Long-term results after mechanical valve replacement in patients with small aortic root

Abstract

Objective To evaluate the long-term effect after mechanical valve replacement in adult patients with small aortic root, and guide clinical practice. Methods From July 2003 to December 2005, 36 patients with small aortic root (diameter ≤ 19 mm) received aortic prostheses; among which 25 cases underwent aortic valve replacement alone, and the other received mitral valve replacement besides aortic valve replacement. 23mm CarboMedics valve were implantated in 14 patients(CM group) by using of Manougnian's annulus enlarging technique; 22 patients received implantation of 19mmCarboMedics Top Hat Supra-Annular valve(CMSA group). All of patients were followed up with echocardiography and cardiac functions Pre-operation ang 6th Year post-operation. Results Comparing with those before operation, cardiac function(NYHA) improved obviously, Left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) increased significantly, left ventricular end-diastolic diameter(LVDD)and pressure gradients across aortic valve(PGav) decreased obviously. Comparison Between groups, PGav, interventricular septal thickness(IVST)and left ventricular posterior wall thickness(LVPWT)of CM group reduced more obvious than CMSA group, has reached healthy adult level. Conclusion The long-term effect after surgery is satisfied in adult patients with small aortic root, especially in left ventricular function. Implant ing a larger prosthesis is more beneficial for left ventricular morphology reversal. Key words: Small aortic root; Aortic valve replacement; Aortic annulu enlarge; Left ventricular function; Left ventricular morphology