Early and Late Outcomes of Aortic Valve Replacement with Aortic Annular Enlargement: A Propensity Analysis

Abstract

Objectives Early and late outcomes were evaluated in Japanese patients undergoing aortic valve replacement (AVR) with or without aortic annular enlargement (AAE). Propensity matching adjusted for baseline differences in this study. Methods Between January 2001 and July 2014, 589 patients underwent AVR for aortic stenosis. Of these, 58 patients received AVR with AAE (AAE group), and the others received standard AVR without annular enlargement (sAVR group). Of these 589 patients, 116 patients were selected using propensity score matching analysis. We compared early and late outcomes between the two groups. Results Compared with the sAVR group, cardiopulmonary bypass time (177 ± 42 vs. 157 ± 39 minutes) and aortic cross-clamp time (126 ± 32 vs. 110 ± 34 minutes) were significantly longer in the AAE group. However, there were no significant differences between the AAE group and the sAVR group in 30-day mortality (1.7 vs. 3.4%) and in-hospital mortality (1.7 vs. 3.4%). There was no severe patient-prosthesis mismatch after AVR in the AAE group. The overall survival rate and freedom from cardiac events in the AAE group and in the sAVR group at 10 years were 92.4 versus 75.9% (p = 0.477) and 89.5 versus 82.8% (p = 0.076), respectively. No differences were found between the two groups. Conclusions AAE was performed safely in Japanese patients with small aortic annulus. Surgical outcomes of the AAE group were not inferior to those of sAVR. Using this technique, which did not require advanced skills, it was easy to avoid severe patient-prosthesis mismatch.

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

“…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).…”

Comparison of the short-term outcomes between Y-incision aortic annular enlargement and traditional aortic annular enlargement techniques

“…Our study is the first to directly compare the shortterm outcomes of AAE between the established operative techniques, Nicks and Manouguian, and the newlyintroduced Y-incision technique. The Nicks and Manouguian techniques have seen widespread utilization since they were developed in the 1970s, and there have been numerous studies which evaluated their safety profiles in comparison with AVR without annular enlargement (19)(20)(21)(22)(23)(24). By contrast, the Y-incision technique has only been used since August 2020, and has not yet had widespread use.…”

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

“…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.…”

“…All 15 included studies are observational and nonrandomized (12,20,21,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44). Of the included studies, five compared propensity-matched groups (34,36,38,41,43), two employed case-control designs to define their reference SAVR groups (34,42), and four reported adjusted midterm outcomes of interest (21,37,43,44).…”

“…All 15 included studies are observational and nonrandomized (12,20,21,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44). Of the included studies, five compared propensity-matched groups (34,36,38,41,43), two employed case-control designs to define their reference SAVR groups (34,42), and four reported adjusted midterm outcomes of interest (21,37,43,44). Notably, Tam and colleagues described two distinct cohorts of patients within the same study-patients who underwent isolated SAVR with or without AAE, and patients who underwent SAVR combined with coronary artery bypass grafting (CABG) with or without AAE (43).…”