Time course of left ventricular remodeling after stentless aortic valve replacement

Background Stentless aortic valves are associated with a significant decrea se in left ventricular hypertrophy. This study examined the time course and factors affecting left ventricular mass regression (LVMR) after aortic val ve replacement (AVR) with Cryolife O'Brien (CLOB) (Cryolife International, Atlanta, Ga) stentless valves. Methods Between 1993 and 2000, 130 consecutive patients underwent AVR with CLOB. Mean age was 71.3 +/- 6.3 years. Sixty-four (49.2%) were male. Mean b ody surface area (BSA) was 1.7 +/- 0.2 m(2). Mean valve size implanted was 23.6 +/- 2.0 mm. All patients were monitored with serial echocardiograms; t he first study was performed preoperatively, and subsequent controls were a t 6 months, 1, 2, 3, 4, 5, 6, and 7 years, respectively. Left ventricular m ass was calculated by the Devereux formula and indexed by BSA. Results Analysis of variance showed a significant reduction in the left ven tricular mass index (LVMI) over time (P <.001). Most LVMRs occurred within the first 6 months, and after 1 year LVMI had decreased by 37.5% with furth er, but not statistically significant, reductions at later examinations. We found that baseline BSA >1.75 m(2), male sex, arterial blood pressure grea ter than or equal to 150 mm Hg, left ventricular ejection fraction less tha n or equal to 35%, New York Heart Association functional class greater than or equal to III, non-sinus rhythm, and prevalent aortic incompetence to be factors influencing LVMR. LVMR was not related to postoperative effective orifice area less than or equal to0.85 cm/m(2) and prosthetic size. Conclusions AVR with a CLOB valve is followed by a significant LVMR that oc curs soon after surgery. It is influenced by several patient-related factor s: most of them can be predicted preoperatively.