Valve replacement for aortic stenosis in patients with poor left ventricular function - Comparison of early changes with stented and stentless valves

Background-Long-standing aortic stenosis causes significant left ventricula r (LV) dysfunction, which may progress irreversibly. In many cases, LV func tion can be salvaged by aortic valve surgery, although debate exists regard ing the best valve prosthesis to use. Methods and Results-We studied 33 patients retrospectively who had signific ant aortic stenosis and impaired LV systolic function, as assessed by trans thoracic Doppler echocardiography. Patients were assessed preoperatively an d before discharge from the hospital. A total of 20 patients received a ste ntless (homograft or Toronto) valve, and 13, a stented valve. No patient ha d significant aortic regurgitation or other valvular disease. Preoperativel y, fractional shortening was 18.8+/-5.5% in the stentless group and 18.6+/- 3.8% in the stented group, Postoperatively, it was 25.6+/-6.9% (P<0.001 com pared with baseline) and 17.0+/-2.8%, respectively (P<0.001 compared with s tentless group). Fractional shortening improved because of a reduction in L V end-systolic and end-diastolic dimensions in the stentless group. Systoli c long axis function at the LV free wall also recovered, with an increase i n systolic excursion and both peak shortening and lengthening rates. No cha nge was noted in mitral valve Doppler patterns, Conclusions-Patients who received a stentless valve demonstrated a signific antly greater early improvement in LV systolic function compared with those who received a stented valve.