Surgical Method for Facilitation of Aortic Valve Replacement: Intraoperative Application of External Pressure for Increasing the Transverse Axis of Aortic Annulus

Abstract

Background: Surgical method was introduced for enhancement of prosthetic valve insertion and overcoming difficulties ensourcing from prosthesis-patient mismatch. Methods: Twenty-two patients that underwent aortic valve replacement between January 2005 and July 2009 were included in this prospective study. In these patients, the insertion of prosthesis larger than the annulus diameter was attempted after the application of an external pressure that increased the transverse axis diameter of the aortic annulus. The postoperative results and complications were assessed. Results: This surgical method was performed on 22 patients (16 males, 6 females, mean age: 52.2 ± 15.8 years) during the valve replacement. In 12 patients (55%), replacement of proper sized aortic valve compliant to their surface area was accomplished, while the insertion of a proper valve could not be achieved in 10 (45%) of the patients. No perioperative mortality or complications related to the procedure were reported. Conclusion: Increasing the transverse diameter of aortic valve may not only facilitate the insertion of a prosthetic valve but also aid in overcoming * Corresponding author. Ş. Bozok et al. 109prosthesis-patient mismatch. Further studies on larger series are necessary to document the actual effectively and precise selection criteria for application of this method.

Anatomical and functional changes after aortic valve replacement with different sizes of mechanical valves

“…When selecting a larger prosthesis, it may be necessary to take the valve off the holder and tilt it for proper introduction into the root. 27,28 We determined that patients who received no 19 valves experienced less regression of LVM, especially in the third and fifth postoperative years. In all groups, changes were more obvious in the sixth postoperative month, whereas these changes became less notable after the first year.…”