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Indian Journal of Thoracic and Cardiovascular Surgery

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22.02.2021 | Review Article

Aortic root widening: “pro et contra”

verfasst von: Balaji Srimurugan, Neethu Krishna, Rajesh Jose, Kirun Gopal, Praveen Kerala Varma

Erschienen in: Indian Journal of Thoracic and Cardiovascular Surgery | Sonderheft 1/2022

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Abstract

In patients with a small aortic annulus, the clinical benefits of aortic valve replacement depend on avoidance of patient-prosthesis mismatch as it is associated with reduced overall survival. Aortic root widening or enlargement is a useful technique to implant larger valve prosthesis to prevent patient-prosthesis mismatch. Posterior annular enlargement is the commonest technique used for aortic root enlargement. Consistent enlargement of the aortic root requires more extensive procedures like Manouguian or Konno-Rastan techniques. The patients commonly selected are younger patients with good life expectancy. However, caution is advised in applying this procedure in elderly patients, patients with heavily calcified annulus and when performing concomitant procedures. There is no definitive conclusion on the best material to use for the reconstruction of aortic annulus and aorta in aortic root enlargement procedures.

Horstkotte D, Loogen F. The natural history of aortic valve stenosis. Eur Heart J. 1988;9:57–64.PubMedCrossRef

Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:2440–92.PubMedCrossRef

Chambers J. Echocardiography and the small aortic root. J Heart Valve Dis. 1996;5:S264–8.PubMed

Ghosh P, Kumar S, Pandey S, Kumar AS, Sinha N. Small aortic annulus: a functional definition. Ann Thorac Cardiovasc Surg. 1998;4:251–61.PubMed

Freitas-Ferraz AB, Tirado-Conte G, Dagenais F, et al. Aortic stenosis and small aortic annulus. Circulation. 2019;139:2685–702.PubMedCrossRef

Muraru D, Maffessanti F, Kocabay G, et al. Ascending aorta diameters measured by echocardiography using both leading edge-to-leading edge and inner edge-to-inner edge conventions in healthy volunteers. Eur Heart J Cardiovasc Imaging. 2014;15:415–22.PubMedCrossRef

Bahlmann E, Cramariuc D, Minners J, et al. Small aortic root in aortic valve stenosis: clinical characteristics and prognostic implications. Eur Heart J Cardiovasc Imaging. 2017;18:404–12.PubMed

Rossebø AB, Pedersen TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008;359:1343–56.PubMedCrossRef

Doty JR, Raza S, Sabik JF III. Chapter 11-Aortic root enlargement techniques. In: Atlas of Cardiac Surgical Techniques: Elsevier; 2019. p. 156–76.

10.

Rahimtoola SH. Choice of prosthetic heart valve in adults an update. J Am Coll Cardiol. 2010;55:2413–26.PubMedCrossRef

11.

Koch CG, Khandwala F, Estafanous FG, Loop FD, Blackstone EH. Impact of prosthesis-patient size on functional recovery after aortic valve replacement. Circulation. 2005;111:3221–9.PubMedCrossRef

12.

Medalion B, Blackstone EH, Lytle BW, White J, Arnold JH, Cosgrove DM. Aortic valve replacement: is valve size important? J Thorac Cardiovasc Surg. 2000;119:963–74.PubMedCrossRef

13.

Cano Ó, Andrés A, Alonso P, et al. Incidence and predictors of clinically relevant cardiac perforation associated with systematic implantation of active-fixation pacing and defibrillation leads: a single-centre experience with over 3800 implanted leads. Europace. 2017;19:96–102.PubMed

14.

Dhareshwar J, Sundt TM 3rd, Dearani JA, Schaff HV, Cook DJ, Orszulak TA. Aortic root enlargement: what are the operative risks? J Thorac Cardiovasc Surg. 2007;134:916–24.PubMedCrossRef

15.

Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: definition, clinical impact, and prevention. Heart. 2006;92:1022–9.PubMedCrossRef

16.

Lazar HL. Aortic root enlargement-is it a safe and effective approach to prevent patient-prosthesis mismatch and is it for everyone? Can J Cardiol. 2019;35:707–9.PubMedCrossRef

17.

Dayan V, Vignolo G, Soca G, Paganini JJ, Brusich D, Pibarot P. Predictors and outcomes of prosthesis-patient mismatch after aortic valve replacement. JACC Cardiovasc Imaging. 2016;9:924–33.PubMedCrossRef

18.

Chen J, Lin Y, Kang B, Wang Z. Indexed effective orifice area is a significant predictor of higher mid- and long-term mortality rates following aortic valve replacement in patients with prosthesis-patient mismatch. Eur J Cardiothorac Surg. 2014;45:234–40.PubMedCrossRef

19.

