Technique for Adaptation of Konno Aortoventriculoplasty in Patient-Prosthesis Mismatch

2021 ◽  
Author(s):  
Kerem M. Vural ◽  
Timucin Sabuncu
Keyword(s):  
Aortic Valve ◽  
Surgical Technique ◽  
Aortic Valve Replacement ◽  
Adult Patient ◽  
Valve Replacement ◽  
Aortic Root ◽  
Adverse Outcome ◽  
Efficient Treatment ◽  
Patient Prosthesis Mismatch ◽  
Aortic Root Enlargement

AbstractThe patient-prosthesis mismatch has been reported as an important cause of adverse outcome following aortic valve replacement. The relief of patient-prosthesis mismatch generally requires a reoperation of comprehensive nature, which necessitates an extensive aortic root enlargement. The Konno aortoventriculoplasty represents an efficient treatment option, as this technique provides both extreme root enlargement and relief of the frequently associated subvalvular obstruction. However, the application and conduct of the procedure may somewhat differ from the pediatric Konno procedures.This article describes our surgical technique adaptation in Konno-aortoventriculoplasty for adult patient-prosthesis mismatch cases, highlighting the differing points from the pediatric-Konno.

Aortic root enlargement to mitigate patient–prosthesis mismatch: do early adverse events justify reluctance?†

2019 ◽  
Vol 56 (2) ◽  
pp. 335-342 ◽  
Author(s):  
Josephina Haunschild ◽  
Sven Scharnowski ◽  
Meinhard Mende ◽  
Konstantin von Aspern ◽  
Martin Misfeld ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Early Mortality ◽  
Surgical Aortic Valve Replacement ◽  
Patient Prosthesis Mismatch ◽  
The Mean ◽  
Aortic Root Enlargement

Abstract OBJECTIVES Concomitant aortic root enlargement (ARE) at the time of surgical aortic valve replacement can be performed to avoid patient–prosthesis mismatch, an important predictor of adverse long-term outcome. METHODS We performed a single-centre, retrospective analysis of 4120 patients receiving isolated aortic valve replacement, of whom 171 (4%) had concomitant ARE between January 2005 and December 2015. The analysis of postoperative outcome and early mortality was performed. Owing to inequality of the groups, patients were matched 1:1. RESULTS The mean age of all 4120 patients was 68.8 ± 10.5 years, and comorbidities were equally balanced after matching. The mean aortic cross-clamp time, cardiopulmonary bypass time and total operative time were prolonged by 19, 20 and 27 min in the ARE group, respectively. Early mortality was not statistically significantly different with 1.4% in the surgical aortic valve replacement and 1.8% in the ARE group. Postoperative complications were <5% in all matched 338 patients: bleeding (3% vs 3%), pericardial effusion (3.0% vs 4.2%), sternal instability (1.8% vs 0%) and sternal wound infection (3.0% vs 1.2%). A significant higher number of patients had respiratory failure after ARE (unmatched: 17.1% vs 9.9%, P < 0.001; matched: 18.3% vs 9.5%, P = 0.028). Factors independently associated with overall mortality were age [hazard ratio (HR) 1.71], chronic obstructive pulmonary disease (HR 1.47), diabetes (HR 1.82), atrial fibrillation (HR 2.14) and postoperative respiratory failure (HR 2.84). CONCLUSIONS ARE can be performed safely in experienced centres with no significant increase in the risk of early postoperative surgical complications and early mortality. However, the surgeon and the intensive care unit team should be aware of an increased risk for postoperative respiratory failure in ARE patients.

scholarly journals Tanned xenograft pericardium for aortic root enlargement during aortic valve replacement

1991 ◽  
Vol 17 (2) ◽  
pp. A361
Author(s):  
Donato Sisto ◽  
Sylvia Fernandes ◽  
Antonio Palma ◽  
Michele Nanna ◽  
Robert Frater
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Aortic Root Enlargement

scholarly journals Aortic Root Enlargement during Aortic Valve Replacement in Adults

2021 ◽  
pp. 56-62
Author(s):  
Miroslav M. Furman ◽  
Sergey V. Varbanets ◽  
Oleksandr M. Dovgan
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Severe Aortic Stenosis ◽  
Aortic Root Replacement ◽  
Safe Procedure ◽  
Aortic Pathology ◽  
Aortic Root Enlargement

