title: Strategy to avoid patient-prosthesis mismatch: aortic root enlargement.
abstract: BACKGROUND
  The choice of a valve with an effective orifice area matching the body surface area and providing efficient hemodynamics is an important factor affecting mortality and morbidity in patients undergoing aortic valve replacement.
  
  
  METHODS
  Our preventative strategy was to implant a larger prosthetic valve by aortic root enlargement using the Nunez procedure in 17 patients between February 2010 and January 2011. The decision to enlarge the aortic root was taken when the 19-mm sizer could not be negotiated easily through the aortic root, or on the basis of body surface area of the patient or type of prosthesis available.
  
  
  RESULTS
  Postoperative reductions in peak and mean pressure gradients across aortic valve of 12.8-16.5 and 10.2-12.6 mm Hg, respectively, were observed. Postoperative effective orifice areas of the aortic valves were 1.1-1.5 cm(2). By upsizing the aortic valve, we were able to eliminate patient-prosthesis mismatch in 5 patients, and reduce severe patient-prosthesis mismatch to moderate in 11.
  
  
  CONCLUSIONS
  Aortic root enlargement is a safe procedure. Therefore, cardiac surgeons should not be reluctant to enlarge the aortic root with an autologous pericardial patch to permit implantation of an adequate size of aortic valve prosthesis, with minimal additional aortic crossclamp time and no added cost.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, S.S.K.M. Hospital, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Dharmendra Kumar
authors.initials: DK
authors.lastname: Srivastava
authors.forename: Prokash
authors.initials: P
authors.lastname: Sanki
authors.forename: Subhankar
authors.initials: S
authors.lastname: Bhattacharya
authors.forename: Javed Veqar
authors.initials: JV
authors.lastname: Siddique
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D064592:Autografts; D001830:Body Surface Area; D015150:Echocardiography, Doppler; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation; D011183:Postoperative Complications / Q000517:prevention & control; D011474:Prosthesis Design; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aortic valve; heart valve diseases; heart valve prosthesis implantation; mitral valve; prosthesis fitting