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

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Abstract

Objectives

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 Δ increase in aortic area index (postoperative aortic area index minus preoperative aortic area index) was 0.30 ± 0.14 cm2/m2. Thirty-two patients had an indexed effective orifice area of less than 0.8 cm2/m2. At multivariate analysis (r = 0.63; r2 = 40%; P < 0.0001) preoperative LVM (P = 0.006), hypertension (P = 0.018) and Δ 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.

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