Comparison of the Results of Three Variants of Aortic Valve Replacement in Patients with a Small Aortic Annulus

Evgeny Rosseykin , Evgeny Kobzev, Vladlen Bazylev

Federal Center of Cardiovascular surgery, Penza, Russia

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objective: Aortic valve replacement in patients with a small aortic annulus is a challenging problem. The objective of this study was to compare 3 surgical approaches in terms of hemodynamics and perioperative outcomes.

Materials and methods.A retrospective study included 177 patients with a small aortic annulus (≤21 mm), who underwent aortic valve surgerybetween January 2010 and June 2017. Surgical techniques included standard aortic valve replacement with stented bioprosthesis in 21 patients (group 1), aortic valve replacement and aortic root enlargement in 33 (group 2) and aortic valve reconstruction using an autologous pericardium (Ozaki procedure) in 123 (group 3).

Results. The 30-day mortality in group 1 was 4.8% (1 patient), in group 2 - 3.3% (1 patient), in group 3 - 1.6% (2 patients). Aortic cross-clamp and cardiopulmonary bypass times were longer in groups 2 and 3 (p<0,001). There was a lower incidence of permanent pacemaker implantation in the Ozaki group (1,6%,р = 0,042). For the remaining postoperative complications (myocardial infarction, stroke, bleeding), no significant differences between the groups were detected. Postoperative peak and mean transvalvular gradients was lower in the group 3 (12.5 ± 5.2 mm Hg and 6.3 ± 3.0 mm Hg, respectively, p<0,001). The effective orifice area and indexed effective orifice area was greater in the Ozaki group (p<0,001). 3 (14%) patients of the 1st group and 3 patients (9%) of the 2nd group had a moderate patient-prosthetic mismatch, while in group 3 there were no such cases (p <0.001).

Conclusions. Ozaki procedure compared to the stented bioprosthesis androot enlargementshows lower peak and mean pressure gradient, larger effective orifice area and indexed effective orifice area.This procedure may be one of the option for small aortic annuls, especially in patients with prognosis higher risk of prosthesis-patient mismatch.