Early Regional Assessment of LV Mass Regression and Function after Stentless Valve Replacement: Comparative Randomized Study
DOI:
https://doi.org/10.1532/HSF98.20041096Abstract
Early regional performance and hypertrophy regression after stentless aortic valve replacement are still incompletely characterized. We compared early postoperative changes of segmental thickness and function after stentless and stented aortic valve replacement as assessed by cardiac magnetic resonance (CMR). In 16 patients randomly assigned to stented (Mosaic, 8 patients) and stentless (Freestyle, 8 patients) groups, 4 parallel short-axis images at the level of the apex (slice 4), midventricle (slices 2-3), and mitral valve (slice 1) were obtained with a 1.5 T CMR scanner (Magnetom Sonata, Siemens) before and 1 month after surgery. Cine images were obtained using an echo gradient sequence. Left ventricle mass was calculated as the difference between the left ventricular end-diastolic volume at the epicardial and endocardial borders multiplied by a myocardium density factor (1.05). Each slice was divided into 8 segments (octants) from anterior (octant I-II) to septal (octant V-VIII). A total of 32 segments encompassed the entire heart. From each of these elements end diastolic thickness and systolic function (fractional thickening) were calculated. In stentless valves significant reduction of septal octant thickness on the mid-ventricular slice was noted. There was no difference in regional systolic function-segment thickening. In stented valves no segmental thickness changes were observed. In stentless valves there was early postoperative thickness reduction of septal segments at the midventricular level. However, this finding did not coincide with changes in segmental function.References
Carrel T, Zingg U, Jenni R, Aeschbacher B, Turina MI. 1996. Early in vivo experience with the hemodynamic plus St. Jude medical heart valves in patients with narrowed aortic annulus. Ann Thorac Surg 61:1418-22.nCollinson J, Henein M, Flather M, Pepper JR, Gibson DG. 1999. Valve replacement for aortic stenosis in patients with poor left ventricular function: comparison of early changes with stented and stentless valves. Circulation 100(19 suppl):II1-5.nDujardin KS, Enriquez-Sarano M, Rossi A, Bailey KR, Seward JB. 1997. Echocardiography assessment of left ventricular remodeling: are left ventricular diameters suitable tools? J Am Coll Cardiol 30:1534-41.nGardin JM. 1999. How reliable are serial echocardiography measurements in detecting regression in left ventricular hypertrophy and changes in function? J Am Coll Cardiol 34:1633-6.nGordon EP, Schnittger I, Fitzgerald PJ, Popp RL. 1983. Reproducibility of left ventricular volumes by two-dimensional echocardiography. J Am Coll Cardiol 2:506-13.nHe GW, Grunkemeier GL, Gately HL, Furnary AP, Starr A. 1995. Up to thirty-year survival after aortic valve replacement in the small aortic root. Ann Thorac Surg 59:1056-62.nYoganathan AP, Woo YR, Sung HW, Williams FP, Franch RH, Jones M. 1986. In vitro hemodynamic characteristics of tissue bioprostheses in the aortic position. J Thorac Cardiovasc Surg 92:198-209.nYoganathan AP, Woo YR, Williams FP, et al. 1983. In vitro fluid dynamic characteristics of Ionescu-Shiley and Carpentier-Edwards tissue bio-protheses. Artif Organs 7:459-69.nJin XY, Gibson DG, Yacoub MH, Pepper JR. 1995. Peri-operative assessment of aortic homograft, Toronto stentless valve and stented valve in the aortic position. Ann Thorac Surg 60:S395-401.nJin XY, Zhong MZ, Gibson DG, Yacoub MH, Pepper JR. 1996. Effects of valve substitutes on changes in left ventricular function and hypertrophy after aortic valve replacement. Ann Thorac Surg 62:683-90.nKon ND, Westaby S, Amarasena N, Pillai R, Cordell R. 1995. Comparison of implantation techniques using freestyle stentless porcine aortic valve. Ann Thorac Surg 59:857-62.nLevy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. 