Prosthesis Dependant Left Ventricular Mass Regression After Aortic Valve Replacement. A Prospective Randomized Trial.

OBJECTIVES: This study assesses the hemodynamic performance of various aortic valve substitutes, the subsequent regression of left ventricular hypertrophy and the clinical outcomes after aortic valve replacement, in different age groups

METHODS: A total of 120 patients with isolated aortic valve stenosis were included in this prospective randomized trial. In group I (age 75 years), patients received a stentless bioprosthesis (CE Prima Plus n=20) or a stented bioprosthesis (CE Perimount n=20).

RESULTS: At 12 months, in group I, pulmonary autografts had significantly lower mean gradients when compared to mechanical valves ( 2.6 vs 10.9 mmHg, p=0.0005). Left ventricular mass regression however, was comparable in both groups (114±27.2 vs 110±30.2 g/m²). In group II, mean gradients were lower for stentless bioprostheses compared to mechanical valves (7.0 vs 8.9 mmHg, p=0.81), however it did not reach statistical significance. The rate of left ventricular mass regression was comparable(109±29.3 vs 111±27.6 g/m²). In group III, mean gradients did not differ significantly (7.8 vs 6.5 mmHg, p=0.06).Regression of left ventricular mass was comparable in both groups (104±28.5 vs 106±32.5 g/m²).

CONCLUSIONS: The rate and completeness of left ventricular mass regression was uniform for all prostheses and was not influenced by the differences in transvalvular gradients.

Author(s): Mirko Doss, Heinz Deschka, Petar Risteski, Gerhard Wimmer Greinecker, Anton Moritz

Effects of geometric left ventricular remodelling on the function of stentless quadrileaflet mitral valve bioprostheses. A four year experience.

OBJECTIVES: The stentless quadrileaflet mitral valve prosthesis (QMV) is sutured to the mitral annulus and the papillary muscle heads, thereby preserving the subvalvular apparatus. After mitral valve replacement, remodeling of the left ventricle is often observed, causing a dilated ventricle to shrink in diameter. Thus, the distance between annulus and papillary heads, which in the QMV is fixed at the time of surgery by the papillary flaps, also changes with time and might cause late mitral valve incompetence.

METHODS: From September 1997 to October 2000, 24 patients received QMV at our institution. The patients were followed up at yearly intervals (mean 4.04 years /range 2-5). All pre- and postoperative echocardiograms were evaluated, with attention focused on the subvalvular apparatus, leaflet morphology and occurrence of late mitral regurgitation.
RESULTS: 41% patients (10/24) developed late mitral regurgitation ( mild n=5, moderate n=5).The site of regurgitation was located at the two commisures in all cases. In eight patients changes in left ventricular diameter had occurred. The point of leaflet coaptation had shifted away from the annulus in four patients.

CONCLUSIONS: Midterm changes in left ventricular geometry seem to affect the competence of the QMV. As late regurgitation always occurred at the commissures, we have to consider that rotational remodeling of the left ventricle also took place. Predicting these changes and subsequently adapting the sizing procedure remains a challenging task.

Author(s): Doss M, Aybek T, Wood JP, Martens S, Wimmer-Greinecker G, Moritz A.
in: 2003, Society for Heart Valve Disease 2nd Biennial Meeting, Paris / France