HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mark D. Peterson Michael A. Borger Christopher M. Feindel Tirone E. David Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Peterson, M. D. Articles by David, T. E. Search for Related Content PubMed PubMed Citation Articles by Peterson, M. D. Articles by David, T. E. Related Collections Valve disease

Ann Thorac Surg 2007;83:2044-2049
© 2007 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Aortic Annular Enlargement During Aortic Valve Replacement: Improving Results With Time

Division of Cardiac Surgery, Toronto General Hospital, Department of Surgery, University of Toronto, Toronto, Ontario, Canada

Accepted for publication January 29, 2007.

^_* Address correspondence to Dr Feindel, Division of Cardiac Surgery, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, M5G 2C4, Canada (Email: chris.feindel{at}uhn.on.ca).

Background: Enlargement of the aortic annulus during aortic valve replacement permits insertion of a larger prosthetic valve. Previous reports suggest patch enlargement of the aortic annulus increases operative morbidity and mortality during aortic valve replacement. We compared outcomes for this procedure in a contemporary group of patients with those operated on during an earlier era, to determine whether aortic annular enlargement is still associated with worse outcomes.

Methods: We reviewed prospectively gathered data on all patients undergoing aortic valve replacement and aortic annular enlargement at our institution from 1995 to 2005 (n = 669). We compared patient outcomes from two consecutive time periods: 1995 through 2000 (n = 360) versus 2001 through 2005 (n = 309). Propensity matching adjusted for baseline differences in a secondary analysis.

Results: Operative mortality was significantly lower in the more recent surgical group (2.9% versus 7.2%; p = 0.013). The rates of perioperative myocardial infarction (1.9% versus 1.1%; p = 0.4), stroke (2.9% versus 3.3%; p = 0.8), and pacemaker implantation (9.1% versus 12.5%; p = 0.16) were similar for both groups (2001 through 2005 versus 1995 through 2000, respectively). The earlier group of patients had a higher prevalence of congestive heart failure, syncope, angina, New York Heart Association class III or IV symptoms, chronic obstructive pulmonary disease, mitral valve disease, and previous cardiac surgery. After adjusting for these baseline differences with propensity matching, the risk of perioperative death remained lower in the contemporary group (3% versus 7.5%; p = 0.04).

Conclusions: Enlargement of the aortic annulus in the modern era is a safe adjunct to aortic valve replacement, and should be considered in selected patients to avoid patient–prosthesis mismatch.

This article has been cited by other articles:

				M. Vicchio, A. Della Corte, M. De Feo, and M. Cotrufo Reply Ann. Thorac. Surg., September 1, 2009; 88(3): 1050 - 1051. [Full Text] [PDF]

				A. Kulik, N. T. Kouchoukos, and M. Ruel Avoiding prosthesis-patient mismatch in the elderly: options other than mechanical prostheses. Ann. Thorac. Surg., September 1, 2009; 88(3): 1049 - 1050. [Full Text] [PDF]

				M. R. Moon, J. S. Lawton, N. Moazami, N. A. Munfakh, M. K. Pasque, and R. J. Damiano Jr. POINT: Prosthesis-patient mismatch does not affect survival for patients greater than 70 years of age undergoing bioprosthetic aortic valve replacement. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 278 - 283. [Abstract] [Full Text] [PDF]

				C. M. Feindel COUNTERPOINT: Aortic valve replacement: size does matter. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 284 - 285. [Full Text] [PDF]

				V. S. Lad Valve Size Does Matter in the Young: Letter 1 Ann. Thorac. Surg., January 1, 2009; 87(1): 353 - 354. [Full Text] [PDF]

				A. Kulik, M. Al-Saigh, V. Chan, R. G. Masters, P. Bedard, B.-K. Lam, F. D. Rubens, P. J. Hendry, T. G. Mesana, and M. Ruel Enlargement of the Small Aortic Root During Aortic Valve Replacement: Is There a Benefit? Ann. Thorac. Surg., January 1, 2008; 85(1): 94 - 100. [Abstract] [Full Text] [PDF]