This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Collinson, J. Articles by Gibson, D. G. Search for Related Content PubMed PubMed Citation Articles by Collinson, J. Articles by Gibson, D. G. Related Collections Valvular heart disease Echocardiography CV surgery: aortic and vascular disease

(Circulation. 1999;100:II-1.)
© 1999 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Valve Replacement for Aortic Stenosis in Patients With Poor Left Ventricular Function

Comparison of Early Changes With Stented and Stentless Valves

Julian Collinson, BSc, MBBS, MRCP; Michael Henein, MD, PhD; Marcus Flather, BSc, MBBS, MRCP; John R. Pepper, FRCS; Derek G. Gibson, FRCP

From the Clinical Trials and Evaluation Unit (J.C., M.F.), the Department of Echocardiography (M.H., D.G.G.), and the Department of Cardiac Surgery (J.R.P.), Royal Brompton Hospital and National Heart and Lung Institute, London, UK.

Correspondence to Julian Collinson, Clinical Trials and Evaluation Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. E-mail j.collinson{at}rbh.nthames.nhs.uk

Background—Long-standing aortic stenosis causes significant left ventricular (LV) dysfunction, which may progress irreversibly. In many cases, LV function can be salvaged by aortic valve surgery, although debate exists regarding the best valve prosthesis to use.

Methods and Results—We studied 33 patients retrospectively who had significant aortic stenosis and impaired LV systolic function, as assessed by transthoracic Doppler echocardiography. Patients were assessed preoperatively and before discharge from the hospital. A total of 20 patients received a stentless (homograft or Toronto) valve, and 13, a stented valve. No patient had significant aortic regurgitation or other valvular disease. Preoperatively, fractional shortening was 18.8±5.5% in the stentless group and 18.6±3.8% in the stented group. Postoperatively, it was 25.6±6.9% (P<0.001 compared with baseline) and 17.0±2.8%, respectively (P<0.001 compared with stentless group). Fractional shortening improved because of a reduction in LV end-systolic and end-diastolic dimensions in the stentless group. Systolic long axis function at the LV free wall also recovered, with an increase in systolic excursion and both peak shortening and lengthening rates. No change was noted in mitral valve Doppler patterns.

Conclusions—Patients who received a stentless valve demonstrated a significantly greater early improvement in LV systolic function compared with those who received a stented valve.

Key Words: echocardiography • valves • stenosis • surgery