Frequency of Aortic Root Enlargement to Prevent PPM Patients Undergone Aortic Valve Replacement in Peshawar Institute of Cardiology

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Abdul Nasir
Aamir Iqbal
Abdul Haseeb
Attiya Hameed Khan


Background: Surgical aortic valve replacement (AVR) remains the gold standard for treating symptomatic aortic valve stenosis, aiming to alleviate left ventricular overload, relieve symptoms, and enhance survival. Aortic root enlargement (ARE) is a technique used alongside AVR to accommodate a properly sized prosthetic valve, particularly in patients with a small aortic annulus, to prevent patient-prosthesis mismatch (PPM) and improve clinical outcomes.

Objective: This study aimed to evaluate the outcomes of AVR with or without ARE at the Peshawar Institute of Cardiology, focusing on the procedural efficacy, incidence of PPM, and short-term post-operative outcomes.

Methods: A retrospective analysis was conducted on 76 patients who underwent AVR, with or without ARE, from December 2020 to March 2023. Data were collected on demographics, clinical manifestations, etiology, comorbidities, operative details, and post-operative outcomes. Statistical analyses included mean ± SD for quantitative variables and frequencies with percentages for qualitative variables, using SPSS 26.0 for data analysis.

Results: The average age of patients was 37.53 ± 15.589 years, with a mean BMI of 24.9125 ± 5.07249. Among the procedures, 48.7% were AVR alone, 11.8% AVR with ARE, 10.5% AVR with coronary artery bypass grafting (CABG), and 28.9% AVR with mitral valve replacement (MVR). The mean bypass time for AVR+ARE was 189.3333 ± 77.83155 minutes, compared to 161.9254 ± 64.08737 minutes for other valvular surgeries. Post-operative hospital stay averaged 5.4444 ± 1.74005 days for AVR+ARE cases, against 6.52 ± 2.003 days for other surgeries.

Conclusion: AVR with ARE is a feasible and effective strategy for patients with small aortic annuli, demonstrating satisfactory short-term outcomes and potential to reduce PPM. The study highlights the need for cardiac surgeons to gain proficiency in ARE techniques and calls for further research to evaluate long-term outcomes.

Article Details

How to Cite
Nasir, A., Iqbal, A., Haseeb, A., & Khan, A. H. (2024). Frequency of Aortic Root Enlargement to Prevent PPM Patients Undergone Aortic Valve Replacement in Peshawar Institute of Cardiology. Journal of Health and Rehabilitation Research, 4(1), 694–700.
Author Biographies

Abdul Nasir, Peshawar Institute of Cardiology Pakistan.

Assistant Professor Cardiac Surgery, Department of Cardiac Surgery.

Aamir Iqbal, Peshawar Institute of Cardiology Pakistan.

Postgraduate Resident, Cardiac Surgery, Department of Cardiac Surgery.

Abdul Haseeb, Peshawar Institute of Cardiology Pakistan.

Postgraduate Resident, Cardiac Surgery, Department of Cardiac Surgery.

Attiya Hameed Khan, Peshawar Institute of Cardiology Pakistan.

Research Analyst, Cardiac Surgery Department of Clinical Research.


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