Long-term results of aortic valve replacement with posterior root enlargement.

Background: Posterior root enlargement provides the implantation of suitable-sized prosthetic valves in patients with a small aortic root. The aim of this study was to evaluate the long-term results of posterior root enlargement in patients undergoing aortic valve replacement.

Methods: Between 1997 and 2011, 103 patients with a small aortic annulus (indexed effective orifice area < 0.75 cm(-2) · m(-2)) underwent aortic valve replacement with posterior aortic root enlargement. Forty-six (44%) patients were male. The mean age was 28.62 ± 18.56 years. Survivors were followed up for a mean of 45.6 ± 32.4 months.

Results: Early mortality was 9.6%. The most common cause of early mortality was low cardiac output syndrome (6 patients). There were 2 (1.9%) late deaths due to cerebrovascular events. During the follow-up period, mild paravalvular leakage occurred in only one (1%) patient, and one suffered a malfunction of the prosthesis. A significant reduction was seen in the peak pressure gradients across the replaced aortic valves (p < 0.001). Moreover, a significant increase was noted in left ventricular ejection fraction (p = 0.001).

Conclusions: Aortic root enlargement using the Manouguian technique can be applied with acceptable safety. It effectively decreases postoperative gradients and increases left ventricular ejection fraction. Short- and long-term mortality and morbidity rates are satisfactory.