Early and Late Outcomes of Aortic Valve Replacement with Aortic Annular Enlargement: A Propensity Analysis

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Early and late outcomes were evaluated in Japanese patients undergoing aortic valve replacement (AVR) with or without aortic annular enlargement (AAE). Propensity matching adjusted for baseline differences in this study.


Between January 2001 and July 2014, 589 patients underwent AVR for aortic stenosis. Of these, 58 patients received AVR with AAE (AAE group), and the others received standard AVR without annular enlargement (sAVR group). Of these 589 patients, 116 patients were selected using propensity score matching analysis. We compared early and late outcomes between the two groups.


Compared with the sAVR group, cardiopulmonary bypass time (177 ± 42 vs. 157 ± 39 minutes) and aortic cross-clamp time (126 ± 32 vs. 110 ± 34 minutes) were significantly longer in the AAE group. However, there were no significant differences between the AAE group and the sAVR group in 30-day mortality (1.7 vs. 3.4%) and in-hospital mortality (1.7 vs. 3.4%). There was no severe patient-prosthesis mismatch after AVR in the AAE group. The overall survival rate and freedom from cardiac events in the AAE group and in the sAVR group at 10 years were 92.4 versus 75.9% (p = 0.477) and 89.5 versus 82.8% (p = 0.076), respectively. No differences were found between the two groups.


AAE was performed safely in Japanese patients with small aortic annulus. Surgical outcomes of the AAE group were not inferior to those of sAVR. Using this technique, which did not require advanced skills, it was easy to avoid severe patient-prosthesis mismatch.

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