Faculty Collaboration Database

Aortic root enlargement in octogenarian patients results in less patient prosthesis mismatch. Ann Thorac Surg 2014 May;97(5):1533-8

Date

03/25/2014

Pubmed ID

24655468

DOI

10.1016/j.athoracsur.2013.11.050

Scopus ID

2-s2.0-84899993825 (requires institutional sign-in at Scopus site)   27 Citations

Abstract

BACKGROUND: Aortic root enlargement has not been well studied as a modality to prevent patient prosthesis mismatch in octogenarian patients with a small aortic root.

METHODS: We reviewed the records of 117 octogenarian patients who received surgical aortic valve replacement (AVR) between 1993 and 2010. From this group, 87 patients received a 19-mm AVR (small aortic valve, SAV group) and 30 received an aortic root enlargement and a 21-mm AVR (aortic root enlargement, ARE group).

RESULTS: The median age of the patients was 84 years (range, 80 to 93) and there were 111 women (95%). Aortic cross-clamp time was 50 minutes (26 to 116) in the SAV group and 67 (26 to 136) in the ARE group (p=0.02). There were no differences in the operative morbidity or morality rates between the groups. Postoperative aortic valve area index was 0.77 cm2/m2 (0.25 to 1.47) in the SAV group and 1.06 (0.51 to 1.94) in the ARE group (p<0.001). Severe patient prosthesis mismatch occurred in 23 patients (32%) in the SAV group in comparison with 3 (12%) in the ARE group (p=0.04). There were no differences in the mid-term outcomes of New York Heart Association functional class (p=0.230) or survival between patients with or without mismatch (p=0.84).

CONCLUSIONS: Aortic root enlargement in octogenarian patients allows for insertion of larger aortic valve prostheses without any apparent increase in operative morbidity or mortality. The larger prostheses demonstrate better hemodynamic performance and less patient prosthesis mismatch, but no apparent functional or survival advantage.

Author List

Penaranda JG, Greason KL, Pislaru SV, Schaff HV, Daly RC, Park SJ, Suri RM, Burkhart HM, Joyce LD, Stulak JM, Dearani JA

MESH terms used to index this publication - Major topics in bold

Aged, 80 and over
Aortic Valve
Cohort Studies
Databases, Factual
Female
Follow-Up Studies
Geriatric Assessment
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Humans
Male
Prosthesis Design
Prosthesis Fitting
Retrospective Studies
Risk Factors
Survival Analysis
Tissue Expansion
Treatment Outcome
Vulnerable Populations