A Single Center Retrospective Analysis Of Aortic Valve Replacement In Elderly Patients With Small Aortic Annulus

Objective To investigate the early and medium-term effectafter aortic valve replacement with enlarged aortic root or erlarged aortic valve annulus in elderly small aortic valve annulus patients.To explore the feasibility and security with the autologous pericardial patch to enlargeaortic root.Methods From January 2009 to June 2016,41 elderly small aortic valve annulus patients entered the study.21 patients(10males and 11 females)received aortic valve replacement with aortic rootenlargement(A group),20 patients(9 males and 11 females)received aortic valve replacement with aortic valve annular enlargement(B group).The size of valve implantation,the time of cardiopulmonary bypass(CPB),the time of aortic cross clamp,the mortality of the perioperative period,the incidence of complications and the 24 hour drainage operation were collected.Preoperation and three months,six months,one year postoperation,we applyechocardiography to measure the left ventricular ejection fraction(LVEF),mean transvalvular pressure gradient,and effective orifice area index(EOAI).The valve size,perioperative mortality,the incidence of complications and the recovery of cardiac structure and function between the two groups after the operation were compared between the two groups.The two groups were compared with t test or t’test if the measured data conforming to normal distribution in each group.The measurement data that did not conform to the normal distribution were compared with Kruskal-Wallis rank sum test,and the qualitative data were compared with the x2 test,and the difference of P<0.05 was statistically significant.Results In group A,1 patients died of low cardiac output during the perioperative period,and no deaths occurred in group B.There was no reopration in two groups.There was no significant difference in mortality and reopration between two groups(P > 0.05).In group A,2 patients were implanted with 21# valve,17 patients were implanted 23# valves,and 2 patients were implanted with 25# valve.In group B,2 patients were implanted with 21# valves,15 were implanted with 23# valves and 3 were implanted with 25# valves.There was no statistical difference between the two groups(P = 0.860).After transthoracic echocardiography,there was no significant difference between the LVDd,the EOAI and mean transvalvular pressure gradient between A group and B group in March,half year and 1 years(P > 0.05).In group A and group B,there was a significant difference in the diameter of annulus between 3 months after operation(P< 0.001),while the diameter of sinus diameter(P = 0.063)was not statistically significant.The time of CPB and the time of aortic crossclamp in A group were(83.7±29.9)min and(63.0±18.4)min.The time of CPB and the time of aortic crossclamp in B group was(97.5±32.3)min,(82.6±30.2)min,and the time of CPB and the time of aortic crossclamp in B group longer than that of A group(P < 0.001).The quantityof drainage of group A and group B was(599 + 197.7)ml,(741 + 220.7)ml,and the drainage of group B was more than that of A group(P = 0.036).Conclusions For the elderly small aortic valve annulus patients,to comparethe surgical procedure of the aortic valve replacement(AVR)after aortic root enlargement with autologous pericardium or aortic root enlargement with the Nicks,the operation process was simplified,the operation time was significantly shortened,and the postoperative quantityof drainage was significantly reduced.Aortic root enlargement with autologous pericardium compared with the Nicks methodcan achieve the same early and medium-term effect.For the elderly small aortic valve annulus patients,the operation is safe and feasible.