title: Aortic Annulus Enlargement: Early and Long-Terms Results.
abstract: OBJECTIVE
  Patient-prosthesis mismatch (PPM) is a common occurrence in aortic valve surgery. Even the discussions about the impact of this phenomenon on the results of aortic valve surgery, the management of this problem remain one of the main topics in this kind of surgery. One of the ways of a solution is aortic annulus enlargement. The main topic of this study is to evaluate the early and longterm results of this technique in our country.
  
  
  METHODS
  During the period January 2010 -January 2015, 641 patients performed aortic valve surgery. In ten patients we performed aortic annulus enlargement according to Manouguian technique to avoid severe patient-prothesis mismatch. Operative mortality and perioperative complications (low cardiac output, pulmonary complications, etc..) were considered the indicators of the early results. Survival, clinical presentation according to NYHA, quality of life were the indicators to evaluate long-term results. Preoperative and postoperative echocardiographic data were also used to evaluate our results. We collected the data from hospital registrations and periodical clinical visit and echographic examination after hospital discharge.
  
  
  RESULTS
  In our group, 6 of 10 patients were diagnosed with stenotic aortic valve, two patients had aortic valve regurgitation and two mixed valve pathology. Four patients had concomitant cardiac surgery procedure, mitral or CABG. In all cases, aortic valve pathology was the primary diagnose. In the preoperative echocardiographic examination mean transvalvular gradient was 54.3 ± 6.42. We had no death during early or late postoperative period. Only one patient had pulmonary complications and long time of respiratory assistance because of his pulmonary pathology. The same patient had low cardiac output and wound infection. Early after surgery mean transprostethic gradient was 16.2 ± 3.44 and late postoperative was 15.9 ± 4.3. No patient had the severe patient-prothesis mismatch. Mean follow-up was 49 ± 20.26 months. During follow-up, we had no death, and all patients had very good quality of life.
  
  
  CONCLUSIONS
  Aortic valve annulus enlargement can be used with very good early and late results with the final goal to increase the potential benefit of the patient from surgery of aortic valve.
authors.affiliation: University Hospital Centre "Mother Theresa", Service of Cardiac Surgery, Tirana, Albania.
authors.forename: Selman
authors.initials: S
authors.lastname: Dumani
authors.affiliation: University Hospital Centre "Mother Theresa", Service of Cardiac Surgery, Tirana, Albania.
authors.forename: Ermal
authors.initials: E
authors.lastname: Likaj
authors.affiliation: University Hospital Centre "Mother Theresa", Service of Cardiac Surgery, Tirana, Albania.
authors.forename: Laureta
authors.initials: L
authors.lastname: Dibra
authors.affiliation: Obstetric Gynaecologic Hospital "Queen Geraldine", Tirana, Albania.
authors.forename: Vera
authors.initials: V
authors.lastname: Beca
authors.affiliation: University Hospital Centre "Mother Theresa", Service of Cardiac Surgery, Tirana, Albania.
authors.forename: Saimir
authors.initials: S
authors.lastname: Kuci
authors.affiliation: University Hospital Centre "Mother Theresa", Service of Cardiac Surgery, Tirana, Albania.
authors.forename: Ali
authors.initials: A
authors.lastname: Refatllari
keywords: Aortic valve; aortic annulus enlargement; aortic valve replacement; heart valve prothesis; patient prothesis mismatch