Surgical Method for Facilitation of Aortic Valve Replacement:Intraoperative Application of External Pressure for Increasing the Transverse Axis of Aortic Annulus

Background: Surgical method was introduced for enhancement of prosthetic valve insertion and overcoming difficulties ensourcing from prosthesis-patient mismatch. Methods: Twenty-two patients that underwent aortic valve replacement between January 2005 and July 2009 were included in this prospective study. In these patients, the insertion of prosthesis larger than the annulus diameter was attempted after the application of an external pressure that increased the transverse axis diameter of the aortic annulus. The postoperative results and complications were assessed. Results: This surgical method was performed on 22 patients (16 males, 6 females, mean age: 52.2 ± 15.8 years) during the valve replacement. In 12 patients (55%), replacement of proper sized aortic valve compliant to their surface area was accomplished, while the insertion of a proper valve could not be achieved in 10 (45%) of the patients. No perioperative mortality or complications related to the procedure were reported. Conclusion: Increasing the transverse diameter of aortic valve may not only facilitate the insertion of a prosthetic valve but also aid in overcoming prosthesis-patient mismatch. Further studies on larger series are necessary to document the actual effectively and precise selection criteria for application of this method.

Comparison of the early curative effect in patients undergoing mechanical vs. bioprosthetic aortic valve replacement with concomitant annuloplasty by the Nicks procedure

Background The probability of prosthesis-patient mismatch(PPM)is high in aortic valve replacement surgery for small aortic valve annulus,which increases the postoperative prosthetic valve transvalvular pressure gradient.Concurrent aortic annuloplasty is a commonly applied surgical procedure,but there is currently no uniform standard or guideline on the type of prosthetic valve that should be used during surgery.Therefore,this study aimed to analyze whether there was any difference in the short-term prognosis between the choice of mechanical valves and bioprosthetic valves during aortic valve replacement surgery with concomitant aortic annuloplasty by the Nicks procedure.Methods A retrospective analysis was conducted based on the clinical data from 55 patients undergoing aortic valve replacement surgery with concomitant annuloplasty by the Nicks procedure at the Cardiac Surgery Department of Guangdong Provincial People’s Hospital from November 2021 to December 2023.In this study,all patients received aortic annuloplasty by the Nicks procedure.Among these patients,30 were in the mechanical valve group,while the other 25 were in the bioprosthetic valve group.Data including left ventricular end-diastolic/endsystolic diameters,left ventricular ejection fraction,interventricular septal thickness,left ventricular posterior wall thickness,transvalvular pressure gradient,left ventricular fractional shortening,and left ventricular mass index were collected 1 week preoperatively and 1 week and 3 months postoperatively.Information on gender,age,body surface area,types of perioperative complications,operation time,complication rates,and outcomes was also collected.Results Among the 55 patients enrolled in this study,4 died.The main causes of death included postoperative low cardiac output syndrome,severe pulmonary infection,and multi-organ dysfunction.Meanwhile,there was a statistically significant difference in left ventricular end-diastolic diameter between the mechanical valve group and the biological valve group 1 week after surgery.However,differences in other indicators such as aortic crossclamp duration,cardiopulmonary bypass duration,postoperative ventilator support duration,postoperative intensive care unit(ICU)stay,total postoperative hospital stay,and echocardiography results 1 week and 3 months postoperatively were not significant between the two groups.Conclusions For patients undergoing aortic annuloplasty by the Nicks procedure in the aortic valve replacement surgery,the postoperative recovery time is not significantly different between the bioprosthetic and mechanical valve groups.Additionally,there is no notable difference in the improvement of left ventricular function or the reduction of PPM incidence between the two types of valves.[S Chin J Cardiol 2024;25(1):29-37].

Comparison of low-dose sequences of dual-source CT and echocardiography for preoperative evaluation of aortic valve disease

Background Accurate evaluation of coronary artery,aortic valve annulus diameter （AVAD）,and cardiac function in patients with aortic valve disease is of great significance for surgical strategy.In this study,we explored the preoperative evaluation of low-dose sequence （MinDose sequence） scan of dual-source CT （DSCT） for those patients.Methods Forty patients suspected for aortic valve disease （the experimental group） underwent MinDose sequence of DSCT to observe coronary artery,AVAD,and left ventricular ejection fraction （LVEF）.Another 33 subjects suspected for coronary artery disease （the control group） underwent conventional retrospective electrocardiographically-gated sequence of DSCT.Two-dimensional transthoracic echocardiography （2D-TTE） and four-dimensional transthoracic echocardiography （4D-TTE） were applied in the experimental group to measure AVAD and LVEF and compared with MinDose-DSCT.Results There was a strong correlation between LVEFs measured by 2D-TTE and MinDose-DSCT （r=0.87,P ＜0.01）,as well as between 4D-TTE and MinDose-DSCT （r=0.90,P ＜0.01）.AVAD measured by MinDose-DSCT was in good agreement with corresponding measurements by 2D-TTE （r=0.90,P ＜0.01）.The effective dose in the experimental group was 63.54％ lower than that in the control group.Conclusions MinDose sequence of DSCT with a low radiation dose serving as a one-stop preoperative evaluation makes effective assessment of the coronary artery,AVAD,and LVEF for patients with aortic valve disease.