ENLARGEMENT OF THE AORTIC ANNULUS WITH GLUTARALDEHYDE-FIXED BOVINE PERICARDIUM DURING AORTIC-VALVE REPLACEMENT

Background and aims of the study: Aortic valve replacement in patients with a small aortic annulus may represent a surgical challenge. We ha ve evaluated a simplified technique to enlarge the aortic annulus whic h consists of extending the aortotomy incision to divide the commissur e between the left and non-coronary cusps into the interleaflet triang le without opening the left atrium. Methods: This technique was used i n 16 patients (15 women, one man; mean age 66 +/- 9 years) who underwe nt aortic valve replacement between August 1994 and February 1996. Aor tic stenosis was the predominant valvular lesion. A mechanical prosthe sis was implanted in 13 patients (81%) (21 mm in six, 23 mm in seven) while three received a bioprosthesis (21 mm in one, 23 mm in two). In all patients it was possible to insert a prosthesis at least one size larger than the original aortic annulus diameter. Results: There were no operative deaths and no late deaths. Mean follow up was 20 +/- 6 mo nths (range: 12 to 30 months). Echocardiographic controls at 12 months postoperatively showed no evidence of periprosthetic leaks or mitral regurgitation. Comparison with preoperative data showed no significant variations of mean aortic diameter at the sinus level (30.7 +/- 2.2 m m versus 31.3 +/- 2.6 mm) or at the sino-tubular junction (33.6 +/- 2. 7 mm versus 34.3 +/- 2.9 mm) (p = NS). Significant reduction of left v entricular mass was observed (314 +/- 57 g versus 260 +/- 45 g; p <0.0 01). Conclusions: This technique is simple, reproducible and effective in allowing adequate enlargement of the aortic annulus and provides e xcellent clinical and hemodynamic results. Glutaraldehyde-fixed bovine pericardium used as a patch material showed no tendency to aneurysmal dilatation with progression of time at a maximum follow up of 30 mont hs.