Aortic Root Enlargement in patients with small aortic annulus undergoing
double valve replacement. A retrospective Comparative cohort study.
Background: Small Aortic Annulus (AA) is big issue during Aortic Valve
Replacement (AVR) necessitating replacement of an undersized prosthetic
valve especially with Double Valve Replacement (DVR). Despite that small
aortic valve prostheses can lead to Prosthesis-Patient Mismatch (PPM),
there remains reluctance to perform aortic root enlargement (ARE)
procedures fearing from morbidity and mortality. Objective: To evaluate
clinical and echocardiographic outcomes in patients with small aortic
annulus undergoing double valve replacement. Methods: The study included
100 consecutive patients underwent DVR for combined rheumatic aortic and
mitral valve diseases, between Jan. 2016 and Sept. 2020. Only (50)
patients had ARE with DVR. ARE was performed using an autologous or
bovine pericardium or Dacron patch by Nicks or Manouguian procedures.
The estimated postoperative end-points were mortality, effective orifice
areas (EOA), mean aortic pressure gradient and valve-related
complications. The least postoperative follow-up period was 6 months.
Results: The study included 30 male and 70 female patients with mean age
of 35±20 years, body surface area (BSA) of 1.7 ±0.3 m2, aortic annulus
diameter was 20±1.4 mm, aortic orifice area was 0.8±0.1 cm2, and mean
pressure gradient 85±2.5 mmHg. During follow-up period, there was a mild
to moderate paravalvular leak (1%) with, (1%) heart block, and
residual gradient on prosthetic aortic valve; that was all in DVR alone.
Conclusion: Enlargement of aortic root by Nicks or Manouguian technique
is safe and effective in patients with small aortic annulus undergoing
double valve replacements.