Effects of valve replacement on left ventricular function in patients with aortic regurgitation and severe ventricular disease.
OBJECTIVE
Longstanding aortic regurgitation (AR) can result in left ventricular (LV) dysfunction that may reverse after aortic valve replacement (AVR). Stentless valves may result in a more rapid recovery in function due to a more physiological flow and lower outflow resistance.


METHODS
The effect of AVR on LV function was studied in 47 patients who received either a stentless (n = 33) or stented (n = 14) valve for isolated AR. All patients had evidence of pre-existing LV dysfunction (end-systolic dimension (ESD) >50 mm). Patients were studied using transthoracic echocardiography at baseline, postoperatively, and at 2.5-year follow up.


RESULTS
Preoperatively, there were no differences in LV dimensions. The end-diastolic dimension fell from 75 +/- 10 mm to 61 +/- 10 mm postoperatively and to 52 +/- 10 mm at follow up in the stentless group (p <0.001), and ESD fell from 54 +/- 10 mm to 36 +/- 8 mm at follow up (p <0.001). There were no significant early changes in patients who received stented valves, though LV dimensions fell at follow up. Fractional shortening (FS) increased from 25 +/- 8% in the postoperative period to 31 +/- 7% in the stentless group (p <0.001), but there was no change in the stented group (20 +/- 7% versus 23 +/- 8%). In the stentless group, LV mass fell from 366 +/- 104 g to 276 +/- 68 g postoperatively and to 219 +/- 79 g at follow up (p <0.001); there was no postoperative change in the stented group, though a late reduction occurred, from 349 +/- 51 g preoperatively to 265 +/- 61 g at follow up (p = 0.06).


CONCLUSIONS
For patients with AR and LV dysfunction, AVR with a stentless prosthesis offers early reductions in LV dimensions, improved LV function, and regression of LV mass. In patients who received a stented valve, these improvements were delayed and less complete. Hence, for some patients with AR and LV dysfunction, a stentless prosthesis may be preferable.
Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust and National Heart and Lung Institute, London UK.
Julian
J
Collinson
Marcus
M
Flather
John R
JR
Pepper
Michael
M
Henein
D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001696:Biomechanical Phenomena; D015150:Echocardiography, Doppler; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left / Q000502:physiology*