Aortic root enlargement in octogenarian patients results in less patient prosthesis mismatch

Juan G. Penaranda, Kevin L. Greason, Sorin V. Pislaru, Hartzell V Schaff, Richard C. Daly, Soon J. Park, Rakesh M. Suri, Harold M. Burkhart, Lyle D. Joyce, John M. Stulak, Joseph A. Dearani

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background Aortic root enlargement has not been well studied as a modality to prevent patient prosthesis mismatch in octogenarian patients with a small aortic root. Methods We reviewed the records of 117 octogenarian patients who received surgical aortic valve replacement (AVR) between 1993 and 2010. From this group, 87 patients received a 19-mm AVR (small aortic valve, SAV group) and 30 received an aortic root enlargement and a 21-mm AVR (aortic root enlargement, ARE group). Results The median age of the patients was 84 years (range, 80 to 93) and there were 111 women (95%). Aortic cross-clamp time was 50 minutes (26 to 116) in the SAV group and 67 (26 to 136) in the ARE group (p = 0.02). There were no differences in the operative morbidity or morality rates between the groups. Postoperative aortic valve area index was 0.77 cm 2/m2 (0.25 to 1.47) in the SAV group and 1.06 (0.51 to 1.94) in the ARE group (p<0.001). Severe patient prosthesis mismatch occurred in 23 patients (32%) in the SAV group in comparison with 3 (12%) in the ARE group (p = 0.04). There were no differences in the mid-term outcomes of New York Heart Association functional class (p = 0.230) or survival between patients with or without mismatch (p = 0.84). Conclusions Aortic root enlargement in octogenarian patients allows for insertion of larger aortic valve prostheses without any apparent increase in operative morbidity or mortality. The larger prostheses demonstrate better hemodynamic performance and less patient prosthesis mismatch, but no apparent functional or survival advantage.

Original languageEnglish (US)
Pages (from-to)1533-1538
Number of pages6
JournalAnnals of Thoracic Surgery
Volume97
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Prostheses and Implants
Aortic Valve
Morbidity
Survival
Surgical Instruments
Hemodynamics
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Penaranda, J. G., Greason, K. L., Pislaru, S. V., Schaff, H. V., Daly, R. C., Park, S. J., ... Dearani, J. A. (2014). Aortic root enlargement in octogenarian patients results in less patient prosthesis mismatch. Annals of Thoracic Surgery, 97(5), 1533-1538. https://doi.org/10.1016/j.athoracsur.2013.11.050

Aortic root enlargement in octogenarian patients results in less patient prosthesis mismatch. / Penaranda, Juan G.; Greason, Kevin L.; Pislaru, Sorin V.; Schaff, Hartzell V; Daly, Richard C.; Park, Soon J.; Suri, Rakesh M.; Burkhart, Harold M.; Joyce, Lyle D.; Stulak, John M.; Dearani, Joseph A.

In: Annals of Thoracic Surgery, Vol. 97, No. 5, 2014, p. 1533-1538.

Research output: Contribution to journalArticle

Penaranda, JG, Greason, KL, Pislaru, SV, Schaff, HV, Daly, RC, Park, SJ, Suri, RM, Burkhart, HM, Joyce, LD, Stulak, JM & Dearani, JA 2014, 'Aortic root enlargement in octogenarian patients results in less patient prosthesis mismatch', Annals of Thoracic Surgery, vol. 97, no. 5, pp. 1533-1538. https://doi.org/10.1016/j.athoracsur.2013.11.050
Penaranda, Juan G. ; Greason, Kevin L. ; Pislaru, Sorin V. ; Schaff, Hartzell V ; Daly, Richard C. ; Park, Soon J. ; Suri, Rakesh M. ; Burkhart, Harold M. ; Joyce, Lyle D. ; Stulak, John M. ; Dearani, Joseph A. / Aortic root enlargement in octogenarian patients results in less patient prosthesis mismatch. In: Annals of Thoracic Surgery. 2014 ; Vol. 97, No. 5. pp. 1533-1538.
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abstract = "Background Aortic root enlargement has not been well studied as a modality to prevent patient prosthesis mismatch in octogenarian patients with a small aortic root. Methods We reviewed the records of 117 octogenarian patients who received surgical aortic valve replacement (AVR) between 1993 and 2010. From this group, 87 patients received a 19-mm AVR (small aortic valve, SAV group) and 30 received an aortic root enlargement and a 21-mm AVR (aortic root enlargement, ARE group). Results The median age of the patients was 84 years (range, 80 to 93) and there were 111 women (95{\%}). Aortic cross-clamp time was 50 minutes (26 to 116) in the SAV group and 67 (26 to 136) in the ARE group (p = 0.02). There were no differences in the operative morbidity or morality rates between the groups. Postoperative aortic valve area index was 0.77 cm 2/m2 (0.25 to 1.47) in the SAV group and 1.06 (0.51 to 1.94) in the ARE group (p<0.001). Severe patient prosthesis mismatch occurred in 23 patients (32{\%}) in the SAV group in comparison with 3 (12{\%}) in the ARE group (p = 0.04). There were no differences in the mid-term outcomes of New York Heart Association functional class (p = 0.230) or survival between patients with or without mismatch (p = 0.84). Conclusions Aortic root enlargement in octogenarian patients allows for insertion of larger aortic valve prostheses without any apparent increase in operative morbidity or mortality. The larger prostheses demonstrate better hemodynamic performance and less patient prosthesis mismatch, but no apparent functional or survival advantage.",
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T1 - Aortic root enlargement in octogenarian patients results in less patient prosthesis mismatch

