Long-Term Results of Pericardial Autologous Patch Enlargement of the Aortic Annulus Using the Manouguian Technique
DOI:
https://doi.org/10.1532/hsf.1258Abstract
Background: The management of a small aortic root at the time of aortic valve replacement is controversial. In cases in which the aortic root is very small the choice of aortic valve type and of root-enlargement method is difficult. The technical challenge of the small aortic root has instigated the creation of methods for annular enlargement. Severe mismatch as a predictor of overall 30-day mortality or midterm mortality reports about long-term results of aortic valve replacement using autologous pericardial patch are scarce. Moreover, no reports about patient series are present in the English medical literature. This retrospective study was designed to address this gap in evidence.Methods: Twenty consecutive patients undergoing aortic valve replacement (with or without mitral valve replacement and/or coronary artery bypass grafting) at Başkent University Adana Medical Center between June 30, 1999 and April 10, 2006 were retrospectively evaluated. All clinical and echocardiographical data belonging to this population were specified. Their perioperational data were assessed.
Results: Twenty patients operated using the Manouguian technique for narrow aortic root from June 1999 to April 2006 were followed for 8.54 ± 3.35 years. Fourteen patients were alive at the end of the follow-up. Six patients had died. Early mortality rate was 5% and late mortality after 8.54 ± 3.35 years was 30%. Late mortality related to cardiac reasons was 5%. Only one death could be attributed to a cardiac cause which occured in a 36-year-old male patient 3 years and 6 months after the operation. 70% of the patients were alive after a mean follow-up period of 8.54 ± 3.35 years.
Conclusion: The main finding of the present study is that aortic root enlargement using untreated fresh autologous pericardium in Manouguian type operations is a durable option, especially in conditions when homograft or stentless valve use is difficult or economically not feasible. We found that no patient had aneurysmal dilatation or mitral regurgitation after a mean follow-up of 8.54 ± 3.35 years with autologous untreated pericardium as the enlargement patch.
References
Alizadeh Ghavidel A, Omrani G, Chitsazan M, Totonchi Z, Givtaj N. Long term results of aortic valve replacement with posterior root enlargement. Asian Cardiovasc Thorac Ann. 2014;22:1059-1065.
Ardal H, Toker ME, RabuÅŸ MB, Uyar Ä°, Antal A, ÅžiÅŸmanoÄŸlu M, et al. Does aortic root enlargement impair the outcome of patients with small aortic root? J Card Surg 2006;21.449-453.
Borowski A, Kurt M. A modification to the Manouguian aortoplasty for biological valve implantation in patients with small (≤19mm) aortic annuli-rationale and benefit. Tex Heart Inst J 2008;35:425-427.
Bortolotti U, Scioti G, Milano A, Nardi C, Tartarini G. Enlargement of the aortic annulus with gluteraldehyde-fixed bovine pericardium during aortic valve replacement. Heart Valve Dis. 1998;7:299-304.
Christakis GT, Joyner CD, Morgan CD, Fremes SE, Buth KJ, Sever JY, et al. Left ventricular mass regression early after aortic valve replacement. Ann Thorac cSurg 1996;62:1088-1089.
Cotoni DA, Palac RT, Dacey LJ, O’Rourke DJ. Defining patient-prosthesis mis match and its effect on survival in patients with impaired ejection fraction. Ann Thorac Surg 2011;91:692-699.
Eghtesady P, Hanley F. Posterior aortic annular enlargement for mechanical aortic valve replacement. Op Tech Cardiovasc Surg 2002;7:181-187.
Eloakeley RM, Grotte GJ. Severe calcification of a pericardial patch used in an aortic root enlargement: Case Report. J Thorac Cardiovasc Surg. 1994;107:634-635.
Haluck RS, Richenbacher WE, Myers JL, Miller CA, Wise RK, Waldhausen JA. Pericardium as a thoracic aortic patch: gluteraldehyde –fixed and fresh autologous pericardium. J Surg Res.1990;48:611-4.
Hashimoto K. Patient-prosthesis mismatch: The Japanese experience. Ann Thorac Cardiovasc Surg 2006;12:159-165.
Imanaka K, Takamoto S, Furuse A. Mitral regurgitation late after Manouguian’s annulus enlargement and aortic valve replacement. J Thorac Cardiovasc Surg. 1998;115:727-729.
Losenno Kl, Gelinas JJ, Johnson M, Chu MW. Defining the efficacy of aortic root enlargement procedures : a comparative analysis of surgical techniques. Can J Cardiol 2013;29:4343-440.
Manouguian S, Seybold-Epting W. Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique. J Thorac Cardiovasc Surg 1979:78:402-412.
Marco AL, Nawaytou O, Von Oppell UO. Late aortic aneurysm after supravalvular aortic stenosis repaired with autologous pericardial patch. Ann Thorac Surg 2013;95:346-348.
Molina EJ. Enlargement of the aortic annulus using a double-patch technique: a safe and effective method. Ann Thorac Surg 2002;73:667-670.
Mothy D, Dumesnil JG, Echahidi N, et al. Impact of prosthesis-patient mismatch on long term survival after aortic valve replacement. J Am Coll Cardiol 2009;53:39-47.
Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: definition, clinical impact, and prevention. Heart 2006;92:1022-1029.
Rahimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation 1978,58:20-24.
Rao V, Jamieson WR, Ivanov J, Armstrong S, David TE.. Prosthesis – patient mismatch affects survival after aortic valve replacement. Circulation 2000;102:Iii-5-Iii-9.
Sundt TM III. Patch enlargement of the aortic annulus using the Manouguian technique. Operative Techniques in Thoracic and Cardiovascular Surgery 2006;11:16-21.
Tully PJ, Aty W, Rice GD, Bennets JS, Knight JL, Baker RA. Aortic valve prosthesis-patient mismatch and long-term outcomes: 19- year single center experience. Ann Thorac Surg 2013;96:884-850.
Uçak A, Onan B, Inan K, Karaca OG, Ugur M, Yilmaz AT. Detachmemnt of an annular patchfollowing the Manouguian procedure. J Card Surg 2010;25:282-302.
Urso S, Sadaba R, Aldamiz-Echevirria G. Is patient –prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement? Interact Cardiovasc Thorac Surg 2009;9:510-519.
Vural KM, Ozyalcin S, Turkmen U, Bozkurt T. Aortoventriculoplasty for correction of patient-prosthesis mismatch examples. Heart Lung Circ 2014;23:e96-e99.
Zhong Q, Xiao Y, Chen J, Ma R. Strategy of aortic root enlargement in patients undergoing aortic and mitral valve replacement. Ann Thorac Surg 2010; 90:782-787.
