AUTHOR=Mve Mvondo Charles , Tchokouani Djientcheu Carole , Ngo Yon Laurence Carole , Banga Douglas Nkomo , Mbele Richard , Bella Ela Amos , Giamberti Alessandro , Frigiola Alessandro , Menanga Alain Patrick , Djientcheu Vincent De Paul , Ngowe Marcelin Ngowe 

TITLE=Aortic root enlargement in patients undergoing mitral and aortic replacement: early outcomes in a sub-Saharan population

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1239032

DOI=10.3389/fcvm.2023.1239032

ISSN=2297-055X

ABSTRACT=Introduction: Aortic root enlargement (ARE) is often required to avoid patient-prosthesis mismatch (PPM) in young patients undergoing aortic surgery, including those undergoing combined mitral and aortic valve replacement (DVR). The addition of ARE to DVR may increase the operative risk by extending the surgical time. Here, we reviewed our experience with ARE in patients who underwent DVR.
Materials and Methods: The medical records of 69 patients who underwent DVR at our institution between February 2008 and November 2021 were retrospectively reviewed. The patients were divided into two groups according to the ARE procedure (ARE-DVR: 25 patients; DVR: 44 patients). Descriptive and comparative analyses of demographic, clinical, surgical data were performed.
Results: Among the 69 patients who underwent DVR, 35 were women (sex ratio, 0.97). The mean age at surgery was 26.7 ± 13.9 years (range: 7–62 years). Among the 47 patients aged < 30 years, 40.4% (19/47) were aged between 10 and 20 years, and 6.3 % (3/47) were aged < 10 years. Patients in 28	ARE-DVR were younger (23.3 ± 12.9 vs. 28.5 ± 14.2 years, p < 0.05). New York Heart Association Class ≥ III dyspnea was the most common symptom (89.9%), with no differences between the two groups. Of all the patients, 84.1% had sinus rhythm. The most common etiology in the entire cohort was rheumatic disease (91.3%). The mean aortic annulus diameter was 20.54 mm with smaller sizes found in the ARE-DVR group (18.00 ± 1.47 mm vs. 22.50 ±2.35 mm, p < 0.05). Aortic cross clamping duration was greater in the ARE-DVR group (177.6 ± 37.9 min vs. 148.3 ± 66.3 min, p = 0.047). The operative mortality rate was 5.6% for the entire cohort (ARE-DVR: 8% vs. DVR: 4.5%, p = 0 .46). Among the patients who underwent echocardiographic control at follow-up, the mean aortic gradient was 19.6 ± 7.2 mmHg (range: 6.14–33 mmHg), with no differences among the groups.
Conclusion: The association between ARE and DVR did not significantly affect operative mortality. ARE can be safely used whenever indications arise to reduce the occurrence of PPM, especially in young patients with growth potential.