Medium-term determinants of left ventricular mass index after stentless aortic valve replacement

Background. This study aimed to investigate the risk factors for elevated l eft ventricular mass index 3 to 5 years after stentless aortic valve replac ement, and to elucidate the underlying physiologic mechanisms. Methods. Eighty-nine patients (age, 76 +/- 6 years, 51 males) having a sten tless porcine valve for aortic stenosis (n = 76) or regurgitation (n = 13) were prospectively studied by Doppler echocardiography 3 to 5 years after o peration. Left ventricular systolic function, mass index, blood pressure, c ardiac rhythm, and New York Heart Association function class were all deter mined. Stentless valve effective orifice area, mean pressure drop, and the presence and degree of aortic regurgitation were quantified. Results. The mean stentless aortic valve size was 24 +/- 2 mm. At follow-up time of 45 +/- 9 months, effective orifice area index was 1.2 +/- 0.35 cm( 2) m(-2), and mean pressure drop was 5.7 +/- 3.8 mm Hg. Left ventricular ma ss index was 128 +/- 47 g.m(-2), and ejection fraction was 63% +/- 14%. Mul tivariant analysis showed a greater left ventricular mass index to be assoc iated with nonsinus rhythm (versus sinus) (163 +/- 8 versus 131 +/- 7 g m-2 ), greater pulse pressure (> 84 mm Hg) (161 +/- 7 versus 133 +/- 7 g: m-2), New York Heart Association class II or III (versus class I) (166 +/- 10 ve rsus 128 +/- 5 g.m-2), and male sex (versus female) (160 +/- 7 versus 134 /- 8 g. m-2), all p < 0.01. Mean pressure drop (> 8 mm Hg), effective orifi ce area index (< 1.0 cm2 m-2), the presence of mild regurgitation of the st entless valve, or the type of previous valve disease were insignificant det erminants of left ventricular mass index. Conclusions. Three to five years after the implantation, stentless aortic v alve hemodynamics remain excellent. Left ventricular hypertrophy caused by previous native aortic valve disease had largely regressed. However, patien t-related factors, particularly systemic blood pressure, cardiac rhythm, an d function, are significant causes of late residual left ventricular hypert rophy. Thus, continued medical care and earlier surgical intervention may f urther improve the outlook for these patients. (C) 1999 by The Society of T horacic Surgeons.