Aortic annuloplasty with aortic root reconstruction to prevent patient-prosthesis mismatch.
Part of the ongoing argument concerning patient-prosthesis mismatch (PPM) following aortic valve replacement (AVR) is due to the perception that aortic annulus enlargement procedures increase the risk and technical difficulty of aortic valve surgery. Here, an aortic root reconstruction that involves enlargement of the annulus and tailoring of the aortic root to accommodate larger stented prostheses is presented that has been personally performed in 196 patients with no technique-related surgical deaths or complications, and thus can be carried out without additional risk. This aortic root enlargement aortoplasty and annuloplasty method can be calibrated to all AVRs involving stented manufactured prostheses when these are deemed the prosthesis of choice for the patient with a relatively small annulus and/or aortic root, severe left ventricular hypertrophy, compromised LV function or a very active lifestyle, to achieve predicted EOA values > or = 1.00 cm2/m2.
Hopkins
Richard A
RA
Department of Cardiothoracic Surgery, Brown University and Rhode Island Hospital, Providence, RI 02905, USA. rahopkins@lifespan.org
D000818:Animals; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D002417:Cattle; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D015203:Reproducibility of Results; D012189:Retrospective Studies