Practical Approach in Small Aortic Root Surgery

Small aortic root still remain as a challenging issue in heart valve surgery. Patient-prosthesis mismatch secondary to the aortic valve replacement with small prosthesis may lead to high transvalvular gradient, poor LV Remodeling, some degrees of heart failure and finally poor quality of life. In the other hand there are some controversies regarding the P-P mismatch long-term effects. The clinical relevance of a small difference in gradient and otherwise asymptomatic patients is unclear. Also lower IEOA is predictor of poorer NYHA early after AVR, but not important during 7-year follow up. In a meta-analysis of 13258 patients undergoing AVR with small valve size showed that operative mortality increases by less than 1% in 10% of cases with small prosthesis but does not reduce midterm or long-term survival.Root replacement, different techniques for aortic root enlargement, low profile prosthesis, stent less bio prosthesis and suture less newly designed tissue valves may use to overcome the small aortic root. I will try to have a comprehensive talk regarding the practical and evidence based approach to the small root dilemma. Can we ignore some degrees of P-P mismatch