Current surgical practice regarding valve replacement has as its primaryconcern the appropriateness of tissue versus mechanical prostheses andperhaps lesser emphasis has been placed on the size of the device. Despitetechnical advances, which provide maximal valve orifice area in valvesubstitutes, small device implantation may be accomplished in the aorticroot but not effectively relieve the obstructive nature of the originaldisease. We reviewed 39 patients who had undergone aortic valve replacement(AVR) for aortic stenosis (AS) and had preoperative and postoperative (6months-3 years) echo measurements which permitted calculation of the leftventricular mass (LVM) and mass index (LVMI). The mean age for the 32 womenand 7 men was 67.4 years (22-83). There were four groups as determined byprosthetic size and aortic root enlargement (ARE) or not. The majority ofthe prostheses were heterografts (26), and the others were tilting discs orbileaflet. There was no difference (P = ns) in preoperative NYHA class, cardiopulmonary bypass (CPB) time, cross-clamp time, associated proceduresor complications among the four groups. Although all groups demonstrated areduction in LVM and LVMI, there was a greater and equal mass and massindex reduction in patients receiving a 21 mm prosthesis or larger. Despitethe refinements in artificial valve designs, the 19 mm size valves may notprovide comparable reduction in LVM and LVMI following AVR for AS, and theaortic root enlargement permits a larger prosthetic implantation andgreater potential for reduction in LVM and LVMI without an increase in theoperative time or postoperative complications.
- Aortic root enlargement
- Aortic stenosis
- Left ventricular mass
- Left ventricular mass index
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine