Aortic valve replacement with anterior and posterior enlargement of small aortic annulus is comparable to surgery with normal annulus.

Objective: To compare results of aortic valve replacement in patients with normal annulus and in those undergoing anterior and posterior enlargement of a small annulus to implant a larger prosthesis. Methods: The study included 22 patients with enlargement of a small aortic annulus and 23 with a normal aortic annulus, with similar demographic characteristics and selected from a large surgical population. For normal annulus, simple valve replacement was performed. For annular enlargement, the posterior approach required incision ill the mid portion of the non-coronary sinus, up to the anterior initral leaflet; anterior enlargement was achieved by an incision between the left and right coronary ostium. extended to the ventricular septum for 2 cm. The aorta was reconstructed with bovine pericardium patches. The results analyzed included diameter of aortic annulus at surgery, clinical evolution {2 to I I years of follow-up), left outflow tract obstruction and left ventricular mass (by Doppler echocardiography). Results: Enlargement increased the aorlic annulus from 18.3±2.2 mm to 2 4.8±2.0 mm (p<0.001), a value similar to aortic annulus considered normal: 24.9 ± 1.5 mm (NS). For annular enlargement, the peak systolic gradient at the prosthesis decreased from 83.6±22.3 mmHg (preoperative) to 26.7±11.4 mmHg (p < 0.01) at the last evaluation. Fur normal annulus, a reduction from 68.2±28.7 mmHg to 32.8±16.2 mmHg occurred (p<0.001) (final values similar between groups; NS). I.eft ventricular mass at the last evaluation was 147.2±45.9 for patients with enlargement and 148.1±70.4 for those with normal annulus. Conclusion: Anterior and posterior aortic annulus enlargement enabled increases in annular diameter and valve prosthesis size, providing clinical and echocardiographic results similar to patients with valve replacement in a normal annulus.