Prospectively Randomized Evaluation of Stentless Versus Conventional Biological Aortic Valves : Impact on Early Regression of Left Ventricular Hypertrophy

Abstract

Background-The aim of this prospectively randomized study was to evaluate left ventricular hypertrophy and its regression after stentless versus conventional biological aortic valve replacement. Methods and Results-From March 1996 through April 1998, 180 patients were prospectively selected; 106 patients received a stentless aortic valve (SAV), and 74 received a conventional stented bioprosthesis (CSB). Of these patients, 95% and 96%, respectively, had aortic stenosis. Their mean age was 72.3 and 74.8 years, and there were no significant differences in left ventricular function, preoperative pressure gradients, and NYHA functional status. Aortic annulus diameter indexes were comparable at 13.46 (SAV) versus 13.55 (CSB) mm (PϭNS). Larger SAVs were implanted because of the oversizing technique. In-hospital mortality (nϭ3 and 1 for SAV and CSB) was not valve related. At follow-up, all patients were in NYHA class 1 or 2. Baseline end-diastolic left ventricular posterior wall thickness was 15.6 (SAV) and 14.8(CSB) mm (PϭNS) and decreased to 11.8 (SAV) and 13.2 (CSB) mm (PϽ0.05) at 6 months. Left ventricular mass index was 213 and 202 g/m 2 at baseline (PϭNS), whereas after 6 months, it was 141 (SAV) and 170 (CSB) g/m 2 (PϽ0.05). Conclusions-Regression of left ventricular hypertrophy occurs in all patients after aortic valve replacement but is significantly enhanced after SAV implantation. This possibly is due to improved transvalvular hemodynamics.

In vitro assessment of flow patterns and turbulence intensity in prosthetic heart valves using generalized phase‐contrast MRI

“…Optimizing implantation and orientation of prosthetic valves according to native flow patterns may be one way to ensure best possible prosthetic performance (2). Improved hemodynamics may improve long-term patient survival (3) and has been shown to be a significant determinant of regression of left ventricular hypertrophy after aortic valve replacement (4).…”

Hemodynamics of Pericardial Aortic Valves: Contemporary Stented versus Stentless Valves in a Matched Comparison

“…Several publications about older generations of stented and stentless valves demonstrated a hemodynamic advantage of stentless bioprostheses, which was also confirmed in a metaanalysis. [14][15][16] Until now, there is no data available regarding contemporary stented, externally mounted pericardial bioprostheses, and third-generation stentless valves. Previously, the stented bioprosthesis LDP showed excellent hemodynamic results, which are comparable to other contemporary stented pericardial valves like the Edwards Perimount Magna (Edwards Lifesciences, Irvine, CA, USA) and the St. Jude Trifecta (Medtronic Inc., Minneapolis, MN, USA).…”

Left ventricular mass regression after aortic valve replacement

“…Randomize olmayan bazı çalışmalarda SVKİ'deki gerilemenin stentsiz protezlerde daha üstün olduğu belirtilmiştir (1). Ancak randomize çalışmaların bazılarında stentli bazılarında ise stentsiz grup lehine sonuçlar mevcuttur (8,(20)(21)(22).…”