title: Hemodynamic behavior of stentless aortic valves in long term follow-up.
abstract: OBJECTIVE
  Stentless aortic valve replacements show improved hemodynamics due to larger orifice area and lower transvalvular gradients in short and mid-term follow-up. Hemodynamic long-term behavior and the adaptation of the left ventricle as well as valve-durability in patients aged ≤60 years remains unclear.
  
  
  METHODS
  7 to 16 years after aortic valve replacement, 54 patients (mean age at operation 53.1 ± years) received echocardiography and clinical examination. Mean follow-up time was 10.8 ± 2.2 years. Evaluated were NYHA class, transvalvular gradients, estimated aortic valve orifice area, degree of aortic valve insufficiency, left ventricular mass and function.
  
  
  RESULTS
  At follow-up only one patient presented with NYHA class III. All other patients were in NYHA class I or II. Maximum and mean pressure gradients of the prostheses were 16.3 ± 7.4 mmHg and 9.1 ± 4.2 mmHg, respectively. Compared to echocardiography at discharge the mean pressure gradients dropped 18.0% (2.0 ± 0.9 mmHg) and stayed stable until 14 years after the operation. Only 5 patients showed relevant regurgitation (at 13-16 years after valve replacement), 49 showed no or trivial regurgitation. Left ventricular mass had decreased 26.5% (107.9 ± 18.5 g). Left ventricular ejection fraction (LVEF) had increased in most patients and decreased in only one. For patients with preoperatively impaired left ventricular function an increase of LVEF of 13.1 ± 3.1% was seen.
  
  
  CONCLUSIONS
  Porcine stentless aortic valves provide excellent hemodynamic long-term results without significant rise of transvalvular pressure gradients or relevant insufficiencies until 14 years after implantation, leading to sustained decrease of left ventricular mass and improvement of left ventricular function.
authors.affiliation: Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. torsten.christ@charite.de.
authors.forename: Torsten
authors.initials: T
authors.lastname: Christ
authors.affiliation: Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. herko.grubitzsch@charite.de.
authors.forename: Herko
authors.initials: H
authors.lastname: Grubitzsch
authors.affiliation: Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. benjamin.claus@charite.de.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Claus
authors.affiliation: Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. georg.heinze@charite.de.
authors.forename: Georg
authors.initials: G
authors.lastname: Heinze
authors.affiliation: Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. simon.dushe@charite.de.
authors.forename: Simon
authors.initials: S
authors.lastname: Dushe
authors.affiliation: Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. wolfgang.konertz@charite.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Konertz
mesh_terms: D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012307:Risk Factors; D016019:Survival Analysis; D016277:Ventricular Function, Left