Time course of left ventricular remodeling after stentless aortic valve replacement

• Published in: The American heart journal 2001-09, Vol.142 (3), p.556-562
• Main Authors: Gelsomino, Sandro, Frassani, Romeo, Morocutti, Giorgio, Nucifora, Rosario, Col, Paolo Da, Minen, Giorgio, Morelli, Angelo, Livi, Ugolino
• Format: Article
• Language: English
• Subjects: Aged; Aortic Valve - pathology; Aortic Valve - surgery; Biological and medical sciences; Blood Pressure; Electrocardiography; Equipment Design; Female; Follow-Up Studies; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Medical sciences; Middle Aged; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left; Ventricular Remodeling - physiology
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1067/mhj.2001.117777

Background Stentless aortic valves are associated with a significant decrease in left ventricular hypertrophy. This study examined the time course and factors affecting left ventricular mass regression (LVMR) after aortic valve 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 body surface area (BSA) was 1.7 ± 0.2 m2. Mean valve size implanted was 23.6 ± 2.0 mm. All patients were monitored with serial echocardiograms; the first study was performed preoperatively, and subsequent controls were at 6 months, 1, 2, 3, 4, 5, 6, and 7 years, respectively. Left ventricular mass was calculated by the Devereux formula and indexed by BSA. Results Analysis of variance showed a significant reduction in the left ventricular mass index (LVMI) over time (P 1.75 m2, male sex, arterial blood pressure ≥150 mm Hg, left ventricular ejection fraction ≤35%, New York Heart Association functional class ≥III, non–sinus rhythm, and prevalent aortic incompetence to be factors influencing LVMR. LVMR was not related to postoperative effective orifice area ≤0.85 cm/m2 and prosthetic size. Conclusions AVR with a CLOB valve is followed by a significant LVMR that occurs soon after surgery. It is influenced by several patient-related factors: most of them can be predicted preoperatively. (Am Heart J 2001;142:556-62.)