title: Long-term results of aortic valve replacement with posterior root enlargement.
abstract: BACKGROUND
  Posterior root enlargement provides the implantation of suitable-sized prosthetic valves in patients with a small aortic root. The aim of this study was to evaluate the long-term results of posterior root enlargement in patients undergoing aortic valve replacement.
  
  
  METHODS
  Between 1997 and 2011, 103 patients with a small aortic annulus (indexed effective orifice area < 0.75 cm(-2) · m(-2)) underwent aortic valve replacement with posterior aortic root enlargement. Forty-six (44%) patients were male. The mean age was 28.62 ± 18.56 years. Survivors were followed up for a mean of 45.6 ± 32.4 months.
  
  
  RESULTS
  Early mortality was 9.6%. The most common cause of early mortality was low cardiac output syndrome (6 patients). There were 2 (1.9%) late deaths due to cerebrovascular events. During the follow-up period, mild paravalvular leakage occurred in only one (1%) patient, and one suffered a malfunction of the prosthesis. A significant reduction was seen in the peak pressure gradients across the replaced aortic valves (p < 0.001). Moreover, a significant increase was noted in left ventricular ejection fraction (p = 0.001).
  
  
  CONCLUSIONS
  Aortic root enlargement using the Manouguian technique can be applied with acceptable safety. It effectively decreases postoperative gradients and increases left ventricular ejection fraction. Short- and long-term mortality and morbidity rates are satisfactory.
authors.affiliation: Heart Valve Disease Research Center, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Alireza Alizadeh
authors.initials: AA
authors.lastname: Ghavidel
authors.affiliation: Department of Cardiac Surgery, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Omrani
authors.affiliation: Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran mitra.chitsazan66@yahoo.com.
authors.forename: Mitra
authors.initials: M
authors.lastname: Chitsazan
authors.affiliation: Department of Cardiac Anesthesiology, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Ziae
authors.initials: Z
authors.lastname: Totonchi
authors.affiliation: Department of Cardiac Surgery, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Nader
authors.initials: N
authors.lastname: Givtaj
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000473:pathology* / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D016896:Treatment Outcome
keywords: Aortic valve; Cardiac surgical procedures; Heart valve diseases; Heart valve prosthesis implantation; Treatment outcome