Original article: cardiovascular
Mass regression in aortic stenosis after valve replacement with small size pericardial bioprosthesis

https://doi.org/10.1016/S0003-4975(03)00823-3Get rights and content

Abstract

Background

The aim of the study was to determine whether left ventricular mass regression is influenced by valve size after the implantation of a Carpentier-Edwards Perimount (CEP) pericardial bioprosthesis for pure aortic stenosis.

Methods

Patients receiving 19-mm, 21-mm, and 23-mm CEP aortic valves underwent echocardiography preoperatively and at least 1 year after surgery (mean, 2.3 ± 1 years) and the echocardiograms were compared within and between groups.

Results

The study involved a total of 88 patients: 34 receiving 19-mm CEPs, 29 receiving 21-mm CEPs, and 25 receiving 23-mm CEPs. The mean postoperative prosthetic gradients were respectively 20.6 ± 6.6 mm Hg, 17.9 ± 5.8 mm Hg, and 13.2 ± 4.1 mm Hg (p = 0.0001); the mean postoperative valve areas were respectively 1.24 ± 0.16 cm2, 1.45 ± 0.2 cm2, and 1.63 ± 0.21 cm2 (p = 0.0001). In comparison with the preoperative echocardiographic measurements absolute left ventricular mass significantly decreased by −54.1 ± 48.8 g, −54.1 ± 55.1 g, and −74.4 ± 57.4 g respectively with no statistically significant between-group difference (analysis of variance) but ventricular septum and posterior wall thickness significantly decreased in each group (p < 0.05).

Conclusions

The implantation of 19-mm, 21-mm, and 23-mm CEP aortic prostheses significantly reduces left ventricular mass without any size-related differences.

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)

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