REVERSAL OF VENTRICULAR DILATATION AFTER CORRECTION OF AORTIC INCOMPETENCE - MECHANICAL PROSTHESIS COMPARED WITH BIOLOGICAL PROCEDURES

Background: The aim of the study was to compare early differences in r eversal of LV dilatation between patients with mechanical prosthesis = group A (n = 51: Carbomedics = 40, Tekna/Edwards = 11) and biological procedures = group B (n = 75: pulmonary autograft = 36, aortic valve repair = 29, homograft = 10). Methods: Since 1990 126 consecutive pati ents younger than 50 years who had surgical correction of isolated aor tic incompetence underwent echocardiographic examinations preoperative ly, at discharge, and at one-year follow-up. Left-ventricular (LV) dia meters were measured (LVEDD, LVESD) and matched to body surface area ( LVESDI, LVEDDI and fractional shortening (FS) was calculated. Aortic p eak flow velocities were assessed by Doppler technique and gradients w ere calculated. Results: There were no significant differences preoper atively in aortic incompetence, NYHA classification, LVEDDI, LVESDI, a nd FS. In group B there was a significant decrease of LVESDI (p < 0.00 2) and LVEDDI (p < 0.001) but no change in FS at discharge. In group A a significant reduction of FS (p < 0.05) without any significant chan ges in LV size was observed. No patient died perioperatively or during the first year. At one-year follow-up (complete in 97.6 % patients) t here were no significant differences in LV diameters but group B had b etter ventricular function (p < 0.05) resulting in better NYHA classif ication (p < 0.05). Only group B had normal aortic valve gradients at discharge and at follow-up (A: 25.2 +/- 4.3 vs B: 10.2 +/- 2.4 mmHg). Conclusions: Normal aortic valve gradients in patients after aortic va lve repair or allograft replacement for chronic aortic incompetence le ad to early recovery from ventricular dilatation and significantly bet ter ventricular function at discharge. One year postoperatively they h ad improved ventricular function and NYHA class in comparison with pat ients in whom a mechanical prosthesis was implanted.