Comparative study of aortic root replacement versus aortic root enlargement in small aortic root

Abstract Background For patients with aortic stenosis (AS) and small annulus, aortic root replacement (RR) and aortic root enlargement (RE) are proven methods to prevent prosthesis-patient mismatch (PPM). Our goal was to compare the results of those two categories of operations. This prospective study used our hospitals’ database of aortic valve replacements from 2021 to 2024. Patients who had aortic stenosis treated with RE or RR were compared. The postoperative results and reoperations were compared. Kaplan–Meier survival estimation and log-rank test were used to compare time-to-event data. Results A total of 72 patients had aortic stenosis treated with either RE or RR. Thirty-eight (52%) and 34 (47%) patients underwent RR and RE, respectively. In RR cases, significant postoperative bleeding was noted in 13 patients vs. only 4 patients in RE group ( P -value = 0.001). The length of stay did not differ significantly ( P -value = 0.918) in both groups and the same in early postoperative mortality (2.6% for the RR group vs. 5.9% for the RE group ( P = 0.17)). Additionally, there were no considerable variations in the reoperation rate (2.6% in RR cases vs. 2.9% in RE cases). Patients in the RR group had lower trans-prosthetic gradients and larger valves implanted ( P < .001). The median follow-up period was 24.5 (25th–75th percentiles: 1–48) months. Kaplan–Meier survival estimates for the two groups were similar and did not show a significant difference in mortality. Conclusions Aortic valve reoperations, 4-year survival, and postoperative complications were all similar for AS patients treated with RE and RR. The study showed comparable reoperation rate, postoperative complications and survival rates between root replacement and enlargement in patients with small aortic root.