Original article: cardiovascularMass regression in aortic stenosis after valve replacement with small size pericardial bioprosthesis
Section snippets
Patient population
The study population consisted of 88 patients with pure aortic stenosis (no patient had more than trace or mild aortic regurgitation) and no other heart disease (apart from coronary artery disease) who underwent aortic valve replacement with CEP valves at the Poliambulanza Hospital in Brescia, Italy, between September 1997 and July 2001. Of the 100 patients discharged after aortic valve replacement during this period, 5 died late (see Table 1) and 7 refused to participate in the follow-up study
Results
There were 34 patients in the CEP-19 group, 29 in the CEP-21 group, and 25 in the CEP-23 group. Their clinical characteristics are shown in Table 3. Concomitant coronary artery bypass graft procedures were performed in 54.5% of the patients (48 of 88).
Comment
Left ventricular hypertrophy in patients with pressure overload (such as that due to aortic stenosis) is a compensatory mechanism that allows wall stress and the EF to remain within the normal range. The majority of patients undergoing aortic valve replacement for aortic stenosis show a regression in LV mass, which normalizes in 20% of cases [6].
The implantation of a small aortic valve prosthesis, with a possible patient-prosthesis mismatch or residual gradient, may negatively affect LV mass
Acknowledgements
We would like to thank Dr Pier Virgilio Parrella for his assistance with the statistical analysis.
References (23)
- et al.
Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiography
J Am Coll Cardiol
(1990) - et al.
Impact of size mismatch and left ventricular function on performance of the St
Jude disc valve after aortic valve replacement. Ann Thorac Surg
(1997) - et al.
Aortic valve replacement with patch enlargement of the aortic annulus
Ann Thorac Surg
(1997) - et al.
Aortic valve replacement for octogenarians—are small valves bad?
Ann Thorac Surg
(1998) - et al.
Hemodynamic evaluation of 19-mm Carpentier-Edwards pericardial bioprosthesis in aortic position
Ann Thorac Surg
(2001) - et al.
Regression of hypertrophy after Carpentier-Edwards pericardial aortic valve replacement
Ann Thorac Surg
(2000) - et al.
Patient prosthesis mismatch is rare after aortic valve replacementvalve size may be irrelevant
Ann Thorac Surg
(2002) - et al.
Extent and pattern of regression of left ventricular hypertrophy in patient with small size carbomedics aortic valve
J Thorac Cardiovasc Surg
(1997) - et al.
Influence of aortic valve replacement, prosthesis type, and size on functional outcome and ventricular mass in patients with aortic stenosis
J Thorac Cardiovasc Surg
(1999) - et al.
Regression of left ventricular hypertrophy after aortic valve replacement for aortic stenosis with different valve substitutes
J Thorac Cardiovasc Surg
(1998)
Cited by (34)
Does the type of suture technique affect the fluid-dynamic performance of bioprostheses implanted in small aortic roots' Results from an in vitro study
2015, Journal of Thoracic and Cardiovascular SurgeryPatient-prosthesis mismatch and reduction in left ventricular mass after aortic valve replacement
2013, Annals of Thoracic SurgeryCitation Excerpt :The latter showed a negative relationship with δ LVMI, meaning that smaller ventricles regress less in grams, compared with larger ventricles. Some studies describe LVM regression in all groups but more pronounced regression in the no-PPM group [10, 13]. One study found a LVM regression of 47 g/m2 in the no-PPM group and 28 g/m2 in the PPM group at 18 months follow-up [13].
A prospective randomized comparison of the Medtronic Advantage Supra and St Jude Medical Regent mechanical heart valves in the aortic position: Is there an additional benefit of supra-annular valve positioning?
2008, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :This is in accordance with other studies focusing on AVR with mechanical prostheses and determination of LVM by means of transthoracic echocardiography 6 months postoperatively.4,14,21 Despite this mass regression, 75.8% of the Advantage Supra population and 76.9% of the Regent population still presented with LV hypertrophy, when defining LV hypertrophy with LVM index greater than 131 g/m2 in men and greater than 100 g/m2 in women.26 In patients with aortic valve lesions, persisting LV hypertrophy is likely to be an independent risk factor for long-term survival after AVR.27
Rest and exercise performance of the Medtronic Advantage bileaflet valve in the aortic position
2005, Annals of Thoracic SurgeryHemodynamic comparison of bioprostheses for complete supra-annular position in patients with small aortic annulus
2005, Journal of the American College of CardiologyCitation Excerpt :The aim of this study was to evaluate their hemodynamic performance in patients with small aortic annulus. The intra-supra-annular Perimount prosthesis is considered as a reference valve, which has proven low-pressure gradients even in small valve sizes (4,18). To allow representative comparisons between different bioprostheses of various manufacturers, we introduced a new concept of grouping the prostheses and the obtained results.