Head SJ, Mokhles MM, Osnabrugge RLJ, et al. The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27186 patients with 133141 patient-years. Eur Heart J. 2012;33:1518–29.PubMedCrossRef

20.

Takagi H, Yamamoto H, Iwata K, Goto SN, Umemoto T. A meta-analysis of effects of prosthesis-patient mismatch after aortic valve replacement on late mortality. Int J Cardiol. 2012;159:150–4.PubMedCrossRef

21.

Fallon JM, DeSimone JP, Brennan JM, et al. The incidence and consequence of prosthesis-patient mismatch aftersurgical aortic valve replacement. Ann Thorac Surg. 2018;106:14–22.PubMedCrossRef

22.

Tasca G, Mhagna Z, Perotti S, et al. Impact of prosthesis-patient mismatch on cardiac events and midterm mortality after aortic valve replacement in patients with pure aortic stenosis. Circulation. 2006;113:570–6.PubMedCrossRef

23.

Rao V, Jamieson WR, Ivanov J, Armstrong S, David TE. Prosthesis-patient mismatch affects survival after aortic valve replacement. Circulation. 2000;102:III5–9.PubMedCrossRef

24.

Blais C, Dumesnil JG, Baillot R, Simard S, Doyle D, Pibarot P. Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Circulation. 2003;108:983–8.PubMedCrossRef

25.

Coutinho GF, Correia PM, Paupério G, de Oliveira F, Antunes MJ. Aortic root enlargement does not increase the surgical risk and short-term patient outcome? Eur J Cardiothorac Surg. 2011;40:441–7.PubMed

26.

Badano LP, Pavoni D, Musumeci S, et al. Stented bioprosthetic valve hemodynamics: is the supra-annular implant better than the intra-annular? J Heart Valve Dis. 2006;15:238–46.PubMed

27.

Vriesendorp MD, de Lind van Wijngaarden RAF, Rao V, et al. An in vitro comparison of internally versus externally mounted leaflets in surgical aortic bioprostheses. Interact Cardiovasc Thorac Surg2020; 30:417–423.

28.

Anderson RH. Clinical anatomy of the aortic root. Heart. 2000;84:670–3.PubMedPubMedCentralCrossRef

29.

Piazza N, de Jaegere P, Schultz C, Becker AE, Serruys PW, Anderson RH. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv. 2008;1:74–81.PubMedCrossRef

30.

Becker AE. Surgical and pathological anatomy of the aortic valve and root. Oper Tech Cardiac Thorac Surg. 1996;1:3–14.CrossRef

31.

Hanneman K, Chan FP, Mitchell RS, Miller DC, Fleischmann D. Pre- and postoperative imaging of the aortic root. Radiographics. 2016;36:19–37.PubMedCrossRef

32.

Hosseinpour AR, Anderson RH, Ho SY. The anatomy of the septal perforating arteries in normal and congenitally malformed hearts. J Thorac Cardiovasc Surg. 2001;121:1046–52.PubMedCrossRef

33.

Baumgartner H, Falk V, Bax JJ, et al. ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–91.PubMedCrossRef

34.

Nezić D, Knezević A, Borović S. Surgical techniques for posterior aortic root enlargement. J Thorac Cardiovasc Surg. 2008;135:1401–2.PubMedCrossRef

35.

Nicks R, Cartmill T, Bernstein L. Hypoplasia of the aortic root. The problem of aortic valve replacement. Thorax. 1970;25:339–46.PubMedPubMedCentralCrossRef

36.

Nuñez L, Aguado MG, Pinto AG, Larrea JL. Enlargement of the aortic annulus by resecting the commissure between the left and noncoronary cusps. Tex Heart Inst J. 1983;10:301–3.PubMedPubMedCentral

37.

Manouguian S, Seybold-Epting W. Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique. J Thorac Cardiovasc Surg. 1979;78:402–12.PubMedCrossRef

38.

Kawachi Y, Tominaga R, Tokunaga K. Eleven-year follow-up study of aortic or aortic-mitral anulus-enlarging procedure by Manouguian's technique. J Thorac Cardiovasc Surg. 1992;104:1259–63.PubMedCrossRef

39.

Konno S, Imai Y, Iida Y, Nakajima M, Tatsuno K. A new method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic valve ring. J Thorac Cardiovasc Surg. 1975;70:909–17.PubMedCrossRef

40.

Losenno KL, Gelinas JJ, Johnson M, Chu MWA. Defining the efficacy of aortic root enlargement procedures: a comparative analysis of surgical techniques. Can J Cardiol. 2013;29:434–40.PubMedCrossRef

41.

