Exercise echocardiography in cryopreserved aortic homografts: comparison of a prototype stentless, a stented bioprosthesis, and native aortic valves.
BACKGROUND
Aortic valve replacement with a cryopreserved aortic homograft (CH) is an attractive alternative to bioprosthesis implantation. The aim of the study was to compare the hemodynamic performance of CH implanted with aortic root inclusion compared to prototype stentless (SS) bioprosthesis, standard stented (SD) bioprosthesis, and a native aortic valve.


METHODS
Hemodynamics and Doppler echocardiographic measurements such as left ventricular ejection fraction, aortic valve orifice area index (AVOAI), mean and maximal transvalvular gradients, were obtained at rest and immediately after exercise in 28 patients after aortic valve replacement with CH (n = 10), SS (n = 9), or SD (n = 9), and in a control group (CG) of 15 normal volunteers.


RESULTS
Rest and peak exercise heart rate and workload achieved were not different among the groups. Baseline AVOAI was larger for CH and CG compared to SS and SD groups (P < 0.05). Maximal and mean transvalvular pressure gradients at rest were lower for CH compared to SS and SD groups (P < 0.05), but higher than CG (P < 0,05).


CONCLUSIONS
Implanted aortic CH had better hemodynamic performance than SS and SD bioprosthesis and similar to native normal aortic valves, both at rest and immediately after exercise.
Cordovil
Adriana
A
Federal University of São Paulo, Division of Cardiology (Echocardiography), Brasil. acordovil@ig.com.br
Filho
Orlando Campos
OC
de Andrade
José Lázaro
JL
Rodrigues
Ana Clara Tude
AC
Gerola
Luis Antonio
LA
Moises
Valdir
V
Buffolo
Enio
E
de Camargo Carvalho
Antonio Carlos
AC
D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000637:transplantation*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D015925:Cryopreservation / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography