Aortic root enlargement to mitigate patient-prosthesis mismatch: do early adverse events justify reluctance?†

European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery
Josephina HaunschildChristian D Etz

Abstract

Concomitant aortic root enlargement (ARE) at the time of surgical aortic valve replacement can be performed to avoid patient-prosthesis mismatch, an important predictor of adverse long-term outcome. We performed a single-centre, retrospective analysis of 4120 patients receiving isolated aortic valve replacement, of whom 171 (4%) had concomitant ARE between January 2005 and December 2015. The analysis of postoperative outcome and early mortality was performed. Owing to inequality of the groups, patients were matched 1:1. The mean age of all 4120 patients was 68.8 ± 10.5 years, and comorbidities were equally balanced after matching. The mean aortic cross-clamp time, cardiopulmonary bypass time and total operative time were prolonged by 19, 20 and 27 min in the ARE group, respectively. Early mortality was not statistically significantly different with 1.4% in the surgical aortic valve replacement and 1.8% in the ARE group. Postoperative complications were <5% in all matched 338 patients: bleeding (3% vs 3%), pericardial effusion (3.0% vs 4.2%), sternal instability (1.8% vs 0%) and sternal wound infection (3.0% vs 1.2%). A significant higher number of patients had respiratory failure after ARE (unmatched: 17.1% vs 9.9%, P < 0.001; ...Continue Reading

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Citations

Jul 12, 2020·Journal of Cardiac Surgery·Manuel J Antunes
Dec 13, 2019·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Michiel D VriesendorpRobert J M Klautz
Oct 31, 2020·Journal of Cardiac Surgery·Samuel A MassiasAmer Harky
Mar 10, 2021·The Journal of Thoracic and Cardiovascular Surgery·Kevin L Greason
Jul 6, 2020·Seminars in Thoracic and Cardiovascular Surgery·Michel Pompeu B O SáRicardo C Lima
Sep 24, 2020·Seminars in Thoracic and Cardiovascular Surgery·Gaetano Paone
Nov 27, 2019·The Annals of Thoracic Surgery·Hiroto KitaharaVinod H Thourani
Jul 29, 2021·JTCVS Techniques·Manuel J Antunes

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