A comparative study of surgical treatment of small aortic root with or without aortic root enlargement using a single prosthesis type

Prakash, S.; Agarwal, Saket; Dutta, Nilanjan; Satsangi, Deepak Kumar

doi:10.2459/jcm.0b013e32833e5687

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…The JBI tool for non-randomised studies revealed a moderate risk of bias in 13 studies, 6,10,11,20,21,23–26,28–31 and a low risk of bias in one study. 27 Further details are mentioned in (Supplemental Table 2).…”

Section: Resultsmentioning

confidence: 98%

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

Agarwal

Arnav

Ranjan

et al. 2023

Asian Cardiovasc Thorac Ann

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Background Very few studies provide direct comparisons between aortic root enlargement and sutureless valve implantation in patients with a small aortic annulus who underwent aortic valve replacement. This study aims to provide comparative outcomes between the two in such a subset of patients, through a systematic review and pool analysis. Methods The PubMed, Scopus and Embase databases were searched using the appropriate terms. The data from original articles mentioning aortic root enlargement and sutureless valves in a single or comparative study with another group of patients with a small aortic annulus were pooled and analyzed using descriptive statistics. Results Both cardiopulmonary bypass (68.4 vs. 125.03 min, p < 0.001) and aortic cross-clamp times were significantly shorter in the sutureless valve group, along with a concomitantly higher number of minimally invasive surgeries. The incidence of permanent pacemaker implantation (9.76% vs. 3.16%, p < 0.00001), patient prosthesis mis-match and paravalvular leak was significantly higher in the sutureless valve group. In comparison, the incidence of re-exploration for bleeding was higher in the aortic root enlargement group (5.27% vs. 3.16%, p < 0.02). The two groups had no differences in the duration of hospital stays or mortality. Conclusions Sutureless valves demonstrated a comparable hemodynamic outcome with aortic root enlargement in patients with a small aortic annulus. In addition to this, it greatly facilitated minimally invasive surgery. However, the high incidence of pacemaker implantation is still a concern for the widespread recommendation of sutureless valves, especially in young patients with a small aortic annulus.

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Section: Resultsmentioning

confidence: 98%

“…The most common pathology in patients with SV implants was aortic stenosis. Except for few studies 10,25,29 patients who had ARE, however, had combined diseases (both aortic stenosis and regurgitation).…”

Section: Resultsmentioning

confidence: 99%

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

Agarwal

Arnav

Ranjan

et al. 2023

Asian Cardiovasc Thorac Ann

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“…Title and abstract screening were performed in duplicate, identifying 139 potentially eligible studies that underwent full-text review by two independent reviewers. Overall, 32 potentially eligible studies (12,13,20,21,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51) were identified (52)(53)(54)(55)(56)(57)(58)(59)(60), including 17 studies (13,45-60) that were excluded because they did not include any information on at least one of the mid-term outcomes of interest through 5 years of followup. Consequently, 15 unique studies (12,20,21,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) remained and were included in data extraction and quantitative synthesis.…”

Section: Literature Searchmentioning

confidence: 99%

Early and mid-term outcomes of aortic annular enlargement: a systematic review and meta-analysis

Tanaka,

Vervoort,

Mazine

et al. 2024

Ann Cardiothorac Surg

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Background: There is mounting evidence at experienced centers that aortic annular enlargement (AAE) procedures are safe adjuncts to surgical aortic valve replacement (SAVR) that do not increase perioperative morbidity and mortality. This systematic review and meta-analysis aims to assess the impact of AAE procedures on mid-term outcomes after SAVR.Methods: OVID MEDLINE, OVID Embase, and Cochrane Library were searched comprehensively.Comparative studies examining adult patients undergoing SAVR with and without AAE were eligible for inclusion. Studies involving aortic root replacement, Ross procedures, and Ozaki procedures were excluded.The risk of bias was assessed according to Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I), and the quality of evidence was evaluated according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). Random effects meta-analysis facilitated the quantitative synthesis.Results: A total of 2,765 records were retrieved. After full-text review, 15 eligible studies were identified for data extraction and synthesis. The dataset included a total of 216,654 patients (AAE: 7,967; no AAE: 208,687). Only mid-term outcomes were available. In unmatched and unadjusted studies, perioperative mortality was noted to be higher in the AAE group. However, this difference was not observed in studies with matching or adjusted outcomes. In both the unmatched and unadjusted studies, and the matched and adjusted studies, there were no statistically significant differences identified regarding perioperative stroke, myocardial infarction, or permanent pacemaker implantation. Similarly, there were no statistically significant differences identified in mid-term mortality [hazard ratio (HR), 1.03; 95% confidence interval (CI): 0.95 to 1.11; P=0.49; I 2 =20% (matched/adjusted studies)], aortic valve reintervention [HR, 0.98; 95% CI: 0.75 to 1.27;

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“…Some studies have reported acceptable results of aortic root enlargement (ARE) among young and middle-aged patients with SAA [5,6,11], whereas the outcomes remain controversial in elderly patients due to an elevated surgical risk. Additionally, stentless valves have been reported previously to lower the postoperative residual trans-aortic valve pressure [12][13][14], which has also been limited due to high technical requirements and undetermined long-term durability [4,[15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Early-Term Hemodynamic Performance And Clinical Results of 19-mm st. Jude Medical Regent Valve In Patients With Small Aortic Annulus Undergoing Dual Valve Replacement: A Retrospective Study

Wang

Zhang

Cheng

et al. 2021

Preprint

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Background: The prosthesis selection in patients with small aortic annulus undergoing aortic valve replacement (AVR) has always been a challenge, especially in dual valve replacement (DVR, combined aortic and mitral valve replacement). The present study aimed to analyze early-term hemodynamic parameters of 19-mm St. Jude Medical Regent ( SJMR19 ) valve in patients with small aortic annulus undergoing DVR. Methods: Between January 2015 to December 2020, 54 patients with small aortic annulus who underwent DVR were divided into two groups: SJMR19 valve group (n=30) and 21-mm mechanical (M21) valve group (n=24). The perioperative and early-term hemodynamic data were collected and analyzed. Results: A significant difference in terms of maximum transaortic flow velocity (Vav max), maximum transaortic pressure gradient (PGav max), left ventricular mass index (LVMi) and left ventricular mass (LVM) was observed postoperatively in both groups. The postoperative left ventricular ejection fraction (LVEF) was significantly higher while the LVM and LVMi was evidently decreased in the SJMR19 group, compared with the M21 group. In order to confirm the influencing factors on postoperative LVEF, a multiple linear regression analysis model was established by including all candidate variables and the implanted valve type was identified in the multivariate analysis as an independent predictor for postoperative LVEF. Conclusions: The postoperative cardiac function and hemodynamic parameters was improved both in the SJMR19 and M21 groups. The postoperative LVEF, LVM and LVMi were better in the SJMR19 group compared with those of the M21 group. And the implanted valve type might possess the predictive value of postoperative LVEF in patients with small aortic annulus undergoing DVR.

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A comparative study of surgical treatment of small aortic root with or without aortic root enlargement using a single prosthesis type

Abstract: ARE procedures are invaluable techniques in surgical management of small aortic root patients and can be used without significantly increasing early morbidity and mortality, particularly in those cases in which AVR with a small prosthesis will lead to severe PPM.

Cited by 9 publications

References 24 publications

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

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

Early and mid-term outcomes of aortic annular enlargement: a systematic review and meta-analysis

Early-Term Hemodynamic Performance And Clinical Results of 19-mm st. Jude Medical Regent Valve In Patients With Small Aortic Annulus Undergoing Dual Valve Replacement: A Retrospective Study

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