Journal of Korean medical science · 2026
Annular Enlargement: Can It Be Effective for Patients With a Small Left Ventricular Outflow Tract?
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Park Soo Jin, Kim Kitae, Kim Hong Rae, Yoo Jae Suk, Kim Joon Bum, Jung Sung-Ho, Chung Cheol Hyun, Lee Jae Won, Kim Ho Jin
Аннотация
BACKGROUND: Aortic annular enlargement (AAE) has been suggested as a surgical technique to facilitate the implantation of a larger prosthetic valve in patients with a small aortic annulus. We investigated the differences in clinical and echocardiographic parameters between patient undergoing aortic valve replacement (AVR) with and without AAE, focusing on the impact of left ventricular outflow tract (LVOT) geometry.
METHODS: A total of 899 patients (age, 65.5 ± 9.6 years; 414 female) who underwent AVR from 1996 to 2023 were evaluated. The primary outcomes were all-cause mortality and the trends in echocardiographic parameters, analyzed using a linear mixed-effects model. The secondary outcomes included early complications and valve-related adverse events comprising stroke, congestive heart failure, reoperation and infective endocarditis. Propensity score matching was employed for baseline adjustment.
RESULTS: In the entire cohort, 75 underwent AVR with AAE, and 824 received AVR-only. After pair matching, 274 patients were included in the final analysis (72 vs. 202). Larger-sized valves were implanted in the AVR-AAE group (22.0 ± 2.2 mm vs. 20.9 ± 1.6 mm, P < 0.001). Early complications, survival rates, and valve-related adverse events showed no significant differences. Echocardiography revealed similar left ventricular mass index (LVMI) regression in both groups (P = 0.057). In patients with a larger LVOT than the annulus (13.9%), the AVR-AAE group showed a rapid LVMI regression trend, while in those with a smaller LVOT than the annulus (86.1%), the AVR-only group demonstrated faster LVMI regression (P = 0.021).
CONCLUSION: While AAE enables larger prosthetic valve implantation without affecting clinical outcomes, its impact on LVMI regression varies based on the LVOT-annulus relationship. AAE may not have long-term benefits in patients with a smaller LVOT compared to the annulus. For optimal surgical planning, evaluation of both annulus and LVOT sizes is crucial.
METHODS: A total of 899 patients (age, 65.5 ± 9.6 years; 414 female) who underwent AVR from 1996 to 2023 were evaluated. The primary outcomes were all-cause mortality and the trends in echocardiographic parameters, analyzed using a linear mixed-effects model. The secondary outcomes included early complications and valve-related adverse events comprising stroke, congestive heart failure, reoperation and infective endocarditis. Propensity score matching was employed for baseline adjustment.
RESULTS: In the entire cohort, 75 underwent AVR with AAE, and 824 received AVR-only. After pair matching, 274 patients were included in the final analysis (72 vs. 202). Larger-sized valves were implanted in the AVR-AAE group (22.0 ± 2.2 mm vs. 20.9 ± 1.6 mm, P < 0.001). Early complications, survival rates, and valve-related adverse events showed no significant differences. Echocardiography revealed similar left ventricular mass index (LVMI) regression in both groups (P = 0.057). In patients with a larger LVOT than the annulus (13.9%), the AVR-AAE group showed a rapid LVMI regression trend, while in those with a smaller LVOT than the annulus (86.1%), the AVR-only group demonstrated faster LVMI regression (P = 0.021).
CONCLUSION: While AAE enables larger prosthetic valve implantation without affecting clinical outcomes, its impact on LVMI regression varies based on the LVOT-annulus relationship. AAE may not have long-term benefits in patients with a smaller LVOT compared to the annulus. For optimal surgical planning, evaluation of both annulus and LVOT sizes is crucial.