Aortic Valve Replacement With 17-mm St. Jude Medical Prostheses for a Small Aortic Root in Elderly Patients

Aim. The study was designed to comparatively assess dynamic changes of the aortic root structures depending on a phase of the cardiac cycle in patients with degenerative aortic stenosis, who underwent aortic valve replacement with different types of biological prostheses. Methods. This prospective parallel controlled randomized trial study was performed at Meshalkin National Medical Research Center over a period from 2011 to 2015. The inclusion criteria were severe aortic stenosis and patients’ age older than 65 years. 114 patients were randomized 1:1 in two groups: group I included 57 patients with stentless biological prostheses, while group II (control one) consisted of 57 patients with stented xenopericardial prostheses. The average age was 71 [66; 74] and 72 [69; 77] for the first and second groups, respectively (p = 0.054). All patients underwent aortic valve replacement. The operation was performed under standard normothermic cardiopulmonary bypass. The diameter of the implanted prostheses was 25 mm [24; 26] and 23 mm [21; 23] for the first and second groups, respectively (p = 0.375). An ECG-synchronized CT study of the aortic root was carried out in the postoperative period. Results. An intergroup systolic/diastolic difference in the values of the cross-sectional area of the aortic root at all levels was observed in patients with stentless bioprostheses, while the control group patients (with stented bioprostheses) had no such difference at the levels of the left ventricle output tract and the fibrous ring of the aortic valve. Conclusion. A stentless design of bioprostheses retains the deformational and elastic properties of the aortic root in elderly patients with aortic valve stenosis after surgical treatment.Received 5 December 2017. Revised 12 December 2017. Accepted 15 December 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributions Conception and study design: D.P. Demidov, D.A. Astapov, A.V. Bogachev-Prokophiev Data collection and analysis: D.P. Demidov Drafting the article: D.P. Demidov Critical revision of the article: D.A. Astapov, A.V. Bogachev-Prokophiev Final approval of the version to be published: D.A. Astapov, A.V. Bogachev-Prokophiev, S.I. Zheleznev, A.M. Karaskov

Download Full-text

Management of Small Aortic Root during Aortic Valve Replacement

The Egyptian Cardiothoracic Surgeon ◽

10.35810/ects.v2i1.100 ◽

2020 ◽

Vol 2 (1) ◽

pp. 1-7

Author(s):

Ahmed Nabil Malek ◽

Mohamed A.K. Salama Ayyad ◽

Hussein Elkhayat ◽

Ahmed El-Minshawy

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Aortic Root ◽

Aortic Annulus ◽

Early Results ◽

Significant Difference ◽

Small Aortic Root ◽

Group A ◽

Aortic Root Enlargement

Background: Concomitant aortic root enlargement (ARE) increases the risk of aortic valve replacement (AVR). The objectives of this study were to identify the patients who needed aortic root enlargement and compare the outcomes and the risk of adding ARE to AVR. Methods: We retrospectively reviewed 62 patients who underwent isolated mechanical aortic valve replacement between 2017 and 2019. We divided the patients into two groups: group A included patients with small aortic root who had AVR with one of the different surgical strategies for small aortic annulus (n= 32) and group B, which included patients with a normal aortic annulus and underwent conventional AVR (n= 30). Group A was further sub-divided based on the surgical strategy into 4 categories; patients who had supra-annular implantation of size 19 mm St. Jude prosthetic valve (n= 11; 34.4%), Nicks procedure (n= 13 40.6%), Manougian procedure (n= 4; 12.5%), Konno procedure (n= 4; 12.5%). Results: Group A patients were significantly younger (26.16 ± 11.49 vs. 34.63 ± 8.9 years; p< 0.001) and had lower body weight (55.09 ± 21.41 vs. 69.80 ± 19.20; p= 0.01). Group A had significantly smaller valves (p = 0.03), and total cardiopulmonary bypass (148.65 ± 44.09 vs. 97.46 ± 20.90 minutes; p<0.001) and aortic cross-clamp times (118.13 ± 36.70 vs. 78.06 ± 16.01 minutes; p < 0.001) were significantly longer in group A. There was no significant difference in operative complications between groups. Among patients with small aortic root; Konno procedure had the longest bypass time (236.3 ± 19.70 minutes; p<0.001); cross-clamp time (192.5 ± 22.2 minutes; p <0.001); mechanical ventilation (4.75 ± 0.50 hours; p<0.001) and intensive care unit stay (6.50 ± 0.57 days; p <0.001). Patients with supra-annular implantation of the St. Jude valve had a significantly higher postoperative pressure gradient (14.64 ± 6.84 mmHg; p= 0.02). No difference in procedure complications was observed among aortic root enlargement procedures. Conclusion: Patients who had aortic root enlargement procedure were younger, with lower weight and body surface area. Surgical procedures used to manage small aortic root had comparable early results, and no technique was superior to the others.

