Eleven-year follow-up study of aortic or aortic-mitral anulus-enlarging procedure by Manouguian's technique.

Although Manouguian's operation is well established, there have been little long-term data published on its outcome. From January 1980 to June 1988, 15 patients underwent patch enlargement of the small aortic anulus by Manouguian's approach, either with aortic single valve replacement (7 patients) or with aortic-mitral double valve replacement (8 patients). Follow-up ranged from 3.0 to 11.4 years (mean 8.5) and was completed with a cumulative total of 102 patient-years. One patient died of fulminant hemolysis, probably related to turbulent jet flow and Dacron patch material (operative mortality 6.7%). There were four late deaths, and the actuarial survival, including operative death at 10 years, was 62% +/- 14%. Reoperations were performed seven times in six patients. Most of these complications were not considered to be caused by the anulus-enlarging procedure. Actuarial freedom rate from reoperation at 10 years was 65% +/- 15%. Four patients underwent rereplacement of prostheses for Hancock valve failure during 2.9 to 11.3 years (mean 8.2 years). The anulus enlargement was found to be well healed and presented no problem during reoperation. Surgically induced mitral regurgitation by Manouguian's procedure was observed in two patients. The regurgitation did not progress during follow-up duration of 1.9 to 10.0 years, nor did it cause congestive heart failure. Annular enlargement by Manouguian's procedure with use of mechanical valves is one of the good selections in patients with the narrow aortic valve ring.