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(Circulation. 1999;100:II-6.)
© 1999 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Prospectively Randomized Evaluation of Stentless Versus Conventional Biological Aortic Valves

Impact on Early Regression of Left Ventricular Hypertrophy

Thomas Walther, MD; Volkmar Falk, MD; Georg Langebartels, MD; Martin Krüger, MD; Uta Bernhardt; Anno Diegeler, MD; Jan Gummert, MD; Rüdiger Autschbach, MD; Friedrich W. Mohr, MD

From University Leipzig, Heartcenter, Department of Cardiac Surgery, Leipzig, Germany.

Correspondence to Dr Thomas Walther, Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Russenstrasse 19, 04289 Leipzig, Germany. E-mail walt{at}medizin.uni-leipzig.de

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 (P=NS). Larger SAVs were implanted because of the oversizing technique. In-hospital mortality (n=3 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 (P=NS) and decreased to 11.8 (SAV) and 13.2 (CSB) mm (P<0.05) at 6 months. Left ventricular mass index was 213 and 202 g/m² at baseline (P=NS), whereas after 6 months, it was 141 (SAV) and 170 (CSB) g/m² (P<0.05).

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.

Key Words: valves • echocardiography • hypertrophy • stentless bioprosthesis