Aortic root enlargement in patients undergoing double valve replacement for rheumatic etiology–preliminary results

Abstract

Introduction Combined aortic and mitral valve disease is usually of rheumatic origin. In these patients we often encounter problem of small valve annuli particularly with aortic annulus. It is still debated whether a small prosthesis should be used or aortic root should be enlarged to prevent Patient Prosthesis Mismatch (PPM). This study was undertaken to review our strategy and feasibility of Aortic Root Enlargement (ARE) in patient undergo Double Valve Replacement (DVR) to avoid mismatch without increase in cost of treatment, morbidity or mortality. Materials and methods We reviewed 11 patients who underwent double valve replacement along with aortic root enlargement between January 2010 and December 2010. Patients at high risk for PPM and whose aortic annulus did not admit minimum of 19 mm aortic valve were selected for aortic root enlargement. Operative procedure involved extension of aortotomy incision between left and non coronary cusp without entering left atrium and reconstructing the defect with autologous Pericardium and implanting appropriate size valve to avoid or decrease PPM Results There were no operative or in hospital mortality. Mean age of patients was 33.83 years (range 12-50).Average body surface area was 1.37 m2 (range 1.1-1.65). Most patients underwent root enlargement for stenotic lesion. Mean cardiopulmonary bypass time was 179 min (range 150-238 min). And mean cross clamp time was 120 min (range 91-155 min). With root enlargement one size bigger valve was replaced in 10 patients and PPM was eliminated in 6 patients while in 5 patient PPM was reduced to moderate level. Other variables like inotropic requirement, duration of ventilation, blood product used and Intensive Care Unit (ICU) stay were comparable to a routine double valve replacement without root enlargement. Conclusions Aortic root enlargement can be safely done even in patients undergoing concomitant aortic and mitral valve replacement. With ARE patients benefit bigger size prosthesis without additional mortality and morbidity.

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

“…Most of the patients also have tricuspid valve disease, atrial fibrillation, and severe LV dysfunction that add risk factors on hemodynamics if ARE is not performed. So, there still is debate as to whether small prosthesis implants or ARE avoid increasing morbidity or mortality [Muppiri 2011]. In our study, preoperative risk factors were not obstacles to perform ARE, however, these factors may be worse with PPM.…”

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

“…So, there is still debated whether implant small prosthesis or ARE to avoid increasing morbidity or mortality. [9] . In our study, preoperative risk factors were not obstacles to do ARE, however, these factors may be worse with PPM.…”