Original method of posterior aortoplasty for aortic valve replacement in surgical treatment of combined mitral-aortic valve diseases
Objective. To research of possibilities of reconstruction of aorta`s ostium and ascending aorta during aortic valve replacement and simultaneous correction of mitral valve defects at patients with narrow aorta`s ostium.
Materials and methods. The study group consisted of 46 patients with mitral-aortic heart diseases and combination with a narrow aortic mouth, who were operated on at the A
Amosov National Institute of Cardiovascular surgery for the period from January 1, 2006 to January 1, 2020. All patients underwent reconstruction of the aortic root and ascending aorta according to the original method of posterior aortoplasty. There were 26 men (56.5%) and 20 women (43.5%). The age of patients ranged from 23 to 72 years (average - 58.4±7.3 years). 8 (17.4%) patients belonged to class III NYHA, 38 (82.6%) - to class IV.
Results. Of the 46 operated patients at the hospital stage (30 days after surgery), 4 died (hospital mortality 8.7%). No fatalities were associated with surgical technique. The dynamics of echocardiographic parameters at the hospital stage was as follows: the systolic gradient on the aortic valve was before surgery 112.1 ± 15.2 mm Hg, on the aortic prosthesis at discharge - 23.2 ± 6.4 mm Hg; end-systolic index (ESI) of the left ventricle (ml/m²) - 59.1 ± 7.6 (before surgery) and 48.3 ± 5.9 (after surgery); left ventricle ejection fraction (EF) - 0.45 ± 0.04 (before surgery) and 0.53 ± 0.04 (after surgery).
Conclusions. The proposed original technique of posterior aortoplasty allows to effectively expand the mouth of the aorta for further implantation of an artificial heart valve of larger diameter. The technique is quite safe. At the hospital stage there are no complications directly related to the technique of operations. At the early postoperative period, the morphometric parameters of the left ventricle (EF and ESI) improved. The technique can be successfully used for the correction of combined mitral-aortic valve defects.
Popov V, Bolshak O, Vakulenko K. Correction of narrow ostium of aorta during aortic valve replacement: choice of surgical method. Abstracts of the 67th International Congress of the European Society of Cardiovascular and Endovascular Surgery (ESCVS); April 12-14, 2018. Strasbourg, France. J Cardiovasc Surg. 2018;59(Suppl 2 to N 3):28.
Alameddine AK, Binnall B, Conlin FT, Alameddine KO. How to Control Subannular Hemorrhage during Aortic Root Enlarging Procedures. Aorta (Stamford). 2018 Oct;6(5):120-3. doi: 10.1055/s-0039-1683387. Epub 2019 Apr 1. PMID: 30934108; PMCID: PMC6443392.
Tully PJ, Aty W, Rice GD, Bennetts JS, Knight JL, Baker RA. Aortic valve prosthesis-patient mismatch and long-term outcomes: 19-year single-center experience. Ann Thorac Surg. 2013 Sep;96(3):844-50. doi: 10.1016/j.athoracsur.2013.04.075. Epub 2013 Jun 25. PMID: 23810177.
Girerd N, Mathieu P, Dumesnil JG, Magne J, Charbonneau E, Dagenais F, et al. Impact of aortic stenosis severity and its interaction with prosthesis-patient mismatch on operative mortality following aortic valve replacement. J Heart Valve Dis. 2012 Mar;21(2):158-67. PMID: 22645849.
Hong S, Yi G, Youn YN, Lee S, Yoo KJ, Chang BC. Effect of the prosthesis-patient mismatch on long-term clinical outcomes after isolated aortic valve replacement for aortic stenosis: a prospective observational study. J Thorac Cardiovasc Surg. 2013 Nov;146(5):1098-104. doi: 10.1016/j.jtcvs.2012.07.101. Epub 2012 Sep 7. PMID: 22959323.
Head SJ, Mokhles MM, Osnabrugge RL, Pibarot P, Mack MJ, Takkenberg JJ, et al. The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years. Eur Heart J. 2012 Jun;33(12):1518-29. doi: 10.1093/eurheartj/ehs003. Epub 2012 Mar 8. PMID: 22408037.
Takagi H, Yamamoto H, Iwata K, Goto SN, Umemoto T. A meta-analysis of effects of prosthesis-patient mismatch after aortic valve replacement on late mortality. Int J Cardiol. 2012 Aug 23;159(2):150-4. doi: 10.1016/j.ijcard.2012.04.084. Epub 2012 May 12. PMID: 22584075.
Chen J, Lin Y, Kang B, Wang Z. Indexed effective orifice area is a significant predictor of higher mid- and long-term mortality rates following aortic valve replacement in patients with prosthesis-patient mismatch. Eur J Cardiothorac Surg. 2014 Feb;45(2):234-40. doi: 10.1093/ejcts/ezt245. Epub 2013 May 16. PMID: 23682010.
Dayan V, Vignolo G, Soca G, Paganini JJ, Brusich D, Pibarot P. Predictors and Outcomes of Prosthesis-Patient Mismatch After Aortic Valve Replacement. JACC Cardiovasc Imaging. 2016 Aug;9(8):924-33. doi: 10.1016/j.jcmg.2015.10.026. Epub 2016 May 25. PMID: 27236530.
Dumesnil JG, Pibarot P. The problem of severe valve prosthesis-patient mismatch in aortic bioprostheses: near extinction? J Am Soc Echocardiogr. 2014 Jun;27(6):598-600. doi: 10.1016/j.echo.2014.04.005. PMID: 24863015.
Massias SA, Pittams A, Mohamed M, Ahmed S, Younas H, Harky A. Aortic root enlargement: When and how. J Card Surg. 2020 Oct 30. doi: 10.1111/jocs.15175. Epub ahead of print. PMID: 33124077.
Subhani H, Hossien A, Tran V, Cook A, Abid Q, Saad R. Anatomic Correlation of Posterior Aortic Root Enlarging Incisions. World J Pediatr Congenit Heart Surg. 2016 Nov;7(6):706-10. doi: 10.1177/2150135116658020. PMID: 27834762.
Yu W, Tam DY, Rocha RV, Makhdoum A, Ouzounian M, Fremes SE. Aortic Root Enlargement Is Safe and Reduces the Incidence of Patient-Prosthesis Mismatch: A Meta-analysis of Early and Late Outcomes. Can J Cardiol. 2019 Jun;35(6):782-90. doi: 10.1016/j.cjca.2019.02.004. Epub 2019 Feb 13. PMID: 31151714.
Sá MPBO, Carvalho MMB, Sobral Filho DC, Cavalcanti LRP, Diniz RGS, Rayol SC, et al. Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients. Interact Cardiovasc Thorac Surg. 2019 Jul 1;29(1):74-82. doi: 10.1093/icvts/ivy364. PMID: 30698730.
Tam DY, Dharma C, Rocha RV, Ouzounian M, Wijeysundera HC, Austin PC, et al. Early and late outcomes following aortic root enlargement: A multicenter propensity score-matched cohort analysis. J Thorac Cardiovasc Surg. 2020 Oct;160(4):908-19.e15. doi: 10.1016/j.jtcvs.2019.09.062. Epub 2019 Sep 28. PMID: 31733884.
Bortolotti U, Celiento M, Milano AD. Enlargement of the aortic annulus during aortic valve replacement: a review. J Heart Valve Dis. 2014 Jan;23(1):31-9. PMID: 24779326.
This work is licensed under a Creative Commons Attribution 4.0 International License.