title: Stent valve implantation in conventional redo aortic valve surgery to prevent patient-prosthesis mismatch.
abstract: The goal was to show the technical details, feasibility and clinical results of balloon-expandable stent valve implantation in the aortic position during conventional redo open-heart surgery in selected obese patients with a small aortic prosthesis and severe patient-prosthesis mismatch.
  
  
  
  Two symptomatic overweight patients (body mass index of 31 and 38), each with a small aortic prosthesis (a 4-year-old, 21-mm Hancock II biological valve and a 29-year-old, 23-mm Duromedic mechanical valve), increased transvalvular gradients (59/31 and 74/44 mmHg) and a reduced indexed effective orifice area (0.50 and 0.43 cm 2 /m 2 ) underwent implantation of two 26-mm balloon-expandable Sapien 3 valves during standard on-pump redo valve surgery.
  
  
  
  Using full re-sternotomy, cardiopulmonary bypass and cardioplegic arrest, the two balloon-expandable stent valves were implanted under direct view using a standard aortotomy, after prosthesis removal and without annulus enlargement. Aortic cross-clamp times were 162 and 126 min; cardiopulmonary bypass times were 178 and 180 min; total surgical times were 360 and 318 min. At discharge, echocardiograms showed transvalvular peak and mean gradients of 13/9 and 23/13 mmHg and indexed effective orifice areas of 0.64 and 1.08 cm 2 /m 2 . The 3-month echocardiographic follow-up showed transvalvular peak and mean gradients of 18/9 and 19/11 mmHg and indexed effective orifice areas of 0.78 cm 2 /m 2 and 0.84 cm 2 /m 2 , with improved symptoms (New York Heart Association class 1).
  
  
  
  Implantation of a balloon-expandable stent valve during redo aortic valve surgery is feasible in selected cases and prevents patient-prosthesis mismatch in obese patients without need for aortic annulus enlargement. Moreover, in the case of stent valve degeneration, this approach permits additional valve-in-valve procedures with large stent valves and prevents re-redo surgery.
authors.affiliation: Cardiac Surgery Unit, Cardiocentro Ticino Foundation, Lugano, Switzerland.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrari
authors.affiliation: Cardiac Surgery Unit, Cardiocentro Ticino Foundation, Lugano, Switzerland.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Franciosi
authors.affiliation: Cardiac Anaesthesia Unit, Cardiocentro Ticino Foundation, Lugano, Switzerland.
authors.forename: Sara
authors.initials: S
authors.lastname: Clivio
authors.affiliation: Cardiology Department, Cardiocentro Ticino Foundation, Lugano, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Faletra
authors.affiliation: Cardiology Department, Cardiocentro Ticino Foundation, Lugano, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Moccetti
authors.affiliation: Cardiology Department, Cardiocentro Ticino Foundation, Lugano, Switzerland.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Moccetti
authors.affiliation: Cardiology Department, Cardiocentro Ticino Foundation, Lugano, Switzerland.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pedrazzini
authors.affiliation: Cardiac Surgery Unit, Cardiocentro Ticino Foundation, Lugano, Switzerland.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Demertzis
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000517:prevention & control*; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome
keywords: Aortic valve replacement; Patient–prosthesis mismatch; Redo cardiac surgery; Transcatheter aortic valve replacement