Prospectively randomized evaluation of stentless versus conventional biological aortic valves - Impact on early regression of left ventricular hypertrophy

Background-The aim of this prospectively randomized study was to evaluate l eft ventricular hypertrophy and its regression after stentless versus conve ntional biological aortic valve replacement. Methods and Results-From March 1996 through April 1998, 180 patients were p rospectively selected; 106 patients received a stentless aortic valve (SAV) , and 74 received a conventional stented bioprosthosis (CSB). Of these pati ents, 95% and 96%, respectively, had aortic stenosis. Their mean age was 72 .3 and 74.8 years, and there were no significant differences in Left ventri cular function. preoperative pressure gradients, and NYHA functional status . Aortic annulus diameter indexes were comparable at 13.46 (SAV) versus 13. 55 (CSB) mm (P=NS). Larger SAVs were implanted because of the oversizing te chnique. In-hospital mortality (n=3 and 1 for SAV and CSB) was not valve re lated. At follow-up, all patients were in NYHA class 1 or 2. Baseline end-d iastolic left ventricular posterior wall thickness was 15.6 (SAV) and 14.8( CSB) mm (P=NS) and decreased to 11.8 (SAV) and 13.2 (CSB) mm (P<0.05) at 6 months. Left ventricular mass index was 213 and 202 g/m(2) at baseline (P=N S), whereas after 6 months, it was 141 (SAV) and 170 (CSB) g/m(2) (P<0.05). Conclusions-Regression of left ventricular hypertrophy occurs in all patien ts after aortic valve replacement but is significantly enhanced after SAV i mplantation This possibly is due to improved transvalvular hemodynamics.