Nakano S, Matsuda H, Shimazaki Y, et al. An appraisal of patch enlargement of the small aortic annulus in 33 patients undergoing aortic valve replacement. Eur J Cardiothorac Surg. 1992;6:347–9.PubMedCrossRef

42.

Hartrumpf M, Albes JM, Krempl T, Rudolph V, Wahlers T. The hemodynamic performance of standard bileaflet valves is impaired by a tilted implantation position. Eur J Cardiothorac Surg. 2003;23:283–91.PubMedCrossRef

43.

Rastan H, Atai M, Hadi H, Yazdanyr A. Enlargement of mitral valvular ring. New technique for double valve replacement in children or adults with small mitral annulus. J Thorac Cardiovasc Surg. 1981;81:106–11.PubMedCrossRef

44.

Manouguian S, Kirchhoff PG. Aortic and aortic-mitral annular enlargement. J Thorac Cardiovasc Surg. 1996;112:207.PubMedCrossRef

45.

Rastan D. Aortic and aortic-mitral annular enlargement. J Thorac Cardiovasc Surg. 1995;109:818–9.PubMedCrossRef

46.

Sankar NM, Rajan S, Kalyan Singh RK, Cherian KM. Enlargement of small aortic annulus by modified Manouguian’stechnique. Asian Cardiovasc Thorac Ann. 1999;7:282–6.CrossRef

47.

Cobanoglu A, Thyagarajan GK, Dobbs J. Konno-aortoventriculoplasty with mechanical prosthesis in dealing with small aortic root: a good surgical option. Eur J Cardiothorac Surg. 1997;12:766–70.PubMedCrossRef

48.

Kinskey RH, Antune MJ, McKibbin JK. Enlargement of the narrow aortic root and oblique insertion of St Jude prosthesis. Br Heart J. 1983;50:330–2.CrossRef

49.

Reddy VM, Rajasinghe HA, Teitel DF, Haas GS, Hanley FL. Aortoventriculoplasty with the pulmonary autograft: the “Ross-Konno” procedure. J Thorac Cardiovasc Surg. 1996;111:158–65.PubMedCrossRef

50.

Doty JR, Salazar JD, Liddicoat JR, Flores JH, Doty DB. Aortic valve replacement with cryopreserved aortic allograft: ten-year experience. J Thorac Cardiovasc Surg. 1998;115:371–9.PubMedCrossRef

51.

Pettersson G, Tingleff J, Joyce FS. Treatment of aortic valve endocarditis with the Ross operation. Eur J Cardiothorac Surg. 1998;13:678–84.PubMedCrossRef

52.

Kayalar N, Schaff HV, Daly RC, Dearani JA, Park SJ. Concomitant septal myectomy at the time of aortic valve replacement for severe aortic stenosis. Ann Thorac Surg. 2010;89:459–64.PubMedCrossRef

53.

Manouguian S, Abu-Aishah N, Neitzel J. Patch enlargement of the aortic and mitral valve rings with aortic and mitral double valve replacement. Experimental study. J Thorac Cardiovasc Surg. 1979;78:394–401.PubMedCrossRef

54.

Manouguian S, Kirchhoff PG. Patch enlargement of the aortic and the mitral valve rings with aortic-mitral double-valve replacement. Ann Thorac Surg. 1980;30:396–9.PubMedCrossRef

55.

Zhong Q, Xiao Y, Chen J, Ma R. Strategy of aortic root enlargement in patients undergoing aortic and mitral valve replacement. Ann Thorac Surg. 2010;90:782–7.PubMedCrossRef

56.

Sa´ MPBO, Carvalho MMB, Sobral Filho DC, et al. Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13174 patients. Interact Cardiovasc Thorac Surg. 2019;29:74–82.PubMedCrossRef

57.

Yu W, Tam DY, Rocha RV, Makhdoum A, Ouzounian M, Fremes SE. Aortic root enlargement is safe and reduces the incidence of patient-prosthesis mismatch: ameta-analysis of early and late outcomes. Can J Cardiol. 2019;35:782–90.PubMedCrossRef

58.

Correia PM, Coutinho GF, Branco C, Antunes MJ. Long-term follow-up of patients undergoing aortic root enlargement for insertion of a larger prosthesis. Eur J Cardiothorac Surg. 2016;50:82–8.PubMedCrossRef

59.

Kitamura M, Satoh M, Hachida M, Endo M, Hashimoto A, Koyanagi H. Aortic valve replacement in small aortic annulus with or without annular enlargement. J Heart Valve Dis. 1996;5:S289–93.PubMed

60.

Rocha RV, Manlhiot C, Feindel CM, et al. Surgical enlargement of the aortic root does not increase the operative risk of aortic valve replacement. Circulation. 2018;137:1585–94.PubMedCrossRef

61.

