Autopericardial neocuspidization in patients with small aortic annulus
Abstract
Introduction. Some patients with aortic valve (AV) disease have small aortic annulus. This anatomical feature can lead to prosthesispatient mismatch after AV replacement.
Objective. To improve postoperative outcomes in patients with AV disease and small aortic annulus.Material and methods. We retrospectively analyzed 77 patients with small aortic annulus divided into 2 groups: group 1 (n=49) —
autopericardial neocuspidization (AVNeo) of the aortic valve, group 2 (n=28) — aortic root enlargement and standard aortic valve
replacement using mechanical or biological prostheses. Analysis of comorbidities found no differences between groups.
Results. In-hospital mortality was similar (2,1% (n=1) and 7.1% (n=2), respectively, p=0.321). Survival rate was 96% and 74%, respectively (p=0.04), cumulative freedom from MACE — 95% and 53% (p=0.03), freedom from redo surgery — 95% and 80%, respectively (p=0.381). Duration of cardiopulmonary bypass and myocardial ischemia was similar: 113,84±36,03 vs 116.61±25.01 min,
(p=0.71); 86.74±23.19 vs 91.04±22.71 min, respectively (p=0.404). The incidence of permanent pacemaker implantations was significantly higher in group 2: 6 (21.4%) vs 2 (4.1%) cases (p=0.039). In early postoperative period, transvalvular peak blood flow
velocity (p<0.01) and pressure gradient (p<0.01) significantly decreased in the 1st group compared to the 2nd group. Mean transvalvular pressure gradient in mid-term period was significantly lower in the AVNeo group (p=0.001).
Conclusion. AVNeo in patients with small annulus demonstrates the advantages over aortic root enlargement regarding mid-term
results due to better hemodynamic parameters after surgery.
References
Wilbring M, Alexiou K, Schumann E, Matschke K, Tugtekin SM. Isolated aortic valve replacement in patients with small aortic annulus-a high-risk group on long-term follow-up. Thorac Cardiovasc Surg. 2013;61(5):379-85. https://doi.org/10.1055/s-0032-1331577
Bahlmann E, Cramariuc D, Minners J, Lønnebakken MT, Ray S, GohlkeBaerwolf C, Nienaber CA, Jander N, Seifert R, Chambers JB, Kuck KH, Gerdts E. Small aortic root in aortic valve stenosis: clinical characteristics and prognostic implications. Eur Heart J Cardiovasc Imaging. 2017;18(4):404-412. https://doi.org/10.1093/ehjci/jew159
The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed Little, Brown & Co; Boston, Mass: 1994: 253-256.
Sá MPBO, Carvalho MMB, Sobral Filho DC, Cavalcanti LRP, Diniz RGS, Rayol SC, Soares AMMN, Sá FBCA, Menezes AM, Clavel MA, Pibarot P, Lima RC. Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients. Interact Cardiovasc Thorac Surg. 2019;29(1):74-82. https://doi.org/10.1093/icvts/ivy364
Unai S, Ozaki S, Johnston DR, Saito T, Rajeswaran J, Svensson LG, Blackstone EH, Pettersson GB. Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure in Perspective. J Am Heart Assoc. 2023;12(2):e027391. https://doi.org/10.1161/JAHA.122.027391
Vural U, Aglar AA, Kizilay M. Which method should be preferred in narrow aortic roots? Risks and prognoses of Manouguian and Nicks procedures. Pak Heart J. 2019;52(4):338-348.
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(4):434-440. https://doi.org/10.1016/j.cjca.2012.04.012
Pompeu MSá, Chernov I, Marchenko A, Chagyan V, Komarov R, Askadinov M, Enginoev S, Kadyraliev B, Ismailbaev A, Tcheglov M, Clavel M, Pibarot P, Ruhparwar A, Zhigalov AWK. Aortic Valve Neocuspidization (Ozaki Procedure) in Patients with Small Aortic Annulus (≤21 mm): A Multicenter Study. Structural Heart. 2020;4(5),413-419. https://doi.org/10.1080/24748706.2020.1792595
Mylonas KS, Tasoudis PT, Pavlopoulos D, Kanakis M, Stavridis GT, Avgerinos DV. Aortic valve neocuspidization using the Ozaki technique: A metaanalysis of reconstructed patient-level data. Am Heart J. 2023;255:1-11. https://doi.org/10.1016/j.ahj.2022.09.003
Benedetto U, Sinha S, Dimagli A, Dixon L, Stoica S, Cocomello L, Quarto C, Angelini GD, Dandekar U, Caputo M. Aortic valve neocuspidization with autologous pericardium in adult patients: UK experience and meta-analytic comparison with other aortic valve substitutes. Eur J Cardiothorac Surg. 2021;60(1):34-46. https://doi.org/10.1093/ejcts/ezaa472
