Reduced SAC is a frequent occurrence in elderly patients with AS, where it independently contributes to increased afterload and decreased LV function. Systemic arterial compliance should be taken into consideration when evaluating these patients with regard to diagnosis and treatment.

The present study is the first to report that MS is associated with a faster disease progression and worse outcome in patients with AS. Such findings open new avenues of research and provide a strong impetus for the elaboration of additional prospective studies focusing on this association.

Background-Several studies have reported similarities between calcification of the native aortic valve and atherosclerosis. Recent studies also suggested that hypercholesterolemia may be a risk factor for calcific degeneration of bioprosthetic valves. The metabolic syndrome (MS) is associated with a higher risk of vascular atherosclerosis. We thus hypothesized that the atherogenic features of MS could accelerate bioprosthetic valve degeneration. Methods and Results-We included 217 patients who underwent aortic valve replacement with a bioprosthetic valve in the study. Of these patients, 71 patients (33%) had MS defined according to the modified criteria proposed by the National Cholesterol Education Program Adult Treatment Panel III. The annualized increase in mean transprosthetic gradient and the worsening of transprosthetic regurgitation measured by Doppler echocardiography were used to assess the deterioration of valve hemodynamic function. Patients with MS had higher progression of gradient (ϩ4Ϯ5 mm Hg/ year versus ϩ2Ϯ2 mm Hg/year, PϽ0.001), higher proportion of Ն1/3 degree worsening of regurgitation (25% versus 12%, Pϭ0.02), and higher proportion of valve function deterioration defined as regurgitation worsening and/or Ն3 mm Hg/year increase in gradient (41% versus 25%, Pϭ0.02) when compared with patients without MS. On multivariate analysis, MS was an independent predictor of gradient progression (Pϭ0.01), regurgitation worsening (Pϭ0.02), and valve function deterioration (Pϭ0.02). The other independent predictors were diabetes, renal insufficiency, and higher mean gradient at baseline. Conclusions-This is the first study to report that the MS is independently associated with faster bioprosthetic valve degeneration. This study could pave the way for the development of a new medical therapy able to significantly reduce the structural valve deterioration of bioprostheses.

No abstract

No abstract

No abstract

Background The Ross procedure and aortic homografts have both been shown to have superior hemodynamic performance after valve replacement, but there have been few comparisons. Methods Sequential Doppler echocardiograms were performed up to 5 years after aortic valve replacement in 132 patients with the Ross procedure and 111 patients with an aortic homograft (AH). Measurements included assessment of valvular regurgitation and calculations of valve effective orifice area (EOA) and mean transvalvular gradients; the same measurements were also performed at the level of the pulmonary homograft in the Ross patients as well as during maximum exercise in 20 Ross patients and 14 AH patients. Results Aortic valve hemodynamics were stable during follow-up for both procedures and values at 1 year showed larger indexed EOAs (1.77±0.45 versus 1.42±0.35 cm 2 /m 2 , P <0.001) and lower gradients (2±3 versus 4±3 mm Hg) for the Ross procedure; similar findings were also observed during exercise (1.99±0.44 versus 1.36±0.39 cm 2 /m 2 , P <0.001 and 7±3 versus 17±11 mm Hg). Prevalence and severity of aortic regurgitation were low in both groups, although 4 patients (1 Ross, 3 AH) underwent a second operation for this reason. Also, various degrees of pulmonary homograft stenosis were found in 20% of Ross patients, 4 of which underwent a second operation. Conclusion Both procedures provide continued excellent hemodynamics of the aortic valve. The Ross procedure has a slight advantage, but this is somewhat counterbalanced by the deterioration of the pulmonary homograft in up to 20% of patients. Further studies aimed at clarifying longer-term outcomes as well as preventing pulmonary homograft stenosis with the Ross operation are clearly needed.

No abstract