VALVE REPLACEMENT IN SMALL AORTIC ROOT; A TEN-YEAR EXPERIECE OF AORTIC ROOT RECONSTRUCTION BY MANOUGUIAN’S TECHNIQUE

Back ground:Aortic valve replacement (AVR) in patients with a small aortic annulus may represent a surgical challenge. Although new generation heart valves especially stentless bioprosthesis minimize the need for aortic annulus enlargement procedures but there were some conditions that necessitate the aortic root enlarging method to implant a suitable size of prosthesis. We evaluated the midterm results of the Manouguian procedure as a simple method to aortic root enlargement.Methods Material:We performed a retrospective review of 70 patients (38 female, 32 male; mean age 29.3 +/- 19 years) underwent aortic root enlargement during AVR. The Mean follow-up period was 36.7 months. Primary aortic valve disease included rheumatic heart disease (75.7%), congenital aortic valve disease (14.3%) and active endocarditis (10%) The predominant aortic valve pathology was aortic stenosis (AS) in the majority of cases (75.7%). All patients underwent AVR with a prosthetic valve one or more size larger than patients annulus diameter.Results:Improvement of functional status was seen in all survivors and all of them were in NYHA class I or II. After use of this procedure the mean indexed effective orifice area of patients’ annulus had enhanced from 0.71+/- 0.19 to 1.46 +/- 0.38 based on label size of prosthesis. There was 10 operative mortality (14.3%) and two late deaths (2.8%). The rate of surgically induced mitral regurgitation was 4.2% but only one of these patients need for mitral valve replacement. There was no case of other procedure-related morbidities including peri-prosthetic leak, sever hemolysis, prosthetic valve endocarditis or residual patient prosthetic mismatch (PPM). Conclusion:This procedure seems a simple and effective method to enlargement of aortic annulus and provide excellent hemodynamic results with a low incidence of operation related morbidities. Although the in-hospital mortality rate of our series was high but we should consider that the primary causes of deaths were not related to the enlarging aortic annulus procedure directly.