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
DOI: https://doi.org/10.1532/HSF98.20041003

Abstract

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.

References

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
Published
2005-01-04
How to Cite
Aka, S., Orhan, G., Ünal, ?ennur, Çelik, S., ?enay, ?ahin, Sargin, M., Biçer, Y., & Eren, E. (2005). Functional Results in Aortic Root Enlargement. The Heart Surgery Forum, 7(2), E160-E163. https://doi.org/10.1532/HSF98.20041003
Issue
Vol 7 No 2 (2004)
Section
Articles

Author Disclosure & Copyright Transfer Agreement

In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.

A current form follows:

The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.

However, Publisher grants back to the author(s) the following:

  1. The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
  2. The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
  3. The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
  4. The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
  5. The right to make oral presentations of material from this work.

Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.

I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.

I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).

I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.

Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).

Most read articles by the same author(s)