Early evaluation of the aortic root after Nicks' procedure.
JTCVS Tech
; 4: 85-96, 2020 Dec.
Article
em En
| MEDLINE
| ID: mdl-34317974
ABSTRACT
OBJECTIVES:
To determine the influence of surgical techniques adopted to avoid suture line disruption, periprosthetic leakage, patch dislodgement, pericardial patch aneurysm formation, and the long-term stability of aortic root enlargement (ARE) during aortic valve replacement (AVR).METHODS:
One hundred fifteen patients undergoing AVR or combined aortic and mitral valve replacements with Nicks' posterior ARE between 1997 and 2019 underwent long-term echocardiographic and angio-computed tomographic evaluation. Age was 11-72 years (AVR median, 30; interquartile range, 21-47 years; AVR and mitral valve replacement median, 27.5; interquartile range, 20-37.5 years). The aortotomy was closed using autologous pericardial patch and Teflon-buttressed sutures.RESULTS:
Hospital mortality was 1.7% (n = 2), with 4 (3.5%) late deaths. At a mean follow-up of 123.11 ± 77.67 months, the survival probability from Kaplan-Meier was 93.25 ± 0.03%. No cases of severe prosthesis-patient mismatch (PPM) were observed, and only 2 patients had moderate PPM. Median aortic root diameters at the level of sinus of Valsalva and sinotubular junction were 32 (29-35) mm and 33 (30-36) mm, respectively, at discharge, and were 33 (30-36) mm, and 33 (31-37) mm, respectively, at latest follow-up, with no cases of late pericardial patch aneurysm.CONCLUSIONS:
ARE is a safe adjunct to AVR in patients with a small aortic annulus to prevent PPM. Retention of a pericardial collar and Teflon-buttressed sutures is an expedient, safe, and effective technique in reducing bleeding at the enlarged ventriculo-aortic junction. Autologous pericardial patch aortoplasty is not associated with late aneurysm/pseudoaneurysm formation.
ARE, aortic root enlargement; AVR, aortic valve replacement; LV, left ventricle; LVEF, left ventricular ejection fraction; LVOT, left ventricular outflow tract; MVR, mitral valve replacement; Nicks' procedure; PPM, prosthesispatient mismatch; SD, standard deviation; aortic root enlargement; aortic valve replacement; iEOA, indexed effective orifice area; indexed aortic effective orifice area; pericardial patch aneurysm; periprosthetic leakage; prosthesispatient mismatch
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Bases de dados:
MEDLINE
Idioma:
En
Revista:
JTCVS Tech
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Índia