Original articleCardiovascularAortic Annular Enlargement During Aortic Valve Replacement: Improving Results With Time
Section snippets
Patients and Methods
We reviewed prospectively collected data on all patients undergoing AVR with aortic annular enlargement at our institution from 1995 to 2005 (n = 669), including patients who had concomitant coronary artery bypass grafting or mitral or tricuspid valve surgery. Patients who had aortic annular enlargement during AVR between 1995 and 2000 (n = 360, 16% of total AVR population) were compared with a contemporary cohort of patients from 2001 to 2005 (n = 309, 21% of total AVR population). Our
Results
Table 1 illustrates the demographic differences in preoperative characteristics for patients who underwent aortic annular enlargement during AVR from 1995 to 2000 compared with 2001 to 2005. The earlier time group had a higher proportion of patients with congestive heart failure, New York Heart Association class III or IV symptoms, angina, syncope, chronic obstructive pulmonary disease, concomitant mitral valve disease, reoperation, and smaller body surface area. Because the clinical profile of
Comment
Aortic valve replacement for patients with advanced aortic valve disease reduces mortality, ameliorates exercise capacity, and promotes regression of left ventricular hypertrophy. To maximize the therapeutic benefit from AVR, an appropriately sized prosthesis should be implanted into the patient, as a prosthesis with a small EOA may result in persistence of high transvalvular pressure gradients [3, 5]. Rahimtoola [18] was the first to describe PPM based on the disparity between prosthesis and
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