title: Does aortic root enlargement impair the outcome of patients with small aortic root?
abstract: BACKGROUND
  Posterior root enlargement procedures provide the implantation of suitable-sized prosthetic valves in patients with a small aortic root to prevent a high postoperative transvalvular gradient. The aim of this study was to evaluate long-term results of the posterior root enlargement.
  
  
  METHODS
  Between 1985 and 2002, 124 patients underwent aortic valve replacement with a posterior root enlargement. The main indication was a small aortic valve orifice area to patient body surface area (indexed valve area < 0.85 cm2/m2). Fifty-four (44%) patients were male, and 70 (56%) were female with a mean age 39.1 +/- 14.3 years. Indications for operation were severe calcified aortic valve stenosis (37.1%), severe aortic insufficiency (25.8%), or combination (37.1%). Seventy-five (60%) patients received double-valve replacement. A pericardial patch was used in 100 patients (80.6%) and a Dacron patch was used in 24 patients.
  
  
  RESULTS
  Operative mortality was 6.4% (8 patients). The causes of hospital mortality were low cardiac output syndrome (LCOS) (in 6 patients), cerebrovascular events (in 1 patient) and multiple organ failure (in 1 patient). Multivariate analysis demonstrated concomitant coronary revascularization to be a significant (p = 0.03) predictor for early mortality. There were six (5.4%) late deaths. Cox proportional hazards regression analysis demonstrated LCOS (p = 0.013) and infective endocarditis (p = 0.003) to be significant predictors for late mortality. Atrioventricular block required a permanent pacemaker was observed in 4 patients (3.2%).
  
  
  CONCLUSIONS
  Posterior aortic root enlargement techniques can be easily applied without additional risks. Long-term survival and freedoms from valve-related complications are satisfactory.
authors.affiliation: Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Kadikoy, Istanbul, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Ardal
authors.forename: Mehmet Erdem
authors.initials: ME
authors.lastname: Toker
authors.forename: Murat Bülent
authors.initials: MB
authors.lastname: Rabuş
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Uyar
authors.forename: Arzu
authors.initials: A
authors.lastname: Antal
authors.forename: Mesut
authors.initials: M
authors.lastname: Sişmanoğlu
authors.forename: Denyan
authors.initials: D
authors.lastname: Mansuroğlu
authors.forename: Kaan
authors.initials: K
authors.lastname: Kirali
authors.forename: Cevat
authors.initials: C
authors.lastname: Yakut
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001021:Aortic Valve / Q000473:pathology* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002648:Child; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012086:Reoperation; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome