Aortic root enlargement does not increase the surgical risk and short-term patient outcome

Objective: To analyze the short-term outcome of aortic root enlargement (ARE) using death and adverse events as end points. Methods: From January 1999 through December 2009, 3339 patients were subjected to aortic valve replacement (AVR). A total of 678 were considered to have small aortic roots (SARs) in which an aortic prosthesis size 21mm or smaller was implanted. ARE using a bovine pericardial patch was performed in another 218 patients, who constitute the study population. This comprised 174 females (79.8%); the mean age was 69.4±13.4 years (8-87, median 74 years), the body surface area (BSA) was 1.59±0.15m(2) and the body mass index (BMI) 25.77±3.16kgm(-2), and 192 (88.5%) were in New York Heart Association (NYHA) II-III. Preoperative echocardiography revealed significant left ventricular (LV) dysfunction in 17 patients (8%), a mean aortic valve area of 0.57±0.27cm(2), and a mean gradient of 62.51±21.25mmHg. A septal myectomy was performed in 129 subjects (59.2%), and other associated procedures, mostly coronary artery bypass grafting (CABG), in 60 (27.5%). Bioprostheses were implanted in 161 patients (73.9%). The mean valve size was 21.9±1.0 (21-25). The mean extracorporeal circulation (ECC) and aortic clamping times were 82.8±19.8min and 56.8±12.5min, respectively. Results: Hospital mortality was 0.9% (n=2) for ARE as compared with 0.6% (n=4) for the SAR group (p=0.8). Inotropic support was required in only 13 (5.9%) patients and the first 24-h chest drainage was 336.2±202ml. Other complications included pacemaker implantation (7.8%), acute renal failure (10.6%), respiratory (4.1%), and CVA/transient ischemic attack (CVA/TIA) (3.2%). Postoperative echocardiographic evaluation showed a significant decrease in peak and mean aortic gradients (23.7±9.5 and 14±6.2mmHg, respectively, p<0.0001). The mean indexed effective orifice area (iEOA) was 0.92±0.01cm(2)m(-2) (vs 0.84±0.07cm(2)m(-2), in SAR, p