title: Aortic valve replacement for aortic insufficiency: valve type as a determinant of systolic strain recovery.
abstract: OBJECTIVE
  Left ventricular (LV) 3D systolic strain decreases in absolute value postoperatively and does not recover in patients who undergo aortic valve replacement (AVR) for chronic aortic insufficiency (AI). We investigated whether choice of valve prosthesis (mechanical [St. Jude], bioprosthetic [bovine pericardial], Ross procedure) had a significant impact on strain recovery in this surgical population.
  
  
  METHODS
  MRI with tissue-tagging was performed on 14 patients with chronic AI both before and 28 +/- 13 months after AVR. Average values of LV systolic strain and end-systolic stress (ESS) were computed from MRI data for the LV. Three types of prosthetic valve were examined (Ross procedure n = 4, bovine pericardial n = 5, and St. Jude n = 5).
  
  
  RESULTS
  Overall, systolic strain, ESS, LV volumes, ejection fraction, and LV mass all changed significantly following AVR. Comparisons between individual valve types revealed no differences in any of these measurements. Patients who received a mechanical valve had a greater decrease in the absolute value of systolic strain following surgery compared to patients from the nonmechanical group (Ross procedure and bioprosthetic valve). Comparisons between the Ross group and the prosthetic group (St. Jude and bioprosthetic) produced no significant differences in strain, ESS, LV volume, and mass.
  
  
  CONCLUSIONS
  These early results suggest that valve prosthetic type may be a factor in efforts to improve strain recovery after AVR for AI, although further investigation is warranted. MRI with tissue-tagging may be a useful tool for comparing the impact of prosthetic valve choice on incompletely recovered systolic strain following AVR for chronic AI.
authors.affiliation: Division of Cardiovascular Medicine, Washington University, St. Louis, Missouri 63110-1013, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Pomerantz
authors.forename: Marc D
authors.initials: MD
authors.lastname: Krock
authors.forename: Jason R
authors.initials: JR
authors.lastname: Wollmuth
authors.forename: Brian P
authors.initials: BP
authors.lastname: Cupps
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Kouchoukos
authors.forename: Victor G
authors.initials: VG
authors.lastname: Davila-Roman
authors.forename: Michael K
authors.initials: MK
authors.lastname: Pasque
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D013318:Stroke Volume; D013599:Systole; D016896:Treatment Outcome