Influence of aortic valve replacement, prosthesis type, and size on functional outcome and ventricular mass in patients with aortic stenosis

Citation
O. Bech-hanssen et al., Influence of aortic valve replacement, prosthesis type, and size on functional outcome and ventricular mass in patients with aortic stenosis, J THOR SURG, 118(1), 1999, pp. 57-65
Citations number
27
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
ISSN journal
00225223 → ACNP
Volume
118
Issue
1
Year of publication
1999
Pages
57 - 65
Database
ISI
SICI code
0022-5223(199907)118:1<57:IOAVRP>2.0.ZU;2-1
Abstract
Objectives: Two years after surgery for severe aortic stenosis, we prospect ively evaluated the influence of aortic valve replacement, as well as valve type (mechanical or stented biologic) and size, on functional status, left ventricular function, and regression of mass. Methods: Patients who receiv ed either a mechanical (n = 95) or a biologic valve (n = 42) were studied b y echocardiography before the operation and after 2 years. Results: The per centage of patients with severe dyspnea decreased from 53% to 13% (P = .001 ). The cardiac index increased from mean 2.6 L/min per square meter (95% CI : 2.48-2.72 L/min per square meter) to 3.1 L/min per square meter (95% CI: 2.94-3.26 L/min per square meter; P = .001), The percentage of the patients with mild-to-moderate diastolic dysfunction decreased from 43% to 18% (P = .001). The left ventricular mass index was reduced by 42.4 g (95% CI: 35-5 0 g; P = .001), In comparison with biologic valves of the same size, mechan ical valves produced a more pronounced reduction in mass index (overall dif ference 21.7 g; 95% CI: 37.1-6.4 g; P = .007) and a lower mean Doppler grad ient (overall difference 4 mm Hg; 95% CI: 2-6 mm Hg; P = .0002). Conclusion s: Patients undergoing aortic valve replacement had an improvement in funct ional status, as well as systolic and diastolic left ventricular function, and a reduction in left ventricular mass index, irrespective of prosthesis size and type. Mechanical valves are somewhat less obstructive than stented bioprosthetic valves of the same size. They are also associated with a con comitantly more pronounced reduction of left ventricular mass.