Effect of the increase in valve area after aortic valve replacement with a 19-mm aortic valve prosthesis on left ventricular mass regression in patients with pure aortic stenosis.
OBJECTIVE
Although patients with aortic stenosis, who receive 19-mm valves, are at high risk for prosthesis-patient mismatch, most of them show a significant left ventricular mass (LVM) regression postoperatively. The aim of this study was to identify factors predicting postoperative relative LVM regression in this subgroup of patients.


METHODS
A population of 44 patients operated on for pure aortic stenosis and receiving a 19-mm valve was studied by echocardiography at 1.4 +/- 0.5 years postoperatively.


RESULTS
The mean relative LVM regression was -19.3 +/- 18.9%, the mean gradient drop was -31.6 +/- 13.3 mmHg, and the mean Delta increase in aortic area index (postoperative aortic area index minus preoperative aortic area index) was 0.30 +/- 0.14 cm/m. Thirty-two patients had an indexed effective orifice area of less than 0.8 cm/m. At multivariate analysis (r = 0.63; r = 40%; P < 0.0001) preoperative LVM (P = 0.006), hypertension (P = 0.018) and Delta aortic area index (P = 0.049) were independent predictors of relative LVM regression.


CONCLUSIONS
Our study shows that, at least 1 year postoperatively, in patients receiving a 19-mm valve, LVM regression is influenced by several parameters, in particular preoperative LVM, hypertension and the magnitude of the increase in aortic area.
Mhagna
Zen
Z
Department of Cardiac Surgery, Poliambulanza Hospital, Brescia, Italy.
Tasca
Giordano
G
Brunelli
Federico
F
Cirillo
Marco
M
Amaducci
Andrea
A
DallaTomba
Margherita
M
Troise
Giovanni
G
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D011237:Predictive Value of Tests; D011474:Prosthesis Design / Q000009:adverse effects; D012107:Research Design; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left