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J.Jpn. Surg. Soc.. 122(5): 456-461, 2021


Feature topic

SURGICAL STRATEGIES FOR AORTIC STENOSIS IN PATIENTS WITH SMALL AORTIC ANNULUS

Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan

Jun Takaki, Kosaku Nishigawa, Takashi Yoshinaga, Ken Okamoto, Toshihiro Fukui

With the aging of the population, the number of patients with senile aortic stenosis has been increasing every year. Since Japanese patients generally have smaller physiques than those in Western countries, the proportion of patients with small aortic annulus is relatively high in Japan. One concern associated with surgical aortic valve replacement (SAVR) is postoperative patient–prosthesis mismatch, which has negative impacts on hemodynamic performance and long-term outcomes after SAVR. It is frequently difficult to implant an appropriately sized prosthetic valve in patients with small aortic annulus. Surgical strategies including the use of an externally mounted pericardial valve, single interrupted sutures, and annular enlargement procedures should be developed for SAVR in patients with small aortic annulus.


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