Optimizing Aortic Valve Replacement Through Strategic Upsizing: A Modern Framework for Lifetime Valve Management
Dimitrios E. Magouliotis, Vasiliki Androutsopoulou, Andrew Xanthopoulos, Noah Sicouri, Bo Yang

TL;DR
This paper proposes upsizing aortic valves during surgery to prevent long-term complications and improve future treatment options.
Contribution
It introduces a modern framework for optimizing aortic valve replacement through strategic upsizing to reduce prosthesis-patient mismatch.
Findings
Aortic annular enlargement techniques allow implantation of larger prostheses and reduce prosthesis-patient mismatch.
Computational fluid dynamics show annular enlargement improves postoperative flow dynamics and reduces pressure gradients.
Systematic valve sizing and PPM surveillance can enhance both immediate and long-term outcomes in aortic valve replacement.
Abstract
Aortic valve disease is increasingly recognized as a chronic, progressive condition in which the initial valve intervention exerts a decisive influence on all subsequent therapeutic options. The persistence of prosthesis–patient mismatch (PPM), often driven by implantation of small surgical prostheses (≤21–23 mm), is associated with higher residual transvalvular gradients, attenuated left ventricular reverse remodeling, inferior long-term survival, and compromised outcomes following valve-in-valve (ViV) transcatheter procedures. Accumulating clinical and imaging evidence indicates that aortic annular enlargement (AAE), particularly using contemporary Y-incision and extended “roof” reconstruction techniques, can safely and reproducibly expand the annulus, sinuses of Valsalva, and sinotubular junction, thereby permitting implantation of larger prostheses and substantially reducing the…
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Taxonomy
TopicsCardiac Valve Diseases and Treatments · Aortic Disease and Treatment Approaches · Cardiovascular Function and Risk Factors
