Objective: To assess the safety and efficacy of aortic root enlargement for small aortic root to avoid patient prosthesis mismatch in patients undergoing aortic valve replacement.

Method: We reviewed early outcomes of 4/500 patients who received posterior enlargement of aortic annulus along with AVR from a period of January 2015 to December 2018. All were female patients. St Jude Medical regent valve (SJM) (St Jude Medical, St Paul, Minn) were implanted in 3 patients and Carpentiers-Edwards PERIMOUNT Magna Ease Bioprosthesis (Edwards Life sciences, Irvine, CA, USA) was implanted in one patient. Posterior root enlargement was done by modified manougian technique when the annulus was small for adequately sized valve as per BSA. Patients were followed up with serial echocardiography for a period of mean-17months.

Results: Root enlargement allowed us to implant at least 2 size larger prosthetic valve. There was no mortality. Clamp time was almost doubled. One patient had acute kidney injury in post-operative period. One patient had stuck valve after 3 months. Significant reductions in peak and mean gradients were achieved. Mean reductions in left ventricular dimensions were 12.75%.

Conclusion: Root enlargement done with modified manougian technique is safe and easily reproducible and very useful as a bail out procedure when surgeon encounter a small annulus. Our results favor the continuation of this procedure as it leads to both functional and anatomical improvements of left ventricle.  

Keywords: small aortic root, patient prosthesis mismatch, posterior root enlargement.

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Dr Anubhav Gupta (Prof and H.O.D.)

Dept of Cardiothoracicvascular Surgery, VMMC and Safderjung Hospital, New Delhi.110049, India