Investigation of left ventricular changes according to valve type in patients with surgical replacement due to isolated aortic stenosis

Abstract

Objective: The aim of this study was to investigate postoperative left ventricular changes [left ventricular mass (LVM), left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), patient-prosthesis mismatch (PPM), pulmonary artery pressure (PAP), gradients, and ejection fraction (EF)] according to the valve type used in patients undergoing aortic valve replacement (AVR) due to isolated aortic stenosis.

Methods: A total of 199 patients with isolated AVR due to aortic stenosis between 2010 and 2020 was retrospectively investigated. Four groups were identified according to the valve type used (mechanical, bovine pericardium, porcine and sutureless). Pre-operative and first year postoperative transthoracic echocardiography findings for the patients were compared.

Results: Mean age was 64.4 ± 13.0 years, while the gender distribution was 41.7% women and 58.3% men. Of the valves used in patients, 39.2% were mechanical, 18.1% were porcine, 8.5% were bovine pericardial and 34.2% were sutureless valves. Analysis independent of the valve groups observed LVEDD, LVESD, maximum gradient, mean gradient, PAP, LVM and LVMI values reduced significantly postoperatively (p < 0.001). EF was observed to increase by 2.1% (p = 0.008). Comparisons of the four valve groups revealed that LVEDD, LVESD, maximum gradient, mean gradient, LVM and LVMI significantly decreased in all groups. EF significantly increased only in the sutureless valve group (p = 0.006). Analysis of PPM groups showed that LVESD, maximum gradient, mean gradient, PAP, LVM and LVMI were significantly reduced in all groups. In the normal PPM group, there was an improvement in EF, which was significantly different to the other groups (p = 0.001), while in the severe PPM group, EF appeared to be reduced ( p = 0.19).

Keywords: aortic stenosis; aortic valve replacement; left ventricular mass; left ventricular mass index; patient‐prosthesis mismatch.