Anatomy and Cell Biology Publications
Document Type
Article
Publication Date
4-2013
Issue
4
Journal
CANADIAN JOURNAL OF CARDIOLOGY
Volume
29
First Page
434
Last Page
440
URL with Digital Object Identifier
10.1016/j.cjca.2012.04.012
Abstract
Background: Aortic root enlargement (ARE) procedures are believed to allow implantation of larger valve prostheses; however, little evidence exists to support the specific efficacy of various techniques. Methods: Using a cadaveric model, 20 adult (72.4 +/- 15.3 years) hearts were stratified into 4 groups based on annular diameter: <20 mm, 20-22 mm, 22-24 mm, and >24 mm. Each heart underwent an aortic valve replacement following a Nicks, Manougian, aortoventriculoplasty and modified Bentall procedure, with appropriate reversals between procedures. Results: All 4 groups experienced similar increases in annular diameter (P = 0.43) and prosthesis size implanted (P = 0.51) with each enlargement technique. The Nicks, Manougian, modified Bentall and aortoventriculoplasty procedures enlarged the annulus by 0.43 +/- 0.45 mm, 3.63 +/- 0.95 mm, 0.78 +/- 0.65 mm, and 6.08 +/- 1.19 mm, respectively (P < 0.001). No significant change in prosthesis size was observed after the Nicks procedure (P = not significant). Increases of 1.3 +/- 0.5, 1.3 +/- 0.5, and 2.7 +/- 0.6 prosthesis sizes were achieved with the Manougian, modified Bentall and aortoventriculoplasty techniques respectively (P < 0.001). Conclusions: ARE procedures appear equally efficacious in both small and larger aortic roots. Although all 4 ARE techniques increased the annular diameter, only the Manougian, modified Bentall and aortoventriculoplasty procedures allowed for the implantation of a larger prosthetic valve. The Nicks procedure, which is likely the most commonly performed ARE, does not allow for the implantation of a larger prosthesis. Surgeon preference and patient factors may help in selecting the most appropriate ARE technique, as the modified Bentall and Manougian procedures achieved similar increases in valve size.
Notes
This is a draft of the Author-Accepted Manuscript.