AU - Penaranda, Juan G.

AU - Greason, Kevin L.

AU - Pislaru, Sorin V.

AU - Schaff, Hartzell V

AU - Daly, Richard C.

AU - Park, Soon J.

AU - Suri, Rakesh M.

AU - Burkhart, Harold M.

AU - Joyce, Lyle D.

AU - Stulak, John M.

AU - Dearani, Joseph A.

PY - 2014

Y1 - 2014

N2 - Background Aortic root enlargement has not been well studied as a modality to prevent patient prosthesis mismatch in octogenarian patients with a small aortic root. Methods We reviewed the records of 117 octogenarian patients who received surgical aortic valve replacement (AVR) between 1993 and 2010. From this group, 87 patients received a 19-mm AVR (small aortic valve, SAV group) and 30 received an aortic root enlargement and a 21-mm AVR (aortic root enlargement, ARE group). Results The median age of the patients was 84 years (range, 80 to 93) and there were 111 women (95%). Aortic cross-clamp time was 50 minutes (26 to 116) in the SAV group and 67 (26 to 136) in the ARE group (p = 0.02). There were no differences in the operative morbidity or morality rates between the groups. Postoperative aortic valve area index was 0.77 cm 2/m2 (0.25 to 1.47) in the SAV group and 1.06 (0.51 to 1.94) in the ARE group (p<0.001). Severe patient prosthesis mismatch occurred in 23 patients (32%) in the SAV group in comparison with 3 (12%) in the ARE group (p = 0.04). There were no differences in the mid-term outcomes of New York Heart Association functional class (p = 0.230) or survival between patients with or without mismatch (p = 0.84). Conclusions Aortic root enlargement in octogenarian patients allows for insertion of larger aortic valve prostheses without any apparent increase in operative morbidity or mortality. The larger prostheses demonstrate better hemodynamic performance and less patient prosthesis mismatch, but no apparent functional or survival advantage.

AB - Background Aortic root enlargement has not been well studied as a modality to prevent patient prosthesis mismatch in octogenarian patients with a small aortic root. Methods We reviewed the records of 117 octogenarian patients who received surgical aortic valve replacement (AVR) between 1993 and 2010. From this group, 87 patients received a 19-mm AVR (small aortic valve, SAV group) and 30 received an aortic root enlargement and a 21-mm AVR (aortic root enlargement, ARE group). Results The median age of the patients was 84 years (range, 80 to 93) and there were 111 women (95%). Aortic cross-clamp time was 50 minutes (26 to 116) in the SAV group and 67 (26 to 136) in the ARE group (p = 0.02). There were no differences in the operative morbidity or morality rates between the groups. Postoperative aortic valve area index was 0.77 cm 2/m2 (0.25 to 1.47) in the SAV group and 1.06 (0.51 to 1.94) in the ARE group (p<0.001). Severe patient prosthesis mismatch occurred in 23 patients (32%) in the SAV group in comparison with 3 (12%) in the ARE group (p = 0.04). There were no differences in the mid-term outcomes of New York Heart Association functional class (p = 0.230) or survival between patients with or without mismatch (p = 0.84). Conclusions Aortic root enlargement in octogenarian patients allows for insertion of larger aortic valve prostheses without any apparent increase in operative morbidity or mortality. The larger prostheses demonstrate better hemodynamic performance and less patient prosthesis mismatch, but no apparent functional or survival advantage.

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