparative cohort study

Multicenter experience: early outcome of mitral valve repair in patients with ischemic mitral regurgitation

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