Haemodynamic performance of aortic pericardial bioprostheses and bileaflet prostheses at rest and during exercise: implications for the surgical management of patients with small aortic roots
J R Gonzalez-Juanateya, M V Fernandeza, F G Sampedroc, J M Garcia-Acunaa, J B Garcia-Bengoecheab, A A Cendona, M G de la Penaa
a Department of
Cardiology, Galician General Hospital and University of Santiago
Faculty of Medicine, 15705 Santiago de Compostela, Spain, b Department of Cardiac Surgery, Galician General
Hospital, c Clinical
Epidemiology Unit, Galician General Hospital
Correspondence to: Dr Gonzalez-Juanatey. email: jgonzalezd{at}meditex.es
Accepted for publication 8 February 1999
OBJECTIVE
To determine
the haemodynamic behaviour, at rest and during exercise, of aortic
valve pericardial bioprostheses and different sizes of bileaflet prosthesis.
DESIGNObservational study.
SETTINGTertiary
medical centre.
PATIENTS AND
INTERVENTIONS74 patients (33 women, 41 men; mean
age 64 years) in whom 40 pericardial bioprostheses and 34 bileaflet
prostheses sized 19, 21, or 23 mm had been implanted to replace aortic valves.
MAIN OUTCOME
MEASURESDoppler echocardiography at rest and at
peak exercise, between 12 and 47 months after surgery.
RESULTSAll patients
achieved a significant increase in heart rate, systolic blood pressure,
and cardiac output with exercise. Transvalvar pressure fall, valve
area, and left ventricular systolic and diastolic function indices also
underwent significant changes with exercise. Reductions in peak and
mean transvalvar pressure, at rest and at peak exercise, were greater
in patients with small valves (p < 0.05). Valve areas and effective
area index were greater in the patients with larger valves
(p < 0.001). There were no significant differences between patients
with mechanical and biological prostheses with regard to transvalvar
pressure fall and valve areas at rest and at peak exercise.
CONCLUSIONS19 mm and
21 mm aortic prostheses and bioprostheses continue to create
significant obstruction, particularly with exercise.
Keywords: small aortic prostheses; haemodynamic variables; exercise
© 1999 by Heart
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