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Annulus root enlargement during redo aortic valve replacement: Perioperative results and hemodynamic impact
Author(s) -
Chauvette Vincent,
Sénéchal Mario,
Barrette Vincent,
Dagenais François,
Mohammadi Siamak,
Kalavrouziotis Dimitri,
Voisine Pierre
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14726
Subject(s) - medicine , perioperative , aortic valve replacement , ejection fraction , cardiology , mace , cardiac skeleton , hemodynamics , ventricle , concomitant , context (archaeology) , ventricular outflow tract , surgery , myocardial infarction , heart failure , stenosis , percutaneous coronary intervention , biology , paleontology
Objectives Redo aortic valve replacement (AVR) might present an increased risk for predicted patient‐prosthesis mismatch (PPM). Aortic root enlargement (ARE) procedures can decrease PPM and improve hemodynamic parameters. It is crucial to evaluate the safety of ARE in the context of redo AVR to allow better patient selection. Methods This is a matched case‐control study of 125 patients who underwent a redo AVR between 1991 and 2016, 21 patients had a concomitant ARE procedure. Patients were matched for age, gender, presence of coronary artery disease, renal clearance, left ventricular ejection fraction, and body mass index. The primary outcome was the occurrence of major adverse cardiovascular events (MACE). Secondary outcomes were postoperative impact of the ARE procedures on echocardiographic measurements and survival. Results Preoperatively, indexed aortic valve area (0.49 vs 0.66 cm 2 /m 2 ; P = .02) and left ventricle outflow tract diameters (20.1 vs 22.2 mm; P < .01) were significantly smaller in the ARE group. ARE procedures increased the aortic valve area by an average of 0.4 cm 2 (pre = 0.9, post = 1.3; P < .01), with a reduction of maximum and mean transvalvular gradients of 26.6 mm Hg (pre = 56.8, post = 30.2; P < .01) and 17.1 mm Hg (pre = 31.9, post = 14.8; P < .01), respectively. Postoperatively, the occurrence of MACE was similar (ARE = 19%, no ARE = 14%; P = .68). Survival rates were similar ( P = .29). Conclusions For patients undergoing redo AVR, ARE is not associated with higher perioperative mortality and morbidity when compared with patients undergoing AVR without ARE. The fear of perioperative complications potentially associated with ARE should not be a prohibiting factor in symptomatic redo patients with small aortic annulus and predicted PPM.