Aortic Root Enlargement Is Safe and Reduces the Incidence of Patient-Prosthesis Mismatch: A Meta-analysis of Early and Late Outcomes

Yu, Wanqing; Tam, Derrick Y.; Rocha, Rodolfo V.; Makhdoum, Ahmad; Ouzounian, Maral; Fremes, Stephen E.

doi:10.1016/j.cjca.2019.02.004

Cited by 43 publications

(45 citation statements)

References 28 publications

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“…One of the studies included in this meta‐analysis proved that perioperative death was only associated with New York Heart Association functional class, congestive heart failure, and implantation of a smaller valve; ARE alone did not increase the risk 30 . 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: 79%

“…Moreover, the difference in the indexed effective orifice area (iEOA) between the groups was 0.066 cm 2 /m 2 higher in the “AVR with ARE” group (95% CI, 0.029–0.103, p < .001) on average 29 . Yu et al 31 supports these findings, adding that the incidence of severe PPM (iEOA < 0.65 cm 2 /m 2 ) is further reduced by ARE than moderate PPM (iEOA < 0.85 cm 2 /m 2 ) 31 . These statistics indicate that ARE generally achieves its goal of enabling the installation of more efficient prostheses that reduce the risk of PPM.…”

Section: To Enlarge or Not To Enlargementioning

confidence: 95%

“…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%

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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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Section: To Enlarge or Not To Enlargementioning

confidence: 79%

Section: To Enlarge or Not To Enlargementioning

confidence: 95%

Section: To Enlarge or Not To Enlargementioning

confidence: 96%

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Aortic root enlargement: When and how

et al. 2020

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“…A recent meta-analysis revealed that the incidence of PPM was lower in SAVR with ARE than conventional SAVR. 14 Unlike other randomized controlled studies, the Placement of Aortic Transcatheter Valves (PARTNER) 3 trial showed similar hemodynamic performance after SAVR and TAVR, 15 probably because larger surgical valves were implanted compared with other trials. Importantly, ARE was used in 4.6% of SAVR patients in the PARTNER 3 trial, which is higher than the ARE rate (3.2%) in the Society of Thoracic Surgeons database.…”

mentioning

confidence: 96%

“…2 Although SAVR with ARE has been reported to have longer cardiopulmonary bypass and aortic cross-clamp times than simple SAVR, the rates of reoperation for bleeding and early mortality were reportedly be similar. 14 The potential beneficial effect of ARE on future valve-invalve TAVR is another important point. A larger transcatheter valve can be implanted after SAVR with ARE, and the risk of coronary obstruction at the time of valvein-valve TAVR should be lower because ARE enlarges not only the annulus, but also the sinus of Valsalva and…”

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confidence: 99%

What Is the Best Treatment for Severe Aortic Stenosis Patients With Small Aortic Annulus?

Ito¹,

Tabata

2021

Circ J

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Transcatheter aortic valve implantation in patients with a small aortic annulus: performance of supra-, intra- and infra-annular transcatheter heart valves

et al. 2021

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Background A small aortic annulus is associated with increased risk of prosthesis–patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI). Whether specific transcatheter heart valve (THV) designs yield superior hemodynamic performance in these small anatomies remains unclear. Methods Data from 8411 consecutive patients treated with TAVI from May 2012 to April 2019 at four German centers were retrospectively evaluated. A small aortic annulus was defined as multidetector computed tomography-derived annulus area < 400 mm2. TAVI was performed with a balloon-expanding intra-annular (Sapien-3, n = 288), self-expanding intra-annular (Portico, n = 110), self-expanding supra-annular (Evolut, n = 179 and Acurate-Neo, n = 428) and mechanically expanding infra-annular (Lotus, n = 64) THV according to local practice. PPM was defined as indexed effective orifice area ≤ 0.85cm2/m2. Results A small annulus was found in 1069 (12.7%) patients. PPM was detected in 38.3% overall with a higher prevalence after implantation of a balloon-expanding intra-annular or mechanically expanding infra-annular THV compared to self-expanding intra- and supra-annular THV. Multivariable analysis linked self-expanding THV (Evolut: Odds ratio [OR] 0.341, Acurate-Neo: OR 0.436, Portico: OR 0.291), postdilatation (OR 0.648) and age (OR 0.968) to lower rates of PPM, while aortic valve calcification was associated with an increased risk (OR 1.001). Paravalvular regurgitation > mild was more frequent after TAVI with self-expanding THV (p = 0.04). Conclusion In this large contemporary multicenter patient population, a substantial number of patients with a small aortic anatomy were left with PPM after TAVI. Self-expanding supra- and intra-annular THV demonstrated superior hemodynamics in these patients at risk, however at the cost of higher rates of residual paravalvular regurgitation. Graphic abstract

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Aortic Root Enlargement Is Safe and Reduces the Incidence of Patient-Prosthesis Mismatch: A Meta-analysis of Early and Late Outcomes

Cited by 43 publications

References 28 publications

Aortic root enlargement: When and how

Aortic root enlargement: When and how

What Is the Best Treatment for Severe Aortic Stenosis Patients With Small Aortic Annulus?

Transcatheter aortic valve implantation in patients with a small aortic annulus: performance of supra-, intra- and infra-annular transcatheter heart valves

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