Allison Gerdes
Research Mentor: Bo Yang
Mentor Department: Cardiac surgery, Medicine
Author(s): Allison Gerdes, Aditya Sridhar, China Green, Buqing Ni, Kanhua Yin, Bo Yang
Session: Session 3 (11:00 AM – 11:50 AM)
Presentation Type: Poster 8
Abstract
Background: We aimed to see whether aortic annular enlargement (AAE) in patients with same-sized native aortic annuli (=23 mm) undergoing redo aortic valve replacement surgery is beneficial to the patient by examining short-term outcomes. Methods: From January 2014 to September 2024, 245 patients with native aortic annulus size =25 mm with severe aortic valve stenosis underwent redo aortic valve replacement surgery at the University of Michigan. Of those patients, 110 patients underwent AAE. The short-term hemodynamics were measured by one and two year follow-up echocardiograms. After propensity score matching, 51 pairs were identified, controlling for native annulus diameter, age, sex, diabetes, case status, valve type, and ejection fraction. Results: The demographic and preoperative data were similar between the two groups. However, the redo-AVR with AAE patients had a greater aortic valve mean gradient (43mmHg vs. 32mmHg, p=0.012), body surface area (2.1 m² vs. 1.9 m², p=0.008), and lower effective orifice area (0.8 cm² vs. 1.0 cm², p=0.012) than the redo-AVR group without AAE. Intraoperatively, the median native aortic annulus diameter measured was 23 for both groups, while the median prosthesis measured 23 in the redo-AVR group without AAE, and 27 in the redo-AVR group with AAE. The redo-AVR with AAE group had longer cross-clamp times (124 minutes vs 110 minutes, p=0.043; however, rates of perioperative complications were similar between the two groups. There was no operative mortality recorded across either group, and there was no significant difference in survival at 2 years. Enlarging the annulus resulted in improved short-term hemodynamic outcomes, including a lower mean gradient (8.5 mmHg vs. 11 mmHg, p=0.019) and a greater effective orifice area (2.1 cm² vs. 1.5 cm², p=0.017) at 2-year follow-up. Conclusions: Surgeons should consider performing aortic annular enlargement for patients undergoing redo aortic valve replacement. Aortic annular enlargement may provide improved short-term hemodynamics over aortic valve replacement without enlargement, making it beneficial for the patients.
