To minimize postoperative gradients and left ventricular outflow tract obstruction, posterior enlargement of the small aortic annulus using the Nicks–Nunez surgical approach was performed in 20 patients. To evaluate the risks and benefits of aortic root enlargement (ARE), we examined the outcomes of patients with small aortic roots who underwent aortic valve replacement (AVR) with or without the use of ARE. This prospective study included forty patients with aortic valve stenosis or double aortic valve lesion (stenosis and regurgitation) and has an aortic annular diameter 2 cm or less admitted at Cardiac Surgery Department at Al- Hussein hospital, Al Azhar University, in the period between January 2009 and December 2011. Those patients were equally divided into two groups: Group A who underwent aortic valve replacement with mechanical prosthetic valve size 19 mm, and Group B who underwent aortic root enlargement procedure concomitant with aortic valve replacement. Nicks type of aortic root dilation was done to insert larger mechanical prosthetic valve size ≥ 21 mm. Although the operative time has increased significantly with ARE procedures, the benefits of the procedures in inserting larger valves (21mm in 16 patients and 23mm prosthesis in 4 patients) with larger effective orifice area cannot be negated. The mortality was 0% among both groups. The incidence of morbidity was slightly higher in group ARE+AVR but not statistically significant. We concluded that aortic annular enlargement was a safe procedure with good hemodynamic results if performed by trained surgeons to avoid patient prosthesis mismatch. |
