Take-home message
DVR with aortic root enlargement is safe and feasible to avoid PPM
without increasing morbidity and mortality.
Objectives: Small Aortic Annulus (AA) is big issue during
Aortic Valve Replacement (AVR) necessitating replacement of an
undersized prosthetic valve especially with Double Valve Replacement
(DVR). Despite that small aortic valve prostheses can lead to
Prosthesis-Patient Mismatch (PPM), there remains reluctance to perform
aortic root enlargement (ARE) procedures fearing from morbidity and
mortality. We evaluate clinical and echocardiographic outcomes in
patients with small aortic annulus undergoing double valve replacement.Methods: The study included 100 consecutive patients underwent
DVR for combined rheumatic aortic and mitral valve diseases, between
Jan. 2016 and Sept. 2020. Only (50) patients had ARE with DVR. ARE was
performed using an autologous or bovine pericardium or Dacron patch by
Nick′s or Manouguian procedures. The estimated postoperative end-points
were mortality, effective orifice areas (EOA), mean aortic pressure
gradient and valve-related complications. The least postoperative
follow-up period was 6 months. Results: The study included 30
male and 70 female patients with mean age of 35±20 years, body surface
area (BSA) of 1.5 ±0.20 m2, aortic annulus diameter
was 20±1.4 mm, aortic orifice area was 0.80±0.50 cm2,
and aortic peak gradient (PG) 80±40 mm Hg. During follow-up period,
there was a mild to moderate paravalvular leak (1%) with, (1%) heart
block, and residual PG on prosthetic aortic valve; that was all in DVR
alone. Conclusion: Enlargement of aortic root by Nick′s or
Manouguian technique is safe and effective in patients with small aortic
annulus undergoing double valve replacements.