Mechanical Prostheses in Adults with an Aortic Ring Size of 17–21 mm with and without Posterior Aortoplasty

Introduction. The larger size of the implanted prosthesis provides more favorable conditions for systolic function and more complete regression of left ventricular hypertrophy. In some cases, this can only ensure expansion of the left ventricular outflow tract with a patch. Aim. To compare the immediate results between a group with an isolated mechanical valve replacement inserted into a narrow aortic annulus and a group with a posterior aortoplasty that accommodated a larger mechanical valve. The reasonable proportion of posterior aortoplasty for a narrow ring is 20–30 % of cases. Materials and methods. In 2015–2023, 78 adult patients with a narrow aortic ring (17–21 mm) underwent aortic valve replacement. The isolated prosthetic group consisted of 56 patients, the group with posterior aortoplasty consisted of 22 cases. Results. In the immediate postoperative period, the group with posterior aortoplasty had advantages in: Rashimtoola S.H. index (1,34 ± 0,2 versus 1,06 ± 0,14 см2/м2), significantly lower peak pressure gradient (20,77 ± 6,61 versus 29,33 ± 8,2 mm Hg), mean pressure gradient (10,61 ± 3,23 versus 14,93 ± 4,29 mm Hg) on the prostheses, and left ventricular stroke volume index (29,0 ± 6,56 versus 28,85 ± 7,81 мл/м2). Conclusions. The use of aortoplasty gives better hemodynamic results. The reasonable proportion of posterior aortoplasty for a narrow aortic ring is 28.2 % of cases.