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European Journal of Cardio-Thoracic Surgery, Vol 8, 293-297, Copyright © 1994 by European Association for Cardio-thoracic Surgery
EK Sim, TA Orszulak, HV Schaff and C Shub
Current surgical practice regarding valve replacement has as its primary
concern the appropriateness of tissue versus mechanical prostheses and
perhaps lesser emphasis has been placed on the size of the device. Despite
technical advances, which provide maximal valve orifice area in valve
substitutes, small device implantation may be accomplished in the aortic
root but not effectively relieve the obstructive nature of the original
disease. We reviewed 39 patients who had undergone aortic valve replacement
(AVR) for aortic stenosis (AS) and had preoperative and postoperative (6
months-3 years) echo measurements which permitted calculation of the left
ventricular mass (LVM) and mass index (LVMI). The mean age for the 32 women
and 7 men was 67.4 years (22-83). There were four groups as determined by
prosthetic size and aortic root enlargement (ARE) or not. The majority of
the prostheses were heterografts (26), and the others were tilting discs or
bileaflet. There was no difference (P = ns) in preoperative NYHA class,
cardiopulmonary bypass (CPB) time, cross-clamp time, associated procedures
or complications among the four groups. Although all groups demonstrated a
reduction in LVM and LVMI, there was a greater and equal mass and mass
index reduction in patients receiving a 21 mm prosthesis or larger. Despite
the refinements in artificial valve designs, the 19 mm size valves may not
provide comparable reduction in LVM and LVMI following AVR for AS, and the
aortic root enlargement permits a larger prosthetic implantation and
greater potential for reduction in LVM and LVMI without an increase in the
operative time or postoperative complications.
ARTICLES
Influence of prosthesis size on change in left ventricular mass following aortic valve replacement
Section of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905.
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