Tam DY, Dharma C, Rocha RV, et al. Early and late outcomes following aortic root enlargement: a multicentre propensity score-matched cohort analysis. J Thorac Cardiovasc Surg. 2020;160:908–919.e15.PubMedCrossRef

62.

Sommers KE, David TE. Aortic valve replacement with patch enlargement of the aortic annulus. Ann Thorac Surg. 1997;63:1608–12.PubMedCrossRef

63.

Peterson MD, Borger MA, Feindel CM, David TE. Aortic annular enlargement during aortic valve replacement: improving results with time. Ann Thorac Surg. 2007;83:2044–9.PubMedCrossRef

64.

Svensson LG, Adams DH, Bonow RO, et al. Aortic valve and ascending aorta guidelines for management and quality measures. Ann Thorac Surg. 2013;95:S1–S66.PubMedCrossRef

65.

Kilic T, Yilmaz I. Transcatheter aortic valve implantation: a revolution in the therapy of elderly and high-risk patients with severe aortic stenosis. J Geriatr Cardiol. 2017;14:204–17.PubMedPubMedCentral

66.

Ozaki S, Kawase I, Yamashita H, et al. Aortic valve reconstruction using autologous pericardium for aortic stenosis. Circ J. 2015;79:1504–10.PubMedCrossRef

67.

Elmistekawy E, Lapierre H, Mesana T, Ruel M. Apico-aortic conduit for severe aortic stenosis: technique, applications, and systematic review. J Saudi Heart Assoc. 2010;22:187–94.PubMedPubMedCentralCrossRef

68.

Chowdhury U, Singh S, George N, et al. Early evaluation of the aortic root after Nicks’ procedure. JTCVS Tech. 2020. https://doi.org/10.1016/j.xjtc.2020.08.017.

69.

Chowdhury UK, Sankhyan LK, George N, et al. Posterior aortic root enlargement (Nick’s procedure), mechanical aortic valve replacement and patch closure of the sacciform proximal aortic arch aneurysm by “open” technique without circulatory arrest: a video presentation. Int Med. 2020;2:92–5.CrossRef

70.

Piehler JM, Danielson GK, Pluth JR, et al. Enlargement of the aortic root or annulus with autogenous pericardial patch during aortic valve replacement. Long-term follow-up. J Thorac Cardiovasc Surg. 1983;86:350–8.PubMedCrossRef

71.

Kinsley RH. The narrow aortic annulus. A technique for inserting a larger prosthesis. Am Heart J. 1977;93:759–61.PubMedCrossRef

72.

Brinster DR, Patel JA. The use of CorMatrix extracellular matrix for aortic root enlargement. J Cardiothorac Surg. 2014;9:178.PubMedPubMedCentralCrossRef

73.

Dalichau H, Hannekum A, Niehues B, Irion A, Herse B. Hemodynamic and angiographic late results following enlargement of narrow aortic root using autologous pericardium in prosthetic aortic valve replacement. Thorac Cardiovasc Surg. 1985;33:288–95.PubMedCrossRef

74.

Borracci RA, Rubio M, Camargo RLP, Archer M, Ingino C. Aortic root enlargement of a small annulus using the Nick’s technique during aortic valve replacement. Rev Argent Cardiol. 2014;82:504–7.

75.

Morisaki A, Kato Y, Motoki M, Takahashi Y, Nishimura S, Shibata T. Rupture of equine pericardial aortic-root patch after aortic valve replacement with aortic annulus enlargement: a case report. J Cardiothorac Surg. 2014;9:109.PubMedPubMedCentralCrossRef

76.

Quarti A, Nardone S, Colaneri M, Santoro G, Pozzi M. Preliminary experience in the use of an extracellular matrix to repair congenital heart diseases. Interact Cardiovasc Thorac Surg. 2011;13:569–72.PubMedCrossRef

77.

Gerdisch MW, Akinwande AO, Matheny RG. Use of a novel acellular xenograft as a patch for aortic annular enlargement during aortic valve replacement. Innovations (Phila). 2010;5:60–2.CrossRef

Titel: Aortic root widening: “pro et contra”
verfasst von: Balaji Srimurugan
Neethu Krishna
Rajesh Jose
Kirun Gopal
Praveen Kerala Varma
Publikationsdatum: 22.02.2021
Verlag: Springer Singapore
Erschienen in: Indian Journal of Thoracic and Cardiovascular Surgery / Ausgabe Sonderheft 1/2022
Print ISSN: 0970-9134
Elektronische ISSN: 0973-7723
DOI: https://doi.org/10.1007/s12055-020-01125-6

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