Effects of valve replacement on left ventricular function in patients with aortic regurgitation and severe ventricular disease.

BACKGROUND AND AIM OF THE STUDY: Longstanding aortic regurgitation (AR) can result in left ventricular (LV) dysfunction that may reverse after aortic valve replacement (AVR). Stentless valves may result in a more rapid recovery in function due to a more physiological flow and lower outflow resistance.

METHODS

The effect of AVR on LV function was studied in 47 patients who received either a stentless (n = 33) or stented (n = 14) valve for isolated AR. All patients had evidence of pre-existing LV dysfunction (end-systolic dimension (ESD) >50 mm). Patients were studied using transthoracic echocardiography at baseline, postoperatively, and at 2.5-year follow up.

RESULTS

Preoperatively, there were no differences in LV dimensions. The end-diastolic dimension fell from 75 +/- 10 mm to 61 +/- 10 mm postoperatively and to 52 +/- 10 mm at follow up in the stentless group (p <0.001), and ESD fell from 54 +/- 10 mm to 36 +/- 8 mm at follow up (p <0.001). There were no significant early changes in patients who received stented valves, though LV dimensions fell at follow up. Fractional shortening (FS) increased from 25 +/- 8% in the postoperative period to 31 +/- 7% in the stentless group (p <0.001), but there was no change in the stented group (20 +/- 7% versus 23 +/- 8%). In the stentless group, LV mass fell from 366 +/- 104 g to 276 +/- 68 g postoperatively and to 219 +/- 79 g at follow up (p <0.001); there was no postoperative change in the stented group, though a late reduction occurred, from 349 +/- 51 g preoperatively to 265 +/- 61 g at follow up (p = 0.06).

CONCLUSION

For patients with AR and LV dysfunction, AVR with a stentless prosthesis offers early reductions in LV dimensions, improved LV function, and regression of LV mass. In patients who received a stented valve, these improvements were delayed and less complete. Hence, for some patients with AR and LV dysfunction, a stentless prosthesis may be preferable.