Document Detail


A comparative study of surgical treatment of small aortic root with or without aortic root enlargement using a single prosthesis type.
MedLine Citation:
PMID:  20739902     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The ideal management of aortic stenosis in patients with a small aortic root remains controversial. Reports of adverse effects of patient-prosthesis mismatch (PPM) from a small-sized valve have to be weighed against the increased morbidity and mortality of aortic root enlargement procedures.
METHODS: The present study retrospectively reviewed and compared clinical data of patients with predominant aortic stenosis with small aortic root (n = 209) who underwent isolated aortic valve replacement without (AVR group, n = 162) or with aortic root enlargement (AVR + ARE group, n = 47) using a single prosthesis type between January 2002 and June 2008 to assess their effect on perioperative outcomes.
RESULTS: The in-hospital mortality (4.28% in AVR + ARE vs. 3.08% in AVR group) and other perioperative outcomes were similar in both the groups. Although patients of the AVR + ARE group had a greater degree of left-ventricular (LV) mass regression (-41.3 ± 32.1 vs. -21.5 ± 37.4) in the follow-up period at 12 months, there was no significant difference in functional outcome. Patients with severe postoperative PPM (indexed effective orifice area ≤0.65 cm²/m² body surface area) showed increased perioperative mortality (9.52 vs. 1.85%) and less regression of LV mass (-13.2.8 ± 27.1 vs. -27.6 ± 31.9), higher transvalvular gradient and were more symptomatic at 12-month follow-up (New York Heart Association class 1.44 ± 0.41 vs. 1.22 ± 0.28) compared to those who were having only mild to moderate PPM (indexed effective orifice area > 0.65).
CONCLUSION: ARE procedures are invaluable techniques in surgical management of small aortic root patients and can be used without significantly increasing early morbidity and mortality, particularly in those cases in which AVR with a small prosthesis will lead to severe PPM.
Authors:
Shashi Prakash; Saket Agarwal; Nilanjan Dutta; Deepak K Satsangi
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of cardiovascular medicine (Hagerstown, Md.)     Volume:  11     ISSN:  1558-2035     ISO Abbreviation:  J Cardiovasc Med (Hagerstown)     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-09-30     Completed Date:  2011-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101259752     Medline TA:  J Cardiovasc Med (Hagerstown)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  836-42     Citation Subset:  IM    
Affiliation:
Department of Cardio-thoracic and Vascular Surgery, G.B. Pant Hospital, New Delhi, India.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aortic Valve Stenosis / mortality,  physiopathology,  surgery*,  ultrasonography
Chi-Square Distribution
Echocardiography, Doppler
Female
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / adverse effects,  instrumentation*,  mortality
Heart Ventricles / physiopathology,  ultrasonography
Hospital Mortality
Humans
India
Male
Middle Aged
Prosthesis Design
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Ventricular Function, Left

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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