title: Aortic root enlargement in octogenarian patients results in less patient prosthesis mismatch.
abstract: BACKGROUND
  Aortic root enlargement has not been well studied as a modality to prevent patient prosthesis mismatch in octogenarian patients with a small aortic root.
  
  
  METHODS
  We reviewed the records of 117 octogenarian patients who received surgical aortic valve replacement (AVR) between 1993 and 2010. From this group, 87 patients received a 19-mm AVR (small aortic valve, SAV group) and 30 received an aortic root enlargement and a 21-mm AVR (aortic root enlargement, ARE group).
  
  
  RESULTS
  The median age of the patients was 84 years (range, 80 to 93) and there were 111 women (95%). Aortic cross-clamp time was 50 minutes (26 to 116) in the SAV group and 67 (26 to 136) in the ARE group (p=0.02). There were no differences in the operative morbidity or morality rates between the groups. Postoperative aortic valve area index was 0.77 cm2/m2 (0.25 to 1.47) in the SAV group and 1.06 (0.51 to 1.94) in the ARE group (p<0.001). Severe patient prosthesis mismatch occurred in 23 patients (32%) in the SAV group in comparison with 3 (12%) in the ARE group (p=0.04). There were no differences in the mid-term outcomes of New York Heart Association functional class (p=0.230) or survival between patients with or without mismatch (p=0.84).
  
  
  CONCLUSIONS
  Aortic root enlargement in octogenarian patients allows for insertion of larger aortic valve prostheses without any apparent increase in operative morbidity or mortality. The larger prostheses demonstrate better hemodynamic performance and less patient prosthesis mismatch, but no apparent functional or survival advantage.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota; Cardio-Thoracic and Vascular Surgical Associates, Mobile, Alabama.
authors.forename: Juan G
authors.initials: JG
authors.lastname: Penaranda
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: greason.kevin@mayo.edu.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sorin V
authors.initials: SV
authors.lastname: Pislaru
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Harold M
authors.initials: HM
authors.lastname: Burkhart
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lyle D
authors.initials: LD
authors.lastname: Joyce
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015626:Tissue Expansion / Q000379:methods*; D016896:Treatment Outcome; D035862:Vulnerable Populations