Overview
Disruption of the aortic valve annulus can occur during aortic valve replacement (AVR), necessitating aortic annulus enlargement (AAE). This procedure aims to address anatomical challenges that might otherwise lead to patient-prosthesis mismatch.Diagnosis
Management
Aortic annulus enlargement (AAE) may be performed during surgical aortic valve replacement (AVR) in cases of annulus disruption or small annulus size 1.
AAE is associated with a lower risk of significant patient-prosthesis mismatch (PPM) 1.
AAE is associated with a higher overall difference in means of indexed effective orifice area (iEOA) 1.Special Populations
Key Recommendations
Aortic annulus enlargement (AAE) during aortic valve replacement (AVR) is associated with a lower risk of significant patient-prosthesis mismatch (PPM) 1. (Evidence: Moderate)
Aortic annulus enlargement (AAE) during aortic valve replacement (AVR) is associated with a higher overall difference in means of indexed effective orifice area (iEOA) 1. (Evidence: Moderate)
The overall unadjusted odds ratio for operative mortality showed a statistically significant difference between groups undergoing AVR with AAE compared to AVR without AAE, with a higher risk in the AVR with AAE group 1. (Evidence: Moderate)
In matched populations, there was no significant difference in operative mortality between AVR with AAE and AVR without AAE 1. (Evidence: Moderate)References
1 Sá MPBO, Zhigalov K, Cavalcanti LRP, Escorel Neto AC, Rayol SC, Weymann A et al.. Impact of Aortic Annulus Enlargement on the Outcomes of Aortic Valve Replacement: A Meta-analysis. Seminars in thoracic and cardiovascular surgery 2021. link