The effects of implanted valve sizes on ventricular hypertrophy in aortic stenosis

Abstract

Objective: We aimed to study the effects of the valve sizes according to body surface area on aortic gradient and ventricular hypertrophy in the cases of aortic valve replacement due to isolated aortic stenosis. Methods: Between January 2006 and April 2007, patients (12 men, 15 women; totally 27) followed up prospectively with echocardiography fourth and sixth month postoperatively. The patients were divided into two groups according to the prosthetic aortic valve diameters (19-21 mm vs 23-25 mm). The primary endpoints between the two groups (aortic regurgitation, left ventricular mass index and transvalvular gradient measured by color and continuous wave Doppler) were compared. Fischer exact test and Mann-Whitney U test were used for intergroup comparison whereas intragroup analysis was done with Freidman test. Results: Mean systolic gradient and left ventricular mass index were significantly reduced in 23 mm and 25 mm valves (p<0.01) in the postoperative follow-up. In addition, especially, decline in the values of left ventricular mass, left ventricular mass index, peak systolic gradient and the mean systolic gradient were found to be significant. These values associated with regression were detectable at the postoperative 4 th month, but actual significant regression was observed at the postoperative 6 th month (p<0.01). On the other hand, the values obtained for 19 mm and 21 mm valves also showed significant progress (p<0.05). Conclusion: Factors such as age, gender and activity are important in the selection of appropriate valve sizes in aortic valve replacement. However, the patient's body surface is the most important prognostic factor compared to others.

Comparison of patient-prothesis mismatch after surgical aortic valve replacement and transcatheter aortic valve implantation

“…Surgical approach is still the gold standard for the management of the aortic valve pathologies. [1][2][3][4][5][6][7][8][9][10][11][12] Bioprosthetic valves are preferred to replace the aortic valves of the patients aged above 65 years. The overall mortality of isolated aortic valve replacement is nearly 3.5% in the literature.…”

“…[4] After all, it has been noted that PPM can be largely avoided using the correct preventive strategy at the time of operation both for sAVR and TAVI. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] In surgery, the incidence of PPM can be reduced by choosing the correct size of bioprosthesis, using stentless bioprosthesis, supra-annular implantation of the valve, aortic root manipulations or extensions, considering the left ventricular EF, BSA, age, and gender of the patient during operation. Recent studies have also demonstrated that allografts, homografts, and stentless bioprostheses have less gradient differences inversely greater EOA.…”

“…Patient-prothesis mismatch (PPM) is a well-known and important complication of the surgical aortic valve replacement (sAVR) and transcatheter aortic valve implantation (TAVI) procedures. [1][2][3][4][5][6][7] Prosthesis-patient mismatch develops, when the effective orifice area (EOA) of the inserted prosthetic valve is comparably too small in relation to body size of the patient. Its main hemodynamic consequence is a higher transvalvular gradient on the left ventricular outflow tract, which affects the long-term mortality of patients.…”

“…Its main hemodynamic consequence is a higher transvalvular gradient on the left ventricular outflow tract, which affects the long-term mortality of patients. [1][2][3][4][5][6][7][8][9] Several studies have reported that the incidence of postoperative PPM is higher than 20% after sAVR and the presence of PPM is associated with a 1.2-and 1.8-fold increase in the risk of all-cause mortality. [1,8,9] Literature studies have clearly demonstrated the relation of severe PPM with increased mortality due to decreased regression of the left ventricular mass after aortic valve replacement procedures.…”

“…[1,8,9] Literature studies have clearly demonstrated the relation of severe PPM with increased mortality due to decreased regression of the left ventricular mass after aortic valve replacement procedures. [1][2][3][4][5][6][7][8][9] Moreover, it has been shown in the literature that, in older patients, the presence of mild-to-moderate PPM following bioprosthetic sAVR does not influence long-term survival. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Therefore, surgical approach to aortic valve replacement may still be the first choice in high-risk patients.…”