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Eur J Cardiothorac Surg 1998;13:572-575
© 1998 Elsevier Science NL

Haemodynamics and left ventricular mass regression: a comparison of the stentless, stented and mechanical aortic valve replacement¹

Division of Cardiac Services, The Prince Charles Hospital, Brisbane, Australia

Received 29 September 1997; received in revised form 9 February 1998; accepted 16 February 1998.

Corresponding author. Department of Echocardiography, The Prince Charles Hospital, Chermside, Queensland, Australia. Tel.: +61 7 33508111; fax: +61 7 33508750.

Objective: Our objective was to compare the degree of change in hemodynamics and left ventricular mass (LVM) regression after aortic valve replacement (AVR) with stentless, stented and mechanical valves. Methods: Patients greater than 59 years of age had AVR for aortic stenosis with the stentless xenograft (Cryolife–O'Brien, CLOB), stented xenograft (Carpentier–Edwards, C–E) or mechanical valve (ATS). One-hundred and forty-two patients received stentless, 40 stented, and 69 mechanical valves (mean age 74±6 vs. 72±7 and 67±6 years, respectively). Serial echocardiography was performed. Results: The left ventricular outflow tract diameter was similar pre-operatively in the stentless versus the stented versus the mechanical groups (2.2±0.4 vs. 2.3±0.2 vs. 2.2±0.3 cm; P, n.s). The effective orifice area was larger immediately post-operatively in the stentless versus the stented or the mechanical group (2.4±0.4 vs. 2.0±0.6 vs. 2.0±0.7 cm², P=0.0001 for both comparisons). The peak aortic gradient at 6 months was significantly less in the stentless versus the stented and mechanical groups (15±7 vs. 25±9 vs. 22±9 mmHg, P<0.0001). LVM regressed over 6 months in all subgroups: stentless 272±64 g vs. 220±72 g, P=0.0001, stented 257±58 vs. 230±74 g, P=0.02, and mechanical 267±95 vs. 204±54 g, P=0.003. The reduction in LVM was greater in the stentless versus the stented (P=0.05) but similar to the mechanical group. Conclusions: AVR with the stentless xenograft results in superior hemodynamics compared to the stented and mechanical valve replacements. AVR in all three groups leads to a significant regression of left ventricular hypertrophy within 6 months. However the reduction in LVM is greater in subjects with stentless and mechanical valves, which may have prognostic significance.

Key Words: Aortic valve replacement • Stentless porcine valve • Left ventricular mass

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