Stability of aortic annulus enlargement during aortic valve replacement using a bovine pericardial patch: An 18-year clinical, echocardiographic, and angio–computed tomographic follow-up
| Autor: | Uberto Bortolotti, Lorenzo Faggioni, Matteo Saccocci, Aldo Domenico Milano, Michele Celiento, Andrea De Martino, Carmela Nardi |
|---|---|
| Jazyk: | angličtina |
| Předmět: |
Aortic valve
Male Time Factors adverse effects/instrumentation Postoperative Complications Aortic valve replacement 80 and over Pericardium Adult Aged Aged 80 and over Animals Aortic Valve Insufficiency radiography/surgery/ultrasonography Aortic Valve Stenosis radiography/surgery/ultrasonography Aortic Valve pathology/radiography/surgery/ultrasonography Calcinosis radiography/surgery/ultrasonography Cattle Echocardiography Female Heart Valve Prosthesis Heart Valve Prosthesis Implantation adverse effects/instrumentation Heterografts Hospital Mortality Humans Male Middle Aged Pericardium transplantation Postoperative Complications mortality Predictive Value of Tests Prosthesis Design Retrospective Studies Time Factors Tomography X-Ray Computed Treatment Outcome Cardiac skeleton Hospital Mortality Tomography Aged 80 and over Heart Valve Prosthesis Implantation body surface area Sinotubular Junction Calcinosis Middle Aged X-Ray Computed medicine.anatomical_structure Treatment Outcome Echocardiography Aortic valve stenosis Aortic Valve Heart Valve Prosthesis Cardiology cardiovascular system Heterografts Female Cardiology and Cardiovascular Medicine radiography/surgery/ultrasonography Pulmonary and Respiratory Medicine Adult medicine.medical_specialty enlargement of the aortic annulus Aortic Valve Insufficiency Prosthesis Design Predictive Value of Tests Internal medicine medicine Animals Humans aortic valve replacement angio–computed tomography cardiovascular diseases Aged Retrospective Studies business.industry pathology/radiography/surgery/ultrasonography Aortic Valve Stenosis medicine.disease mortality Surgery Transplantation angio–computed tomography aortic valve replacement body surface area enlargement of the aortic annulus Stenosis Cattle Tomography X-Ray Computed business transplantation |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. (3):977-983 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2013.02.074 |
| Popis: | Objective Enlargement of the aortic annulus may be required during aortic valve replacement to avoid patient–prosthesis mismatch. We reviewed patients with enlargement of the aortic annulus with the aim of assessing the stability of the procedure by means of echocardiographic and angio–computed tomography studies. Methods A series of 53 consecutive patients underwent aortic valve replacement and enlargement of the aortic annulus from 1994 to 2012. The mean age was 68 ± 11 years (range, 29-84 years), and 85% (45 patients) were female. The predominant valvular lesion was aortic stenosis. The mean logistic European System for Cardiac Operative Risk Evaluation was 11.2 ± 13.0. Enlargement of the aortic annulus was performed by extending the aortotomy incision to separate the commissure between the left and noncoronary sinuses into the anterior mitral leaflet and closing the resulting defect with an adequately tailored patch of bovine pericardium. Results Hospital mortality was 2%, with 20 late deaths mostly due to noncardiac causes. At a maximum follow-up of 18 years (mean, 8.9 ± 5.0 years), actuarial survival is 37% ± 9%. No cases of severe patient–prosthesis mismatch were observed, and only 2 patients had moderate patient–prosthesis mismatch. At discharge, the mean aortic root diameter was 30.0 ± 2.3 mm and the mean diameter at the sinotubular junction was 31.5 ± 5.0 mm. At follow-up, the mean aortic root diameter was 31.0 ± 3.4 mm and the mean diameter at the sinotubular junction was 31.7 ± 4.5 mm ( P = not significant) with no cases of late aneurysm formation on angio–computed tomography. Conclusions Enlargement of the aortic annulus is a safe and effective procedure and should be indicated in patients with a small aortic annulus; particularly, it should be considered to prevent patient–prosthesis mismatch and its potential deleterious long-term effects. |
| Databáze: | OpenAIRE |
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