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
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.