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J Thorac Cardiovasc Surg 2007;134:922-924
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Discussion

Dr David A. Fullerton (Denver, Colo). Dr Dhareshwar, I would like to compliment you both on a very crisp and clear presentation and also on an extremely well-written manuscript. Thank you very much for forwarding that to me, as well as a copy of your presentation.

I liked your topic, your presentation, and your article in large part because it fits my bias perfectly. I have to acknowledge that I have a very low threshold for enlarging the annulus, and therefore it is pleasing to see your data, particularly in light of the background literature on the subject.

Acknowledging that in your analysis the annular enlargement per se did not fall out as an independent risk factor for perioperative death, small valve size did. I am curious as to what your insight might be as to why that is the case.

Dr Dhareshwar. In our data set, if you look at the range of preoperative annulus sizes, almost 60 patients had an annulus size of less than 19 mm, which means we could not even get the 19-mm valve in place. Even after an ARE, the valve size that we could implant was 19 mm in almost 43 patients. With the large proportion of patients having a very small aortic annulus, in our study that turned out to be a more significant risk factor than annular enlargement per se.

Dr Fullerton. But according to your article, and I realize I am taking you beyond the analysis of this talk, among those who did not have an annular enlargement, there was a substantial percentage who actually received small . . . [Full Text of this Article]

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Aortic root enlargement: What are the operative risks?

Jayesh Dhareshwar, Thoralf M. Sundt, III, Joseph A. Dearani, Hartzell V. Schaff, David J. Cook, and Thomas A. Orszulak
J. Thorac. Cardiovasc. Surg. 2007 134: 916-924. [Abstract] [Full Text] [PDF]