Aortic valve replacement in small aortic annulus with or without annular enlargement.
OBJECTIVE
Surgical treatments for aortic valve disease in the presence of a small aortic annulus need appropriate indications for operative procedures and precise selection of valve prostheses. The objective of this study was to compare long term results after aortic annular enlargement with those after operation using a small valve prosthesis.


METHODS
Since 1980, 45 patients with small aortic annulus underwent operation at our institution. There were six men and 39 women, and their ages ranged from 16 to 69 with a mean of 45.6 years. Of these patients, 28 underwent aortic annular enlargements (Nicks' procedure in 13, Manouguian's in 12 and apico-aortic bypass in three patients) and 17 patients received standard aortic valve replacement with a small valve prosthesis (19 mm Standard St. Jude Medical). Mean follow up was 8.6 years in the enlargement group and 4.9 years in the standard group.


RESULTS
Early mortality was 3.6% (1/28) in the enlargement group and 5.9% (1/17) in the standard group (NS). The 10-year actuarial survival including all deaths was 85.7% in the enlargement group and 62.7% in the standard group (p < 0.10). The rate of freedom from reoperation at 10 years was 90.7% in the enlargement group and 93.8% in the standard group (NS). The 10-year freedom from all valve-related events was 81.0% in the enlargement group and 58.8% in the standard group (p < 0.05).


CONCLUSIONS
The above results suggest that long term mortality and morbidity after aortic annular enlargement might be superior to those after standard AVR with a small valve prosthesis.
Kitamura
M
M
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Satoh
M
M
Hachida
M
M
Endo
M
M
Hashimoto
A
A
Koyanagi
H
H
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001021:Aortic Valve; D005260:Female; D006349:Heart Valve Diseases / Q000473:pathology* / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D011379:Prognosis; D017678:Sex Distribution; D015996:Survival Rate