Surgical Management of Small Aortic Root

A common goal of Heart valve replace- ment is to prevent or cure symptoms of heart failure and decrease the likelihood of heart failure-related death. Complete abolition of transvalvular gradients is not possible because of the obstructive effects of the prosthetic valve stents and sewing ring. Aortic valve replacement (AVR) in the patients with small aortic annulus is a challenging procedure and is not an uncommon surgical problem. Sever patient-prosthetic mismatch is a predictor of higher long-term mortality and congestive heart failure. For patients undergoing AVR who are at risk of sever mismatch, every effort should be made to use a larger prosthesis or to consider a prosthesis with a larger effec- tive orifice area. Valve selection for the small aortic root is a multi-factorial process. These factors include patient age, lifestyle, pregnancy status, drug compliance, EOA of prosthetic valve, availability of prosthesis, experience skill of surgeon.