Functional Results in Aortic Root Enlargement


  • Serap Aykut Aka
  • Gökçen Orhan
  • ?ennur Ünal
  • Seden Çelik
  • ?ahin ?enay
  • Murat Sargin
  • Ye?im Biçer
  • E. Ergin Eren



Background: The hemodynamically efficient valves with effective orifice areas that are used in aortic valve replacement have been positively determined to affect postoperative exercise capacity. The aim of this study was to evaluate the functional effects of aortic root enlargement in the late postoperative period for patients with a small effective orifice area.

Methods: Nineteen patients with a small effective orifice area were included in the study. The study group comprised 9 patients who underwent isolated aortic valve replacement with 23-mm St. Jude Medical prosthetic valves and posterior aortic root enlargement. The control group comprised 10 patients in whom 19-mm and 21-mm St. Jude Medical prosthetic valves were implanted without aortic root enlargement. The patients were evaluated in the late postoperative period with echocardiography and cardiopulmonary exercise testing.

Results: The 2 groups were similar in anthropometric parameter values, follow-up periods, echocardiographic findings, and the gradients at the prosthetic aortic valve at rest; however, the anaerobic threshold, peak oxygen uptake, minute ventilation volume, and walk time were significantly higher in the study group (P < .05).

Conclusion: The choice of aortic root enlargement for the implantation of a valve with a larger effective orifice area is preferred by most of the surgeons over the implantation of a valve with a smaller effective orifice area. The late postoperative functional capacity of the patient is significantly improved with root enlargement. Surgeons should be encouraged to perform root enlargement in patients with a small effective orifice area, and such surgery may even be performed routinely in these patients.


Becassis P, Hayot M, Frapier JM, et al. 2000. Postoperative exercise tolerance after aortic valve replacement by small-size prosthesis: functional consequence of small-size aortic prosthesis. J Am Coll Cardiol 36:871-7.nChaitman RB. 1997. Exercise stress testing. In: Braunwald E, editor. Heart disease. A textbook of cardiovascular medicine. 5th ed. Philadelphia, Pa: WB Saunders. p 153-76.nClyne CA, Arrighi JA, Maron BJ, Dilsizian V, Bonow RO, Cannon RO III. 1991. Systemic and left ventricular responses to exercise stress in asymptomatic patients with valvular aortic stenosis. Am J Cardiol 68:1469-76.nDe Paulis R, Sommariva L, Russo F, et al. 1994. Doppler echocardiography evaluation of the CarboMedics valve in patients with small aortic anulus and valve prosthesis-body surface area mismatch. J Thorac Cardiovasc Surg 108:57-62.nHirooka K, Kavazoe K, Kosakai Y, et al. 1994. Prediction of postoperative exercise tolerance after aortic valve replacement. Ann Thorac Surg 58:1626-30.nKratz JM, Sade RM, Crawford FA Jr, Crumbley AJ III, Stroud MR. 1994. The risk of small St. Jude aortic valve prostheses. Ann Thorac Surg 57:1114-9.nLehmann G, Kölling K. 1996. Reproducibility of cardiopulmonary exercise parameters in patients with valvular heart disease. Chest 110:685-92.nMudge GH, Goldstein S, Addonizio LJ, et al. 1993. 24th Bethesda conference: cardiac transplantation. Task Force 3: recipient guidelines/prioritization. J Am Coll Cardiol 22:21-31.nPibarot P, Dumesnil JG, Jobin J, Lemieux M, Honos G, Durand LG. 1999. Usefulness of the indexed effective orifice area at rest in predicting an increase in gradient during maximum exercise in patients with a bioprosthesis in the aortic valve position. Am J Cardiol 83:542-6.nStelken AM, Younis LT, Jennison SH, et al. 1996. Prognostic value of cardiopulmonary exercise testing using percent achieved of predicted peak oxygen uptake for patients with ischemic and dilated cardiomyopathy. J Am Coll Cardiol 27:345-52.nTatineni S, Barner HB, Pearson AC, Halbe D, Woodruff R, Labovitz AJ. 1989. Rest and exercise evaluation of St. Jude Medical and Medtronic Hall prostheses. Circulation 80:I-16-23.nTheo KH, Fulop JC, Weisel RD, et al. 1987. Aortic valve replacement with a small prosthesis. Circulation 76:III-123-31.nWiseth R, Lewang OW, Tangen G, Rein KA, Skjaerpe T, Hatle L. 1993. Exercise hemodynamics in small (< or = 21 mm) aortic valve prostheses assessed by Doppler echocardiography. Am Heart J 125:138-46.n



How to Cite

Aka, S. A., Orhan, G., Ünal, ?ennur, Çelik, S., ?enay, ?ahin, Sargin, M., Biçer, Y., & Eren, E. E. (2005). Functional Results in Aortic Root Enlargement. The Heart Surgery Forum, 7(2), E160-E163.




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