Surgical Management of Small Aortic Root

A common goal of Heart valve replacement
is to prevent or cure symptoms of
heart failure and decrease the likelihood
of heart failure-related death. Complete
abolition of transvalvular gradients is
not possible because of the obstructive
effects of the prosthetic valve stents and
sewing ring. Aortic valve replacement
(AVR) in the patients with small aortic
annulus is a challenging procedure and
is not an uncommon surgical problem.
Sever patient-prosthetic mismatch is a
predictor of higher long-term mortality
and congestive heart failure. For
patients undergoing AVR who are at risk
of sever mismatch, every effort should
be made to use a larger prosthesis or to
consider a prosthesis with a larger effective
orifice area. Valve selection for the
small aortic root is a multi-factorial
process. These factors include patient
age, lifestyle, pregnancy status, drug
compliance, EOA of prosthetic valve,
availability of prosthesis, experience &
skill of surgeon.