JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES) ›› 2014, Vol. 52 ›› Issue (8): 43-46.doi: 10.6040/j.issn.1671-7554.0.2014.038

Previous Articles     Next Articles

Study of diameter of ascending aorta and prosthesis-patient mismatch after aortic valve replacement

CHEN Lei, ZOU Chengwei, ZHANG Haizhou, ZHU Xiaolong, HAN Bo   

  1. Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250012, Shandong, China
  • Received:2014-01-15 Revised:2014-06-10 Online:2014-08-10 Published:2014-08-10

PDF (PC)

67

Abstract: Objective To investigate changes of diameter of ascending aorta and the prosthesis-patient mismatch (PPM) after aortic valve replacement. Methods A total of 42 patients with aortic valve disease and ascending aortic dilatation (ascending aorta diameter 3.5 cm~5.0 cm) treated in our hospital during Dec. 2006 to Dec. 2012 were selected (cases with Marfan syndrome and ascending aortic dissection were excluded). The subjects were divided into bicuspid aortic valve group (group Ⅰ, n=22) and tricuspid aortic valve group (group Ⅱ, n=20) according to the features of aortic valves. According to the different types of valves, the subjects were divided into the mechanical valve group (group Ⅲ, n=26), and bioprosthetic valve group (group Ⅳ, n=16). All cases underwent simple aortic valve replacement surgery under cardiopulmonary bypass, without dealing with the dilated ascending aorta. The diameter of ascending aorta was measured and the effective orifice area index (EOAI) was calculated. According to EOAI, PPM was divided into three categories: mild (EOAI>0.85 cm2/m2), moderate (0.652/m2), and severe (EOAI≤0.65 cm2/m2). Results The ascending aorta change rates in group Ⅰ were: patients with aortic stenosis (0.6±1.09) mm/year, patients with aortic stenosis and regurgitation (0.5±0.6) mm/year, patients with aortic regurgitation(0.3±0.8) mm/year; the ascending aorta change rates in group Ⅱ were: patients with aortic stenosis (-0.2±1.2) mm/year, patients with aortic stenosis and regurgitation (-0.2±0.9) mm/year, patients with aortic regurgitation (-0.1±0.6) mm/year. Moderate PPM accounted for 15.38% in group Ⅲ and 43.75% in group Ⅳ. Conclusion Aortic valve replacement surgery is not adequant for BAV patients with aortic dilatation of the ascending aorta (aortic diameter 3.5 cm~5.0 cm), because postoperatively the ascending aorta will dilate to a certain degree. PPM occurs more often after aortic valve replacement and is likely to affect patients with bioprosthetic valve.

Key words: Aortic valve disease, Ascending aorta dilatation, Aortic valve replacement, Prosthesis-patient mismatch

CLC Number: 

