Original article: cardiovascularRoutine enlargement of the small aortic root: a preventive strategy to minimize mismatch
Section snippets
Patient population
We examined the clinical records of 852 consecutive adult patients in whom we performed aortic valve procedures (isolated and combined) from January 1, 1995, through June 30, 2001, at a single institution. Of this group, 195 patients underwent stentless aortic valve replacement or aortic root reconstruction for a variety of indications, and will not be considered further. The remaining 657 patients underwent stented aortic valve replacement either with (all ARE, 114 patients, 17%) or without
Results
The distribution of labeled valve sizes is demonstrated graphically in Figure 2 and summarized in Table 3. The mean labeled aortic valve size was 23.9 ± 2.2 in all AVR patients and 23.2 ± 1.7 in all ARE patients. The median labeled size in both groups was 23 mm. A prosthesis labeled 23 mm or larger was used in 75% of the all ARE patients. A valve size labeled 19 was implanted in 1 (0.9%) ARE patient. This was a unique case requiring enlargement of a “nickel-sized” annulus in an adult to
Comment
This review demonstrates that stented aortic valve replacement can be performed without causing prosthesis-patient mismatch in the vast majority (>97%) of patients who undergo operation. It also demonstrates that aortic root enlargement by the method described adds about 20 minutes of aortic clamp time, but adds no increase in morbidity or early mortality. In fact, we have long considered this technique a simple way to add value to aortic valve replacement and an alternate method of closing the
Acknowledgements
We acknowledge the assistance and expertise of Peter Dolan, who provided us with the anatomical illustrations.
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