title: Midterm results of Manouguian double valve replacement: comparison with standard double valve replacement.
abstract: OBJECTIVE
  Surgical strategies for patients who have a small aortic annulus associated with a small mitral annulus remain controversial. The objective of this study was to assess the validity of the Manouguian procedure for double valve replacement with patch enlargement of the annuli.
  
  
  METHODS
  We reviewed 57 consecutive patients who underwent double valve replacement for combined aortic and mitral disease between September 1991 and October 2000. Thirty patients underwent the Manouguian procedure with patch enlargement of the aortic and mitral annuli, and the other 27 patients had standard double valve replacement. The Manouguian procedure was selected for a small aortic annulus of less than 21 mm in diameter. The patients were followed for a median of 7.5 years. Results of echocardiography and the dobutamine stress test were compared postoperatively.
  
  
  RESULTS
  Double valve replacement with the Manouguian procedure did not increase the early or midterm mortality because the survival (including operative death) at 8 years was 83% in the Manouguian group and 84% in the double valve replacement group (P = .82). The event-free rate at 8 years was 79% in the Manouguian group and 84% in the double valve replacement group (P = .6). The prostheses implanted at the aortic and mitral positions were smaller in the Manouguian group, even after annular enlargement. However, the transprosthetic gradient across the aortic valve evaluated by means of dobutamine stress echocardiography did not differ between the 2 groups, possibly because of a smaller body surface area in the Manouguian group.
  
  
  CONCLUSIONS
  The Manouguian patch enlargement procedure is useful during double valve replacement when associated with the problem of small-valve annuli.
authors.affiliation: DEpartment of Cardiovascular Surgery, Jikei University School of Medicine, Heart Institute, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okuyama
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kurosawa
authors.forename: Kei
authors.initials: K
authors.lastname: Tanaka
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shiratori
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D001830:Body Surface Area; D002315:Cardiopulmonary Bypass; D002423:Cause of Death; D004452:Echocardiography; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D010496:Pericardium / Q000637:transplantation; D012189:Retrospective Studies; D015996:Survival Rate; D017725:Ventricular Pressure / Q000502:physiology