Abstract

Successful aortic stenosis treatment depends on the corresponding prosthesis size implantation. Valve effective orifice index by S. Rashimtoola must exceed 0.85. In our practice we used two methods of aortic rot enlargement. Incision of the posterior aortic wall and mitral-aortic curtain by Nicks R. The second were the same maneuvers with incision prolongation on mitral valve anterior leaflet by Rittenhouse E.A. However, in the cases of advanced aortic root calcinosis these incisions seem to be critically dangerous. In these circumstances it is possible to change the incision direction to the right muscular trigone of the left ventricle outflow tract.

During 01.01.2015-01.09.2021 in the Cardiac Surgery Department of Belgorod regional clinic there were 28 cases of posterior aortoplasty in patients with 21-sized prostheses. Of them the aortoplasty with right muscular trigone incision constituted 4 cases. In all aortoplasty technics we didn’t meet problems with hemostasis or conductive pathway lesion.

The literature review, our practice in David T.E. operation showed small surgical risks for posterior aortoplasty with right muscular trigone incision. It may be used in cases with mitral-aortic curtain and MV anterior leaflet calcinosis.

Keywords: Posterior Aortoplasty; Left Ventricle; Outflow Tract

References

1. Treibel TA., et al. “Multimodality imaging markers of adverse myocardial remodeling in aortic stenosis”. JACC Cardiovasc Imaging 12.8 Pt 1 (2019): 1532-1548.
2. Rashimtoola SH. “The problem of valve prosthesis-patient mismatch”. Circulation 58 (1978): 20-24.
3. Concistrè G., et al. “Aortic valve replacement with smaller prostheses in elderly patients: does patient prosthetic mismatch affect outcomes?” Journal of Cardiac Surgery 28.4 (2013): 341-347.
4. Iqbal A., et al. “Patient prosthesis mismatch and its impact on left ventricular regression following aortic valve replacement in aortic stenosis patients”. Indian Journal of Thoracic and Cardiovascular Surgery 35 (2019): 6-14.
5. Pibarot P., et al. “Imaging for Predicting and Assessing Prosthesis-Patient Mismatch After Aortic Valve Replacement”. JACC Cardiovasc Imaging 12.1 (2019): 149-162.
6. Sá MP., et al. “Impact of aortic annulus enlargement on the outcomes of aortic valve replacement: a meta-analysis”. Seminars in Thoracic and Cardiovascular Surgery 33.2 (2021): 316-325.
7. Yu W., et al. “Aortic Root Enlargement Is Safe and Reduces the Incidence of Patient-Prosthesis Mismatch: A Meta-analysis of Early and Late Outcomes”. Canadian Journal of Cardiology 35.6 (2019): 782-790.
8. Nicks R., et al. “Hypoplasia of the aortic root. The problem of aortic valve replacement”. Thorax 25.3 (1970): 339-346.
9. Manouguian S., et al. “Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique”. The Journal of Thoracic and Cardiovascular Surgery 78.3 (1979): 402-412.
10. Rittenhouse EA., et al. “Radical enlargement of the aortic root and outflow tract to allow valve replacement”. The Annals of Thoracic Surgery 27.4 (1979): 367-373.
11. Chen J., et al. “Indexed effective orifice area is a significant predictor of higher mid- and long-term mortality rates following aortic valve replacement in patients with prosthesis-patient mismatch”. European Journal of Cardio-Thoracic Surgery 45.2 (2014): 234-240.
12. Rocha RV., et al. “Surgical enlargement of the aortic root does not increase the operative risk of aortic valve replacement”. Circulation 137 (2018): 1585-1594.
13. Freitas-Ferraz AB., et al. “Aortic Stenosis and Small Aortic Annulus”. Circulation 139.23 (2019): 2685-2702.
14. Mehaffey JH., et al. “Need for permanent pacemaker after surgical aortic valve replacement reduces long-term survival”. The Annals of Thoracic Surgery 106.2 (2018): 460-465.
15. Klapkowski A., et al. “Complete atrioventricular block after isolated aortic valve replacement”. Kardiologia Polska 74.9 (2016): 985-993.
16. Liebrich M., et al. “The David procedure in different valve pathologies: a single-center experience in 236 patients”. The Annals of Thoracic Surgery 95 (2013): 71-76.
17. TE David and CM Feindel. “An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta”. The Journal of Thoracic and Cardiovascular Surgery 103 (1992): 617-622.
18. Salmasi MY., et al. “Comparing outcomes between valve-sparing root replacement and the Bentall procedure in proximal aortic aneurysms: systematic review and meta-analysis”. Interactive CardioVascular and Thoracic Surgery29.6 (2019): 911-922.

Citation

Citation: Maksim Sazonenkov Alexandrovich., et al. “Patch Enlargement of the Aortic Root with the Incision in Right Muscular Trigone of Left Ventricle Outflow Tract" Acta Scientific Cardiovascular System 1.5 (2022): 32-37.

Copyright

Copyright: © 2022 Maksim Sazonenkov Alexandrovich., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.