INTRODUCTION

Some patients with aortic valve (AV) disease have small aortic annulus. This anatomical feature can lead to prosthesis-patient 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 1^st group compared to the 2^nd 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.