Prosthesis-patient mismatch after aortic valve replacement is associated with increased morbidity and mortality. A myriad of techniques have been described for aortic root enlargement to circumvent this problem. We review the salient techniques with their merits, demerits, and results.
BonowROCarabelloBAChatterjeeK, et al.
ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: executive summary. Circulation2006;
114: 450–527.
2.
RahimtoolaS.The problem of valve prosthesis-patient mismatch.Circulation1978;
58: 20–24.
3.
PibarotPDumesnilJGLemieuxMCartierPMétrasJDurandLG.Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valve. J Heart Valve Dis1998;
7: 211–218.
4.
BlaisCDumesnilJGBaillotRSimardSDoyleDPibarotP.Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Circulation2003;
108: 983–988.
5.
HeadSMokhlesMOsnabruggeR, et al.
The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years. Eur Heart J2012;
33: 1518–1529.
6.
ChenJLinYKangBWangZ.Indexed effective orifice area is a significant predictor of higher mid- and long-term mortality rates following aortic valve replacement in patients with prosthesis-patient mismatch. Eur J Cardiothorac Surg2013;
45: 234–240.
7.
DayanVVignoloGSocaGPaganiniJJBrusichDPibarotP.Predictors and outcomes of prosthesis-patient mismatch after aortic valve replacement. JACC Cardiovasc Imaging2016;
9: 924–933.
8.
KonnoSImaiYIidaYNakajimaMTatsunoK.A new method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic valve ring. J Thorac Cardiovasc Surg1975;
70: 909–917.
9.
RastanHKonczJ.Aortoventriculoplasty: a new technique for the treatment of left ventricular outflow tract obstructionJ Thorac Cardiovasc Surg1976;
71: 920–927.
10.
BreymannTOnoMBobylevD.A modified technique of Konno aortoventriculoplasty for redo aortic valve replacement procedures.Thorac Cardiovasc Surg2014;
62: 222–223.
ManouguianSSeybold-EptingW.Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique.J Thorac Cardiovasc Surg1979;
78: 402–412.
16.
RittenhouseESauvageLStammSMansfieldPBHallDGHerndonPS.Radical enlargement of the aortic root and outflow tract to allow valve replacement.Ann Thorac Surg1979;
27: 367–373.
17.
NuñezLAguadoMGPintoAGLarreaJL.Enlargement of the aortic annulus by resecting the commissure between the left and noncoronary cusps. Tex Heart lnst J1983;
10: 301–303.
18.
BortolottiUSciotiGMilanoANardiCTartariniG.Enlargement of the aortic annulus with glutaraldehyde-fixed bovine pericardium during aortic valve replacement. J Heart Valve Dis1998;
7: 299–304.
19.
BorowskiAKurtM.A modification to the Manouguian aortoplasty for biological valve implantation in patients with small (≤ 19 mm) aortic anuli—rationale and benefit. Tex Heart Inst J2008;
35: 425–427.
20.
MolinaJE.Enlargement of the aortic annulus using a double-patch technique: a safe and effective method. Ann Thorac Surg2002;
73: 667–670.
21.
BlankRHPupelloDFBessoneLNHarrisonEESbarS.Method of managing the small aortic annulus during valve replacement.Ann Thorac Surg1976;
22: 356–361.
22.
PupelloDFBlankRHBessoneLNHarrisonESbarS.Surgical management of the small aortic annulus. Hemodynamic evaluation.Chest1978;
74: 163–166.
23.
YamaguchiMOhashiHImaiMOshimaYHosokawaY.Bilateral enlargement of the aortic valve ring for valve replacement in children. New operative technique.J Thorac Cardiovasc Surg1991;
102: 202–206.
24.
OtakiMOkuHNakamotoSKitayamaHUedaMMatsumotoT.Two-directional aortic annular enlargement for aortic valve replacement in the small aortic annulus.Ann Thorac Surg1997;
63: 261–263.
25.
PengEHasanA.A modified approach to aortic root reconstruction in children: an extended 2-patch root enlargement technique.J Thorac Cardiovasc Surg2013;
146: 1547–1549.
26.
KulikAAl-SaighMChanV, et al.
Enlargement of the small aortic root during aortic valve replacement: is there a benefit?Ann Thorac Surg2008;
85: 94–100.
27.
ZhongQXiaoYChenJMaR.Strategy of aortic root enlargement in patients undergoing aortic and mitral valve replacement. Ann Thorac Surg2010;
90: 782–787.
28.
RochaRVManlhiotCFeindelCM, et al.
Surgical enlargement of the aortic root does not increase the operative risk of aortic valve replacement. Circulation2018;
137: 1585–1594.
29.
DhareshwarJSundtTM3rdDearaniJASchaffHVCookDJOrszulakTA.Aortic root enlargement: what are the operative risks?J Thorac Cardiovasc Surg2007;
134: 916–924.
DumaniSLikajEDibraLBecaVKuciSRefatllariA.Aortic annulus enlargement: early and long-term results. Open Access Maced J Med Sci2017;
5: 23–26.
32.
SáMPCarvalhoMMSobral FilhoDC, et al.
Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients. Interact Cardiovasc Thorac Surg2019;
29: 74–82.
33.
YuWTamDYRochaRVMakhdoumAOuzounianMFremesSE.Aortic root enlargement is safe and reduces the incidence of patient-prosthesis mismatch: a meta-analysis of early and late outcomes. Can J Cardiol2019;
35: 782–790.
34.
SakamotoTMatsumuraGKosakaY, et al.
Long-term results of Konno procedure for complex left ventricular outflow tract obstruction. Eur J Cardiothorac Surg2008;
34: 37–41.
35.
MatsuzakiYHiramatsuTSakamotoT, et al.
Twenty-year experience with the Konno operation: Konno incision does not impair LV function.Gen Thorac Cardiovasc Surg2018;
66: 270–275.
36.
SuriRMDearaniJASchaffHVDanielsonGKPugaFJ.Long-term results of the Konno procedure for complex left ventricular outflow tract obstruction.Eur J Cardiothorac Surg2006;
132: 1064–1071.
UllmannMGorenfloMSebeningC, et al.
Long-term results after reconstruction of the left ventricular outflow tract by aortoventriculoplasty. Ann Thorac Surg2003;
75: 143–146.
39.
ErezEKanterKRTamVKWilliamsWH.Konno aortoventriculoplasty in children and adolescents: from prosthetic valves to the Ross operation. Ann Thorac Surg2002;
74: 122–126.