Download Full-text

Aortic Valve Replacement in the Calcified Small Aortic Root by Hemitranslocation of the Valve

Artificial Organs ◽

10.1046/j.1525-1594.2002.06982.x ◽

2002 ◽

Vol 26 (5) ◽

pp. 483-486

Author(s):

Masahiro Endo ◽

Hiroshi Nishida ◽

Genta Chikazawa ◽

Yasuko Tomizawa

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Aortic Root ◽

Small Aortic Root

Download Full-text

Up to thirty-year survival after aortic valve replacement in the small aortic root

The Annals of Thoracic Surgery ◽

10.1016/0003-4975(95)00075-v ◽

1995 ◽

Vol 59 (5) ◽

pp. 1056-1062 ◽

Cited By ~ 72

Author(s):

Guo-Wei He ◽

Gary L. Grunkemeier ◽

Hugh L. Gately ◽

Anthony P. Furnary ◽

Albert Starr

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Aortic Root ◽

Small Aortic Root

Download Full-text

Hemodynamic and clinical evaluation of the Hancock xenograft bioprosthesis for aortic valve replacement (with emphasis on management of the small aortic root)

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(19)41304-4 ◽

1978 ◽

Vol 75 (2) ◽

pp. 300-308 ◽

Cited By ~ 57

Author(s):

Ellis L. Jones ◽

Joseph M. Craver ◽

Douglas C. Morris ◽

Spencer B. King ◽

John S. Douglas ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Clinical Evaluation ◽

Aortic Root ◽

Small Aortic Root

Download Full-text

Long-Term Results of Pericardial Autologous Patch Enlargement of the Aortic Annulus Using the Manouguian Technique

The Heart Surgery Forum ◽

10.1532/hsf.1258 ◽

2016 ◽

Vol 19 (2) ◽

pp. 067 ◽

Cited By ~ 1

Author(s):

Orhan Saïm Demïrtürk ◽

H.Tarik Kiziltan ◽

İsa Coşkun ◽

Hüseyin Ali Tünel ◽

Hatice Göknur Tekin

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Aortic Root ◽

Long Term Results ◽

Late Mortality ◽

Autologous Pericardial Patch ◽

Small Aortic Root

Background: The management of a small aortic root at the time of aortic valve replacement is controversial. In cases in which the aortic root is very small the choice of aortic valve type and of root-enlargement method is difficult. The technical challenge of the small aortic root has instigated the creation of methods for annular enlargement. Severe mismatch as a predictor of overall 30-day mortality or midterm mortality reports about long-term results of aortic valve replacement using autologous pericardial patch are scarce. Moreover, no reports about patient series are present in the English medical literature. This retrospective study was designed to address this gap in evidence. Methods: Twenty consecutive patients undergoing aortic valve replacement (with or without mitral valve replacement and/or coronary artery bypass grafting) at Başkent University Adana Medical Center between June 30, 1999 and April 10, 2006 were retrospectively evaluated. All clinical and echocardiographical data belonging to this population were specified. Their perioperational data were assessed. Results: Twenty patients operated using the Manouguian technique for narrow aortic root from June 1999 to April 2006 were followed for 8.54 ± 3.35 years. Fourteen patients were alive at the end of the follow-up. Six patients had died. Early mortality rate was 5% and late mortality after 8.54 ± 3.35 years was 30%. Late mortality related to cardiac reasons was 5%. Only one death could be attributed to a cardiac cause which occured in a 36-year-old male patient 3 years and 6 months after the operation. 70% of the patients were alive after a mean follow-up period of 8.54 ± 3.35 years. Conclusion: The main finding of the present study is that aortic root enlargement using untreated fresh autologous pericardium in Manouguian type operations is a durable option, especially in conditions when homograft or stentless valve use is difficult or economically not feasible. We found that no patient had aneurysmal dilatation or mitral regurgitation after a mean follow-up of 8.54 ± 3.35 years with autologous untreated pericardium as the enlargement patch.

Download Full-text