Are small-sized mechanical valves adequate for patients with small aortic roots?

Abstract

Aim Concerns have been raised over patient outcomes following implantation of small aortic valves (size: 19 and 17 mm). However, in patients with a smaller body surface area, these valves may be adequate. The aim of th study was to assess the hemodynamic and functional performance of these valves and their impact on clinical outcomes in patients with a small aortic root. Material and methods This was a prospective observational study that included all consecutive patients undergoing aortic valve replacement (AVR) with a small-sized aortic valve over a 3-year period. Patients were followed up at 1 week, 6 weeks, and 1 year. Functional and clinical evaluation along with echocardiography was carried out for hemodynamic assessment. In-hospital mortality and hemodynamic outcomes at 1-year follow-up were recorded. Results Isolated AVR with a size 17 mm valve was carried out in 15 (25%) and with a 19 mm valve in 45 (75%) patients. The mean annular size was 19.12 ± 2.03 mm. The mean indexed effective orifice area was 1.08 ± 0.16 cm2/m2. Satisfactory decrease in peak and mean trans-prosthetic gradient were evident (peak gradient preoperatively was 92.15 ± 26.2 mmHg, and 25.68 ± 12.28 mmHg at 1 year, mean gradient was 55.31 ± 17.41 mmHg preoperatively and 13.71 ± 7.39 mmHg at 1 year). The functional status of patients also showed significant improvement post AVR. Left ventricular ejection fraction pre-operatively was 59.67% ± 10.38% and 59.57% ± 7.98% at 1-week, 59.15% ± 8.17% at 6 weeks, and 59.59% ± 7.48% at 1 year. Conclusion When confronted with a small aortic root, AVR with a small-sized prosthesis provides a satisfactory hemodynamic and functional outcome. In patients with small body surface area, implantation of a small-sized valve is a viable option.

Frequency of Aortic Root Enlargement to Prevent PPM Patients Undergone Aortic Valve Replacement in Peshawar Institute of Cardiology

“…The analysis encompassed both qualitative and quantitative variables. Frequencies and percentages were calculated for qualitative variables, including gender, geographic location, medical history, clinical manifestations, etiology of the valvular disease, details of the surgical procedure, operative status, New York Heart Association (NYHA) classification, and post-operative complications (20,21). Descriptive statistics, specifically means and standard deviations (±SD), were used to analyze quantitative data.…”

Sutureless valves versus aortic root enlargement for aortic valve replacement in small aortic annulus: A systematic review and pooled analysis

“…Also, PPM has been independently associated with increased long-term mortality after surgery. [1][2][3][4] There are several techniques to combat SAA while performing AVR: aortic root replacement with stentless valves, aortic root enlargement (ARE), sutureless valves (SV), rapid deployment valves, supra-annular placement of stented valves, 1 and recently transaortic valve implantation (TAVI) with self-expanding supra-annular transcatheter valves. 5 Numerous cardiac surgeons are hesitant to switch from a traditional AVR to the technically demanding aortic root replacement with stentless valves with lengthy cardiopulmonary bypass (CPB) durations.…”