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You are here: Contents > 2014 > Volume 23 Number 1 January 2014 > AORTIC VALVE DISEASE > Enlargement of the Aortic Annulus During Aortic Valve Replacement: A Review

Enlargement of the Aortic Annulus During Aortic Valve Replacement: A Review

Uberto Bortolotti1, Michele Celiento1, Aldo D. Milano2

1Section of Cardiac Surgery, University Hospital, Pisa, 2Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy

The main goal of aortic valve replacement (AVR) is to obtain relief from the fixed left ventricular (LV) obstruction by replacing the aortic valve with a prosthesis, either mechanical or biological, of adequate size. Most currently available prostheses provide satisfactory hemodynamic performance, but small-sized prostheses may be associated with high transvalvular gradients and suboptimal effective orifice area that result in prosthesis-patient mismatch (PPM), and thus are far from ideal for use in young, active patients. The avoidance of PPM is advisable as it has been repeatedly associated with increased mortality, decreased

exercise tolerance and an impaired regression of LV hypertrophy after AVR for severe aortic stenosis. Enlargement of the aortic annulus (EAA) has proved to be a valuable method to prevent PPM in the presence of a diminutive aortic root. This review outlines the various techniques described for EAA, presenting technical details, long-term results and major procedure-related complications, and discussing the current role of EAA in patients requiring AVR.

The Journal of Heart Valve Disease 2014;23:31-39

Enlargement of the Aortic Annulus During Aortic Valve Replacement: A Review

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