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Strategy to Avoid Patient Prosthesis Mismatch: Role of Aortic Root Enlargement in the Current Scenario

Navneet Kumar Srivastava , Dharmendra Kumar Srivastava , Navneet Kumar Srivastava , Sudershan Kumar Vijay , SS Rajput

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Journal of Cardiovascular Medicine and Surgery 6(2):p 95-102, April – June 2020. | DOI: http://dx.doi.org/10.21088/jcms.2454.7123.6220.2

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Dharmendra Kumar Srivastava, Navneet Kumar Srivastava, Sudershan Kumar Vijay et al. Strategy to Avoid Patient Prosthesis Mismatch: Role of Aortic Root Enlargement in the Current Scenario. J Cardiovasc Med Surg 2020;6(2):95-102.
 

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Abstract

Background: The choice of valve with an Effective Orifice Area (EOA) and design material providing efficient hemodynamics is an important factor affecting the Quality of Life (QOL) in patients who are going through the aortic valve replacements. The aim of our study was to evaluate non–dyspenic life without any complications of heart failure with different types of available mechanical valve prosthesis irrespective of Body Surface Area (BSA) of patients. Materials and Methods: Our preventive strategy was to implant a larger prosthetic valve in aortic position by using suitable types of mechanical a prosthesis to avoid the patient’s severe Prosthesis Mismatch (PPM). The decision to enlarge the aortic root was taken only when 17 mm sizer could not be easily placed through the aortic root. We reviewed the clinical outcomes and complications in 21 patients who underwent aortic valve replacements
done by a single surgeon from January 2018 to May 2019. Results: The patient’s age ranged from 13–57 years with male predominance (71.42%). Majority of our patients (80.16%) had NYHA class III symptoms at initial presentation while 19.04% had class IV symptoms. The preoperative echocardiography data were in the following range:
aortic annulus diameter (17-24 mm), aortic valve areas (0.6-1.58 cm2), peak and mean gradients (72–131 mmHg, 18-64 mmHg), Left ventricle mass index (LVMI= 68-176 gm/m2). PPM was moderate in 71.425% of cases and severe in 19.04% of cases. The aortic root enlargements (Nunez Procedure) were done in 9.52% of cases. The postoperative
and follow-up echocardiography data were in the following range: peak and mean gradients (13–31 mmHg, 9–16 mmHg), EOA (1.1–3.02 cm2) Left ventricle mass index (LVMI= 26.4-114 gm/m2). Conclusion: In our study, we found that with the availability of newer generations of mechanical aortic valves having thinner sewing rings and supra-annular position with better orifice areas reduce the incidence of PPM and avoid the complications of the aortic root enlargement without compromising the Quality of Life (QOL) of patients. LV regression showed a positive correlation with the reduction of the mean aortic gradient achieved by AVR. AVR caused significant LV regression in all patients irrespective of the presence of PPM.

 

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Cite this article

Dharmendra Kumar Srivastava, Navneet Kumar Srivastava, Sudershan Kumar Vijay et al. Strategy to Avoid Patient Prosthesis Mismatch: Role of Aortic Root Enlargement in the Current Scenario. J Cardiovasc Med Surg 2020;6(2):95-102.
 

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DOI: http://dx.doi.org/10.21088/jcms.2454.7123.6220.2

Keywords

Aortic Stenosis; Patient prosthesis mismatch; Aortic valve replacement; Aortic root enlargement; Left ventricle mass index.

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