PMID- 21236693
OWN - NLM
STAT- MEDLINE
DCOM- 20120112
LR  - 20191210
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 40
IP  - 2
DP  - 2011 Aug
TI  - Aortic root enlargement does not increase the surgical risk and short-term 
      patient outcome?
PG  - 441-7
LID - 10.1016/j.ejcts.2010.11.064 [doi]
AB  - OBJECTIVE: To analyze the short-term outcome of aortic root enlargement (ARE) 
      using death and adverse events as end points. METHODS: From January 1999 through 
      December 2009, 3339 patients were subjected to aortic valve replacement (AVR). A 
      total of 678 were considered to have small aortic roots (SARs) in which an aortic 
      prosthesis size 21 mm or smaller was implanted. ARE using a bovine pericardial 
      patch was performed in another 218 patients, who constitute the study population. 
      This comprised 174 females (79.8%); the mean age was 69.4 +/- 13.4 years (8-87, 
      median 74 years), the body surface area (BSA) was 1.59 +/- 0.15m(2) and the body mass 
      index (BMI) 25.77 +/- 3.16 k gm(-)(2), and 192 (88.5%) were in New York Heart 
      Association (NYHA) II-III. Preoperative echocardiography revealed significant 
      left ventricular (LV) dysfunction in 17 patients (8%), a mean aortic valve area 
      of 0.57 +/- 0.27 cm(2), and a mean gradient of 62.51 +/- 21.25 mm Hg. A septal myectomy 
      was performed in 129 subjects (59.2%), and other associated procedures, mostly 
      coronary artery bypass grafting (CABG), in 60 (27.5%). Bioprostheses were 
      implanted in 161 patients (73.9%). The mean valve size was 21.9 +/- 1.0 (21-25). 
      The mean extracorporeal circulation (ECC) and aortic clamping times were 82.8 +/- 
      19.8 min and 56.8 +/- 12.5 min, respectively. RESULTS: Hospital mortality was 0.9% 
      (n=2) for ARE as compared with 0.6% (n=4) for the SAR group (p=0.8). Inotropic 
      support was required in only 13 (5.9%) patients and the first 24-h chest drainage 
      was 336.2 +/- 202 ml. Other complications included pacemaker implantation (7.8%), 
      acute renal failure (10.6%), respiratory (4.1%), and CVA/transient ischemic 
      attack (CVA/TIA) (3.2%). Postoperative echocardiographic evaluation showed a 
      significant decrease in peak and mean aortic gradients (23.7 +/- 9.5 and 14 +/- 6.2 
      mm Hg, respectively, p<0.0001). The mean indexed effective orifice area (iEOA) 
      was 0.92 +/- 0.01 cm(2) m(-)(2) (vs 0.84+/-0.07 cm(2) m(-)(2), in SAR, p<0.0001). Only 11% of 
      patients (n=24) with ARE exhibited moderate patient-prosthesis mismatch (PPM) and 
      none had severe PPM. Mean hospital stay was 9.7 +/- 9.29 days (median 7 days). 
      CONCLUSIONS: With the growing number of patients with degenerative aortic valve 
      pathology, mainly an older population, sometimes with calcified and fragile 
      aortic wall, the issue of dealing with an SAR poses the dilemma of whether to 
      implant a smaller prosthesis and admit some degree of PPM, or to enlarge the 
      aortic root. This study demonstrates that the latter can be done in a safe and 
      reproducible manner.
CI  - Copyright (c) 2010 European Association for Cardio-Thoracic Surgery. Published by 
      Elsevier B.V. All rights reserved.
FAU - Coutinho, Goncalo F
AU  - Coutinho GF
AD  - Cardiothoracic Surgery, University Hospital, Coimbra, Portugal.
FAU - Correia, Pedro M
AU  - Correia PM
FAU - Pauperio, Goncalo
AU  - Pauperio G
FAU - de Oliveira, Ferrao
AU  - de Oliveira F
FAU - Antunes, Manuel J
AU  - Antunes MJ
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Review
DEP - 20110113
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
CIN - Eur J Cardiothorac Surg. 2012 Apr;41(4):965; author reply 966. PMID: 22423072
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Aorta/pathology/*surgery
MH  - Aortic Valve Insufficiency/pathology/surgery
MH  - Aortic Valve Stenosis/pathology/surgery
MH  - Bioprosthesis
MH  - Child
MH  - Coronary Artery Bypass
MH  - Female
MH  - Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/*adverse effects/methods/mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pericardium/transplantation
MH  - Prosthesis Design
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2011/01/18 06:00
MHDA- 2012/01/13 06:00
CRDT- 2011/01/18 06:00
PHST- 2010/08/18 00:00 [received]
PHST- 2010/11/21 00:00 [revised]
PHST- 2010/11/23 00:00 [accepted]
PHST- 2011/01/18 06:00 [entrez]
PHST- 2011/01/18 06:00 [pubmed]
PHST- 2012/01/13 06:00 [medline]
AID - S1010-7940(10)01041-9 [pii]
AID - 10.1016/j.ejcts.2010.11.064 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2011 Aug;40(2):441-7. doi: 10.1016/j.ejcts.2010.11.064. 
      Epub 2011 Jan 13.