Cor Vasa 2008, 50(9):328-331 | DOI: 10.33678/cor.2008.116

Regression of left ventricular hypertrophy in patients with aortic stent-mounted bioprosthesis implantation

Petr Šantavý^1,*, Marián Benčat¹, Martin Troubil¹, Pavel Marcián¹, Petr Němec², Jana Zapletalová³, Vladimír Lonský¹

¹ Kardiochirurgická klinika, Fakultní nemocnice Olomouc a Lékařská fakulta Univerzity Palackého, Olomouc

² Centrum kardiovaskulární a transplantační chirurgie, Brno

³ Oddělení biometrie, Lékařská fakulta Univerzity Palackého, Olomouc, Česká republika

Objective: Left ventricular hypertrophy caused by degenerative aortic stenosis should resolve after valve replacement. However, currently implanted stent-mounted bioprostheses do not have fully physiological flow parameters. The purpose of this study was to establish if stent-mounted bioprostheses with suboptimal effective orifice area reduce left ventricle hypertrophy post implantation.

Methods: Between March 2002 and December 2006, a total of 293 bioprostheses were implanted at our institution. The bioprostheses used were as follows: Edwards Lifesciences (models 2650, 2900, 3000), Medtronic-Hall (Mosaic), SJM (Epic, Epic Supra), Sorin (More, Soprano). One-hundred and sixty-five men and 128 women, mean age 73.5 ± 6 years, were included into the study. We measured effective orifice area and indexed effective orifice area of the implanted valves by Doppler analysis six months and one year postoperatively. Statistically, we compared the measured septal and left ventricular posterior wall thickness in diastole before and after surgery.

Results: In 91.5% of patients, the measured indexed effective orifice areas (iEOA) was in the range of 0.65-0.8 cm2/m2, a value smaller than the published one for the occurrence of "patient-prostheses mismatch" (PPM). An iEOA greater than 0.85 cm2/m2 was present in only 8.5 % of our patients. Left ventricular hypertrophy before and after surgery was analyzed using the Mann-Whitney test. We found a significantly decreased septal thickness in diastole at six months and one year postoperatively (p < 0.0001). We also found a significantly decreased left ventricular posterior wall in diastole six months and one year postoperatively (p ≤ 0.001).

Conclusions: The stent-mounted bioprostheses we implanted did not show optimal hemodynamic parameters, as documented by our measurement. Even when indexed effective orifice areas were below 0.85 cm2/m2, we showed a statistically significant decrease in left ventricular hypertrophy.

Keywords: Aortic bioprosthesis; Indexed effective orifice area; Left ventricular hypertrophy

Published: September 1, 2008  Show citation