Comparison of the Early Results of Supra-Annular and Intra-Annular Aortic Valve Replacement in Isolated Aortic Valve Replacement

Objectives: This study aims to compare the early results of patients who underwent isolated aortic valve replacement (AVR) with supra-annular and intra-annular AVR.
Methods: Between 2013 and 2019, 113 patients (77 males; mean age 57.8±16.36 years) who underwent isolated AVR were evaluated. The patients were divided into two groups those who underwent supra-annular (n=59) and intra-annular (n=54) AVR. The most commonly used valves in surgeries St Jude Medical Masters (St. Jude Medical, Minneapolis, MN, USA), (n=35, 30.9%), Sorin Mitroflow (Sorin Group Inc., Mitroflow Division, Canada), (n=32, 28.3%, and Carbomedics Top Hat (Sulzer, Carbomedics, Austin, TX), (n=31, 27.4%).
Results: The cross-clamp (XCL) and cardiopulmonary bypass (CPB) times of the patients who underwent supra-annular AVR were found to be significantly higher than the patients who underwent intra-annular AVR. However, there was no significant difference between the two groups in terms of postoperative adverse events. There was no significant difference between the two groups in the postoperative first-week transthoracic echocardiographic (TTE) findings.
Conclusion: When comparing supra-annular and intra-annular valve positioning results in patients undergoing isolated AVR, no significant difference was found between the groups in terms of postoperative complications, gradient differences in postoperative TTE, and ejection fractions. Supra-annular valve positioning should be considered, especially in patients with small annulus, in the presence of suitable anatomical features. However, this issue needs to be investigated in future prospective studies with more patients.

Ýzole Aort Kapak Replasmanýnda Supra-Anüler ve Ýntra-Anüler Aort Kapak Replasmanýnýn Erken Sonuçlarýnýn Karþýlaþtýrýlmasý

Amaç: Bu çalýþmanýn amacý izole aort kapak replasmaný (AVR) yapýlan hastalarýn erken dönem sonuçlarýný supraanüler ve intraanüler AVR ile karþýlaþtýrmaktýr.
Metot: 2013-2019 yýllarý arasýnda izole AVR uygulanan 113 hasta (77 erkek; ortalama yaþ 57,8±16,36 yýl) deðerlendirildi. Hastalar supraanüler (n=59) ve intraanüler (n=54) AVR uygulananlar olmak üzere iki gruba ayrýldý. Ameliyatlarda en sýk kullanýlan kapaklar St Jude Medical Masters (St. Jude Medical, Minneapolis, MN, ABD), (n=35, %30,9), Sorin Mitroflow (Sorin Group Inc., Mitroflow Division, Kanada), (n=32, %28,3 ve Carbomedics Top Hat (Sulzer, Carbomedics, Austin, TX), (n=31, %27,4).
Bulgular: Supraanüler AVR uygulanan hastalarýn kros klemp (XCL) ve kardiyopulmoner bypass (KPB) süreleri intraanüler AVR uygulanan hastalara göre anlamlý olarak yüksek bulundu. Ancak ameliyat sonrasý advers etkiler açýsýndan iki grup arasýnda anlamlý fark yoktu. Ameliyat sonrasý birinci hafta transtorasik ekokardiyografi (TTE) bulgularýnda iki grup arasýnda anlamlý fark yoktu.
Sonuç: Ýzole AVR uygulanan hastalarda supraanüler ve intraanüler kapak konumlandýrma sonuçlarý karþýlaþtýrýldýðýnda, postoperatif komplikasyonlar, postoperatif TTE'deki gradyan farklýlýklarý ve ejeksiyon fraksiyonlarý açýsýndan gruplar arasýnda anlamlý fark bulunamadý. Özellikle küçük anulusa sahip hastalarda uygun anatomik özellikler varlýðýnda supraanüler kapak pozisyonlandýrýlmasý düþünülmelidir. Ancak ileride daha fazla hastayla yapýlacak prospektif çalýþmalarda bu konunun araþtýrýlmasý gerekmektedir. (SETB-2023-11-215)