1989. Left ventricular mass and incidence of coronary heart disease in an elderly cohort: the Framingham Heart Study. Ann Intern Med 110:101-7.nLevy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. 1990. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 322:1561-6.nLund O. 1993. Valve replacement for aortic stenosis: the curative potential of early operation. Scand J Thorac Cardiovasc Surg 40(suppl):1-137.nThompson HL, O'Brien MF, Almeida AA, Tesar PJ, Davison MB, Burstow DJ. 1998. Haemodynamics and left ventricular mass regression: a comparison of the stentless, stented, and mechanical aortic valve replacement. Eur J Cardiovasc Surg 13:572-75.nWalther T, Falk V, Autschenbach R, et al. 1994. Haemodynamic assessment of the stentless Toronto SPV bioprosthesis by echocardiography. J Heart Valve Dis 3:657-65.nWalther T, Falk V, Langebartels G, et al. 1999. Prospectively randomized evaluation of stentless versus conventional biological aortic valves: impact on early regression of left ventricular hypertrophy. Circulation 100 (suppl II):II6-10.nWhite HD, Norris RM, Brown MA, Brandt PWT, Whitlock RML, Wild CJ. 1987. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation 76:44-51.nWilliams RJ, Muir DF, Pathi V, MacArthur K, Berg GA. 1999. Randomized controlled trial of stented and stentless aortic bioprostheses: hemodynamic performance at 3 years. Semin Thorac Cardiovas Surg 11:93-7.nYoganathan AP, Chaux A, Gray RJ, et al. 1984. Bileaflet tilting disc and porcine aortic valve substitutes: in vitro hydrodynamic characteristics. J Am Coll Cardiol 3:313-20.nBaur LH, Schipperheyn JJ, van der Velde EA, et al. 1996. Reproducibility of left ventricular size, shape and mass with echocardiography, magnetic resonance imaging and radionuclide angiography in patients with anterior wall infarction. A plea for core laboratories. Int J Card Imaging 12(4):233-40.nBellenger N, Davies C, Francis JM, Coats AJ, Pennell DJ. 2001. Reduction in sample size for studies of remodeling in heart failure by the use of cardiovascular magnetic resonance. J Cardiov Mag Reson 2(4):271-8.nBottini PB, Carr AA, Prisant LM, Flickinger FW, Allison JD, Gottdiener JS. 1995. Magnetic resonance imaging compared to echocardiography to assess left ventricular mass in the hypertensive patient. Am J Hypertens 8(3):221-8.nLund O, Kristensen LH, Baandrup U, et al. 1998. Myocardial structure as a determinant of pre- and postoperative ventricular function and long-term prognosis after valve replacement for aortic stenosis. Eur Heart J 19(7):1099-108.nLund O, Pilegaard HK, Magnussen K, Knudsen MA, Nielsen TT, Albrechtsen OK. 1990. Long-term prosthesis-related and sudden cardiac-related complications after aortic replacement for aortic stenosis. Ann Thorac Surg 50:396-406.nLytle BW, Cosgrove DM, Taylor PC, et al. 1989. Primary isolated aortic valve replacement: early and late results. J Thorac Cardiovasc Surg 97:675-94.nMissouris CG, Forbat SM, Singer SM, Markandu ND, Underwood R, MacGregor GA. 1996. Echocardiography overestimates left ventricular resonance imaging in patients with hypertension. J Hypertension 14:1005-10.nSharpe N, Doughty RN. 1998. Left ventricular remodelling and improved long-term outcomes in chronic heart failure. Eur Heart J 19(suppl B):B36-9.nStrohm O, Schulz-Menger J, Pilz B, Osterziel KJ, Dietz R, Friedrich MG. 2001. Measurement of left ventricular dimensions and function in patients with dilated cardiomyopathy. J Magn Reson Imaging 13(3):367-71.n
