Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients

Sá, Michel Pompeu Barros Oliveira; Carvalho, Martinha Milliany Barros; Filho, Dário Celestino Sobral; Cavalcanti, Luiz Rafael Pereira; Diniz, Roberto; Rayol, Sérgio C.; Soares, Alexandre Magno Macário Nunes; Sá, Frederico Browne Correia de Araujoe; Menezes, Alexandre; Clavel, Marie‐Annick; Pîbarot, Philippe; Lima, Ricardo Carvalho

doi:10.1093/icvts/ivy364

Cited by 27 publications

(34 citation statements)

References 22 publications

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“…Sá et al [30] carried out a meta-analytical study to evaluate the impact of surgical ARE on the perioperative outcomes of SAVR with 10 studies published from 2002 to 2018 and a total of 13,174 patients (SAVR with ARE: 2,819 patients; SAVR without ARE: 10,355 patients). The total rate of ARE was 21.4%, varying in the studies from 5.7% to 26.3%.…”

Section: Discussionmentioning

confidence: 99%

Impact of Prosthesis-Patient Mismatch on 1-Year Outcomes after Transcatheter Aortic Valve Implantation: Meta-analysis of 71,106 Patients

Cavalcanti¹,

Sarargiotto²,

Perazzo³

et al. 2019

Braz J Cardiovasc Surg

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Objectives This study sought to evaluate the impact of prosthesis-patient mismatch (PPM) on the risk of early-term mortality after transcatheter aortic valve implantation (TAVI). Methods Databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Latin American and Caribbean Literature on Health Sciences [LILACS], and Google Scholar) were searched for studies published until February 2019. PPM after TAVI was defined as moderate if the indexed effective orifice area (iEOA) was between 0.85 cm 2 /m 2 and 0.65 cm 2 /m 2 and as severe if iEOA ≤ 0.65 cm 2 /m 2 . Results The search yielded 1,092 studies for inclusion. Of these, 18 articles were analyzed, and their data extracted. The total number of patients included who underwent TAVI was 71,106. The incidence of PPM after TAVI was 36.3% (25,846 with PPM and 45,260 without PPM). One-year mortality was not increased in patients with any PPM (odds ratio [OR] 1.021, 95% confidence interval [CI] 0.979-1.065, P =0.338) neither in those with moderate PPM (OR 0.980, 95% CI 0.933-1.029, P =0.423). Severe PPM was separately associated with high risk (OR 1.109, 95% CI 1.041-1.181, P =0.001). Conclusion The presence of severe PPM after TAVI increased early-term mortality. Although moderate PPM seemed harmless, the findings of this study cannot not rule out the possibility of it being detrimental, since there are other registries that did not address this issue yet.

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Section: Discussionmentioning

confidence: 99%

Impact of Prosthesis-Patient Mismatch on 1-Year Outcomes after Transcatheter Aortic Valve Implantation: Meta-analysis of 71,106 Patients

Cavalcanti¹,

Sarargiotto²,

Perazzo³

et al. 2019

Braz J Cardiovasc Surg

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“…In a meta-analysis by Sá et al, 29 The thesis of no correlation between ARE and perioperative mortality is supported by Yu et al, 31 who conducted a meta-analysis on 8561 patients from nine observational studies. Furthermore, they reported no link between ARE and long-term mortality; patients were followed up for a mean of 7.8 years in five studies.…”

Section: To Enlarge or Not To Enlargementioning

confidence: 96%

“…Two studies, focused entirely on elderly patients with aortic stenosis and small aortic roots, similarly found no increased risk of short or long-term mortality when patients received ARE. 32,33 Sá et al 29 have reported that ARE does not increase the risk of perioperative myocardial infarction, stroke, complete heart block, and reoperation for bleeding. These findings are supported by Tam et al, 34 who also proved no increased risk of blood transfusion.…”

Section: To Enlarge or Not To Enlargementioning

confidence: 99%

“…25 Those who have already undergone mitral valve replacement may be offered an aortoventriculoplasty given that a Nicks or Manouguian procedure would be technically challenging in these patients. 29 Aortoventriculoplasty is associated with the greatest surgical risk, as it requires repair of the ventricular septal defect and right ventriculotomy. 30 This results in significant risks of damage to the septal branches of the left anterior descending artery and the conducting system, as well as formation of fistulae between the cardiac chambers.…”

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confidence: 99%

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Aortic root enlargement: When and how

et al. 2020

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Aortic valve replacement is the definitive management for severe aortic stenosis. Intraoperatively, an aortic root enlargement (ARE) may be used to facilitate the implementation of a suitably sized prosthetic valve. This is to prevent patient prosthesis mismatch (PPM), a condition that causes a left ventricular outflow obstruction. There are four main techniques that are used to perform ARE, namely, Nicks, Manouguian, Nunez (modified Manouguian), and Kanno-Rastan procedures. They each involve incisions through different anatomical structures and allow a variety of valve sizes to be implanted. Studies prove that ARE effectively reduces the incidence of PPM. In addition, they show that there is no definitive link between ARE and perioperative mortality or other complications. There is a scarcity of literature exploring the comparative outcomes of each surgical technique. Therefore, further research is warranted for these procedures to be compared adequately. This review aims to summarise the available literature surrounding ARE with respect to three main questions. (1) What are the indications for ARE, (2) what surgical techniques exist to facilitate ARE, and (3) are there significant differences in patient outcomes when these surgical techniques are employed?

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“…Sá et al [7] published the first systematic review with meta-analysis including 10 articles and 13,174 patients demonstrating that, overall, patients who underwent SAVR with SARE have statistically significant higher risk of perioperative mortality in comparison to those without ARE, but not without concomitant procedures (actually, they also observed a higher risk, but the difference was statistically non-significant). They also observed that, despite longer cardiopulmonary bypass and aortic cross-clamping times, patients who underwent SAVR with SARE did not experience higher rates of myocardial infarction, stroke, complete heart block/permanent pacemaker implantation and reoperation for bleeding.…”

Section: Sare As An Option Within Reach Of Any Surgeonmentioning

confidence: 99%

Prosthesis-Patient Mismatch after Surgical Aortic Valve Replacement: Neither Uncommon nor Harmless

Rayol¹,

Cavalcanti²,

Saragiotto³

et al. 2019

Braz J Cardiovasc Surg

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Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) is an issue that has been overlooked (not to say neglected). Cardiac surgeons must bear in mind that this is a real problem that we must tackle. The purpose of this paper is to be a wake-up call to the surgical community by giving a brief overview of what PPM is, its incidence and impact on the outcomes. We also discuss the increasing role played by imaging for predicting and assessing PPM after SAVR (with which surgeons must become more acquainted) and, finally, we present some options to avoid PPM after the surgical procedure.

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Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients

Cited by 27 publications

References 22 publications

Impact of Prosthesis-Patient Mismatch on 1-Year Outcomes after Transcatheter Aortic Valve Implantation: Meta-analysis of 71,106 Patients

Impact of Prosthesis-Patient Mismatch on 1-Year Outcomes after Transcatheter Aortic Valve Implantation: Meta-analysis of 71,106 Patients

Aortic root enlargement: When and how

Prosthesis-Patient Mismatch after Surgical Aortic Valve Replacement: Neither Uncommon nor Harmless

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