This preprint is under consideration at Journal of Cardiothoracic Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research article
Aortic Root Enlargement in patients with small aortic annulus undergoing double valve replacement. A retrospective Comparative cohort study
Yasser Shaban Mubarak
Cardiothoracic surgery department
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3068-1607
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Objectives
Small Aortic Annulus (AA) is big issue during Aortic Valve Replacement (AVR) necessitating replacement of inappropriate-sized prostheses especially during Double Valve Replacement (DVR). Despite that small aortic valve prostheses can lead to Prosthesis-Patient Mismatch (PPM), there remains reluctance to perform aortic root enlargement (ARE) procedures fearing from morbidity and mortality. We evaluate clinical and echocardiographic outcomes in patients with small AA undergoing DVR.
Methods
The study included 100 consecutive patients underwent DVR for combined rheumatic aortic and mitral valve diseases, between June 2016 and November 2020. Only (50) patients had ARE with DVR. ARE was performed using an autologous or bovine pericardium or Dacron patch by Nick′s or Manouguian procedures. The estimated post-operative end-points were mortality, effective orifice areas (EOA), mean aortic pressure gradient and valve-related complications. The least post-operative follow-up period was 6 months.
Results
The study included 30 male and 70 female patients with mean age of 45 ± 10 years, body surface area (BSA) of 1.6 ± 0.50 m2, aortic annulus diameter was 20 ± 0.4 mm, EOAi was 0.80 ± 0.50 cm2/m2, and aortic mean gradient (PG) 80 ± 40 mm Hg. During follow-up period, there was a mild paravalvular leak (1%) with, (1%) heart block, and residual mean PG on prosthetic aortic valve with all cases of DVR alone.
Conclusion
Enlargement of aortic root by Nick′s or Manouguian technique is safe and effective in patients with small aortic annulus undergoing double valve replacements.
Keywords
Aortic root enlargement, Manouguian procedure, Nick's procedure, Small aortic annulus, double valve replacement
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This preprint is under consideration at Journal of Cardiothoracic Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Aortic Root Enlargement in patients with small aortic annulus undergoing double valve replacement. A retrospective Comparative cohort study
Yasser Shaban Mubarak
Cardiothoracic surgery department
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3068-1607
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 23 Dec, 2020
No community comments so far
First submitted
On 16 Dec, 2020
Editor assigned
On 16 Dec, 2020
Submission checks complete
On 16 Dec, 2020
Editor invited
On 16 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Objectives
Small Aortic Annulus (AA) is big issue during Aortic Valve Replacement (AVR) necessitating replacement of inappropriate-sized prostheses especially during Double Valve Replacement (DVR). Despite that small aortic valve prostheses can lead to Prosthesis-Patient Mismatch (PPM), there remains reluctance to perform aortic root enlargement (ARE) procedures fearing from morbidity and mortality. We evaluate clinical and echocardiographic outcomes in patients with small AA undergoing DVR.
Methods
The study included 100 consecutive patients underwent DVR for combined rheumatic aortic and mitral valve diseases, between June 2016 and November 2020. Only (50) patients had ARE with DVR. ARE was performed using an autologous or bovine pericardium or Dacron patch by Nick′s or Manouguian procedures. The estimated post-operative end-points were mortality, effective orifice areas (EOA), mean aortic pressure gradient and valve-related complications. The least post-operative follow-up period was 6 months.
Results
The study included 30 male and 70 female patients with mean age of 45 ± 10 years, body surface area (BSA) of 1.6 ± 0.50 m2, aortic annulus diameter was 20 ± 0.4 mm, EOAi was 0.80 ± 0.50 cm2/m2, and aortic mean gradient (PG) 80 ± 40 mm Hg. During follow-up period, there was a mild paravalvular leak (1%) with, (1%) heart block, and residual mean PG on prosthetic aortic valve with all cases of DVR alone.
Conclusion
Enlargement of aortic root by Nick′s or Manouguian technique is safe and effective in patients with small aortic annulus undergoing double valve replacements.
Figure 1
Figure 2
Figure 3