title: [Advantage of supra-annular patch enlargement in aortic stenosis with a small aortic annulus].
abstract: BACKGROUND
  We routinely perform supra-annular patch enlargement as a strategy to avoid patient-prosthesis mismatch (PPM) in patients with a small aortic annulus who are undergoing aortic valve replacement (AVR).
  
  
  METHODS
  We performed a retrospective review of 128 consecutive single AVR patients from 1999 to 2005. Of these, 34 patients underwent supra-annular patch enlargement. The enlargement was selectively performed in patients at risk of PPM. This involved patch extension of the aortotomy just above the annulus of noncoronary sinus, and valve implantation with stitches placed directly on the patch. Along with this procedure, AVR with a valve size appropriate to body surface area (BSA) was performed.
  
  
  RESULTS
  Of these patients, 74% were female and the mean BSA was less than 1.50 m2. The enlargement required an average of 33 minutes of additional aortic clamp time. The 30-day mortality was 0%. A favorable hemodynamic outcome was achieved.
  
  
  CONCLUSIONS
  Our results show that supra-annular patch enlargement can be performed with minimal added risk, relative to standard root enlargement and a satisfactory hemodynamic status can be achieved by employing this procedure.
authors.affiliation: Department of Cardiovascular Surgery, Heart Center, Sendai Kosei Hospital, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Hamasaki
authors.forename: G
authors.initials: G
authors.lastname: Yaginuma
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017755:Prosthesis Fitting / Q000379:methods; D012189:Retrospective Studies