Aortic valve replacement is a gold standard in the treatment of patients with severe aortic stenosis or combined aortic pathology. However, aortic valve pathology is often associated with a narrow aortic orifice, particularly in patients with severe aortic stenosis. In 1978, Rahimtoola first described the term of prosthesis-patient mismatch. He noted that effective orifice area of the prosthesis is smaller than that of the native valve. To minimize this complication, there are several surgical strategies: aortic root enlargement (ARE), implantation of a frameless biological prosthesis in the native position, neocuspidalization procedure, Ross procedure, aortic root replacement with xenograft or homograft. ARE is an excellent option, however, some authors outline additional perioperative risks. The aim. To analyze immediate results of ARE during isolated aortic valve replacement and in cases when it is combined with other heart pathologies. Materials and methods. Our study included 63 patients who underwent ARE. Isolated aortic valve replacement was performed in the majority of cases, but often aortic root replacement procedure was combined with coronary artery bypass grafting. Results and discussion. One of 63 patients died (hospital mortality 1.6%) at an early hospital stage (30 postoperative days). Measurement of the aortic valve ring was performed by two methods, through preoperative echocardiography and perioperative measurement using a valve sizer. However, perioperative dimension was chosen as the basis for the calculations. In 62 patients, the perioperative diameter of the aortic valve ring ranged from 19 to 23 mm, only one patient had a diameter of 24 mm. According to our findings, ARE enabled to achieve an average aortic ring size increase of 2.68 cm2 (from 1.5 to 3.4 cm2) and to prevent prosthesis-patient mismatch in 42 (66.7%) cases. Conclusions. Prosthesis-patient mismatch is considered a serious complication in the postoperative period. Narrow aortic root is a common pathology that should be considered during surgery. ARE is a safe procedure and is not associated with an increased risk of mortality and complications.

scholarly journals Konno-rastan procedure combined with manougian root enlargement for small aortic root

2020 ◽  
Vol 4 (4) ◽  
pp. 18-21
Author(s):  
Metin Onur Beyaz ◽  
◽  
Nur Gizem Elipek ◽  
Ibrahim Demir ◽  
Didem Melis Oztas ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Valve Replacement ◽  
Aortic Root ◽  
Interventional Procedures ◽  
Pediatric Population ◽  
Patient Prosthesis Mismatch ◽  
Small Aortic Root ◽  
Aortic Root Enlargement

Aortic stenosis is a rarely seen condition in the pediatric population. Valve replacement is a treatment option for patients who do not benefit from medical or interventional procedures. In this report, we described our surgical treatment strategy in a 17-year-old patient who developed patient-prosthesis mismatch long after initial aortic valve replacement during the childhood period. Keywords: Konno-rastan procedure; manouguian technique; aortic root enlargement

scholarly journals Aortic Root Enlargement or Sutureless Valve Implantation?

2016 ◽  
Vol 4 (4) ◽  
pp. 742-743 ◽  
Author(s):  
Nikolaos G. Baikoussis ◽  
Panagiotis Dedeilias ◽  
Michalis Argiriou
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Negative Impact ◽  
Term Survival ◽  
Old Patients ◽  
Sutureless Valve ◽  
Aortic Root Enlargement ◽  
Valve Implantation

Aortic valve replacement (AVR) in patients with a small aortic annulus is a challenging issue. The importance of prosthesis–patient mismatch (PPM) post aortic valve replacement (AVR) is controversial but has to be avoided. Many studies support the fact that PPM has a negative impact on short and long term survival. In order to avoid PPM, aortic root enlargement may be performed. Alternatively and keeping in mind that often some comorbidities are present in old patients with small aortic root, the Perceval S suturelles valve implantation could be a perfect solution. The Perceval sutureless bioprosthesis provides reasonable hemodynamic performance avoiding the PPM and providing the maximum of aortic orifice area. We would like to see in the near future the role of the aortic root enlargement techniques in the era of surgical implantation of the sutureless valve (SAVR) and the transcatheter valve implantation (TAVI).

scholarly journals Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients

2019 ◽  
Vol 29 (1) ◽  
pp. 74-82 ◽  
Author(s):  
Michel Pompeu Barros Oliveira Sá ◽  
Martinha Milliany Barros Carvalho ◽  
Dário Celestino Sobral Filho ◽  
Luiz Rafael Pereira Cavalcanti ◽  
Roberto Gouvea Silva Diniz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Meta Analysis ◽  
Aortic Root Enlargement
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