  • R654
[1] Mannacio V, De Amicis V, Vosa C. Prosthesis-patient mismatch after aortic valve replacement: is it time for a redefinition?[J]. Ann Thorac Surg, 2014, 97(4):1482.
[2] 刘胜中, 黄克力,谭今, 等. 二叶式主动脉瓣畸形的外科治疗[J]. 实用医院临床杂志, 2013, 10(2):48-51.
[3] Nataatmadja M, West M, West J, et al. Abnormal extracellular matrix protein transport associated with increased apoptosis of vascular smooth muscle cells in Marfan syndrome and bicuspid aortic valve thoracic aortic aneurysm[J]. Circulation, 2003, 108(Suppl 1):329-334.
[4] Kuzmik G A, Sang A X, Elefteriades J A. Natural history of thoracic aortic aneurysms[J]. J Vasc Surg, 2012, 56(2):565-571.
[5] Goland S, Czer L S, De Robertis M A, et al. Risk factors associated with reoperation and mortality in 252 patients after aortic valve replacement for congenitally bicuspid aortic valve disease[J]. Ann Thorac Surg, 2007, 83(3):931-937.
[6] Padang R, Bagnall R D, Semsarian C. Genetic basis of familial valvular heart disease[J]. Circ Cardiovasc Genet, 2012, 5(5):569-580.
[7] Tadros T M, Klein M D, Shapira O M. Pathophysiology, molecular biology, and clinical implications ascending aortic dilatation associated with bicuspid aortic valve[J]. Circulation, 2009, 119(6):880-890.
[8] Girdauskas E, Disha K, Raisin H H, et al. Risk of late aortic events after an isolated aortic valve replacement for bicuspid aortic valve stenosis with concomitant ascending aortic dilation[J]. Eur J Cardiothorac Surg, 2012, 42(5):832-837.
[9] Davies R R, Kaple R K, Mandapati D, et al. Natural history of ascending aortic aneurysms in the setting of an unreplaced bicuspid aortic valve[J]. Ann Thorac Surg, 2007, 83(4):1338-1344.
[10] Svensson L G, Kim K H, Lytle B W, et al. Relationship of aortic cross-sectional area to height ratio and the risk of aortic dissection in patients with bicuspid aortic valves[J]. J Thorac Cardiovasc Surg, 2003, 126(3):892-893.
[11] 姜敏炎, 张剑平, 吴伟敏, 等. 主动脉瓣二叶式畸形及合并升主动脉瘤样扩张的外科治疗[J]. 中国临床医学, 2010, 17(2):159-160.
[12] 郑向阳, 梁志强, 王平凡, 等. 主动脉瓣病变合并升主动脉扩张主动脉成形术后疗效分析[J]. 中国循证心血管医学杂志, 2012, 4(5):458-459.
[13] Moon M R, Lawton J S, Moazami N, et al. POINT: Prosthesis-patient mismatch does not affect survival for patients greater than 70 years of age undergoing bioprosthetic aortic valve replacement[J]. J Thorac Cardiovasc Surg, 2009, 137(2):278-283.
[14] Howell N J, Keogh B E, Ray D, et al. Patient-prosthesis mismatch in patients with aortic stenosis undergoing isolated aortic valve replacement does not affect survival[J]. Ann Thorac Surg, 2010, 89(1):60-64.
[1] LIANG Fei, ZHANG Wenlong, ZHANG Jun, XU Chongen, ZOU Chengwei. Relevant factors and early complications of significantly elevated enzymes after off-pump coronary artery bypass grafting [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(10): 71-75.
[2] TAN Qi, ZI Jie, LI Qingbao, LI Yong, LI Decai, SUI Runqian, SUN Liangong, YU Li, WANG Anbiao. Embedding strategy of pulmonary valvuloplasty for reconstruction of right ventricular outflow in tetralogy of Fallot [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(8): 57-60.
[3] FENG Zhiyu, YANG Yanliang, GUO Rui, XU Huihui, ZHANG Jian, GUO Kai, WANG Guangzhen, WANG Hui. Diagnosis and surgical treatment of pulmonary artery sling complicated with tracheal stenosis [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(8): 48-51.
[4] LIU Fang, QIAO Lei, CHEN Wenchao, YANG Lina. Cardioprotective effects of allicin postconditioning on myocardial ischemia-reperfusion injury in rats [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(7): 6-11.
[5] WANG Long, ZHAO Xin, LI Yuanyuan, WANG Ximing, LI Decai, SONG Guangmin. Effect of anticoagulation on the remodeling of residual false lumen after aortic valve replacement of DeBakey type I aortic dissection [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(12): 27-31.
[6] . [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(12): 93-94.
[7] YE Cong. Influencing factors for the graft patency of radial artery after coronary artery bypass grafting surgery [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(8): 34-38.
[8] LIU Songtao, SHEN Bin, LIN Hui, LI Xiangwei, WEN Zhaoke. A comparative study of total thoracoscopic mitral valve replacement under heart beating and heart arrest [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(8): 39-43.
[9] GONG Yanjie, WANG Long, DONG Laidong, LI Dong, SONG Guangmin, JU Xiuli. Effects of different cryoprotectants and cooling methods on the histology and immunogenicity of heart valves [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(8): 44-49.
[10] DUAN Hongyong, GUAN Qiang, LIANG Ning, YANG Xiaofei, HAN Feng, MA Ming, LIU Zengqing. Therapy experience of distal embolization occurred during interventional therapy of lower extremities artery occlusion [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(3): 55-58.
[11] . [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(3): 91-94.
[12] LI Xin, WANG Gongming, WANG Hong, WANG Yan, ZHANG Ligong, ZHANG Le, LIU Bei, ZHANG Mengyuan. Inducible nitric oxide synthase contributes to the delayed cardioprotection of ischemic postconditioning in rats [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(2): 16-20.
[13] LU Zhong, SHEN Yunhua, YAN Zhongya, HUANG Xiangyang, LI Chunsheng, LI Huabao, YANG Dongmei. Treatment of atrial septal defect: minimally invasive occlusion procedure vs percutaneous interventional occlusion [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(2): 49-52.
[14] . [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(1): 92-93.
[15] FENG Zhiyu, GUO Rui, YANG Yanliang, LI Haiming, DONG Mingliang, XU Huihui, LIU Yimin, GUO Kai, WANG Guangzhen, WANG Hui. Initial palliative repair of pulmonary atresia with ventricular septal defect by rehabilitating right ventricle to pulmonary artery connection [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(11): 41-45.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd