Journal of the American Society of Echocardiography
Changes in Left Ventricular Mass and Function After Aortic Valve Replacement: A Comparison Between Stentless and Stented Bioprosthetic Valves☆,☆☆,★,★★
Section snippets
Patients
Forty patients with severe aortic stenosis undergoing aortic valve replacement with a porcine bioprosthesis were included in the study. The cohort included 20 patients with a Medtronic Mosaic stented bioprosthetic valve and 20 patients with a Medtronic Freestyle stentless bioprosthetic valve. Since the patient’s age and sex could also affect the remodeling of the left ventricle, the groups were matched for age and sex. The Freestyle bioprosthesis was implanted by using the subcoronary
Clinical Characteristics of Patients
Table 1 shows the characteristics of the 40 patients included in the study.Preoperative and operative data were similar in patients with a stented bioprosthesis and those with a stentless bioprosthesis except for prosthesis size, which was larger in patients with a stentless bioprosthesis. All patients had a preserved ejection fraction (>50%) before surgery documented by a preoperative angiographic study.
Prosthetic Valve Function
The baseline valve effective orifice areas and mean gradients were similar in both groups
DISCUSSION
This study confirms the superior hemodynamic performance of the stentless bioprostheses, which is in part the result of their less obstructive profile and better sizing.12, 15, 20, 21, 22 Furthermore, the performance of stentless bioprostheses improved during the first 6 months after operation, whereas it remained unchanged in stented bioprostheses.12, 15, 20, 21
Likewise, the patients with a stentless bioprosthesis had a more extensive regression of LV mass, which is consistent with previous
Acknowledgements
We thank Jocelyn Beauchemin and Isabelle Laforest for their technical assistance.
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Cited by (40)
Regression of Left Ventricular Mass After Transcatheter Aortic Valve Replacement: The PARTNER Trials and Registries
2020, Journal of the American College of CardiologyPredictors and Changes in Cardiac Hemodynamics and Geometry With Transcatheter Aortic Valve Implantation
2019, American Journal of CardiologyInfluence of stentless versus stented valves on ventricular remodeling assessed at 6 months by magnetic resonance imaging and long-term follow-up
2017, Journal of CardiologyCitation Excerpt :However, this regression had no impact on the survival and occurrence of major CV events during the follow-up. We assessed hemodynamic parameters, including the decrease in peak pressure gradient and in maximal velocity in the stentless group, which have previously been used in the literature [6–8,20,21]. The frequency of prosthesis-patient mismatch was similar in the two groups.
Early regression of severe left ventricular hypertrophy after transcatheter aortic valve replacement is associated with decreased hospitalizations
2014, JACC: Cardiovascular InterventionsCitation Excerpt :After adjusting for baseline LVMi, clinical and echocardiographic variables associated with greater early LVMi regression included female sex, absence of a pacemaker pre-operatively, increased pre-operative midwall fractional shortening, and lower transvalvular mean gradient at 30 days. Many studies have evaluated LVMi regression after AVR, using it as a surrogate endpoint to compare different valve prostheses; this attests to the widespread assumption that LVMi regression after AVR is a clinically beneficial effect of valve replacement (4,5,9). A few studies suggest clinical benefit from greater post-operative LVMi regression, but significant methodological flaws or small sample size led to inconclusive findings (22,23).
Magnetic resonance imaging versus echocardiography to ascertain the regression of left ventricular hypertrophy after bioprosthetic aortic valve replacement: Results of the REST study
2012, Journal of Thoracic and Cardiovascular SurgeryWhich Patients Benefit From Stentless Aortic Valve Replacement?
2009, Annals of Thoracic SurgeryCitation Excerpt :Clinically, an improved hemodynamic performance should result in a faster left ventricular mass reduction, especially in patients with initial aortic stenosis and severe hypertrophy. Both stented and stentless prostheses were shown to lead to a significant reduction of LV mass and hypertrophy during postoperative follow-up [31, 60–68]. Most of the studies reported a faster decrease in LV mass in patients with stentless valves implanted.
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This work was supported in part by operating grants from the Heart and Stroke Foundation of Quebec and the Foundation of the Quebec Heart Institute.
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Dr Pibarot is the recipient of Senior Personal Award from the Heart and Stroke Foundation of Canada. Drs Pibarot, Dumesnil, Cartier, and Métras have financial interest in the products presented in this work in that Medtronic Company (Minneapolis, Minn) provides financial support to the Departments of Cardiology and Surgery of the Quebec Heart Institute for the clinical and echocardiographic follow-up of patients who receive a Medtronic Intact, Freestyle, or Mosaic valve. Drs Métras, Cartier, and Dumesnil are the principal investigators of these research projects. They also hold consultant agreements for this company. In addition, Medtronic Company provided mechanical and bioprosthetic valves to the Laboratory of Biomedical Engineering of the Institut de recherches cliniques de Montréal to perform in vitro studies. Dr Pibarot is an invited researcher at this institution and is co-investigator on this project.
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Reprint requests: Dr Pibarot, Quebec Heart Institute, Laval Hospital, 2725 Chemin Sainte-Foy, Sainte-Foy G1V-4G5, Quebec, Canada (e-mail: [email protected]).
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