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J Thorac Cardiovasc Surg 2005;129:512-517
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Left ventricular mass regression after aortic valve replacement with 17-mm St Jude Medical mechanical prostheses in isolated aortic stenosis

Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, V Monaldi Hospital, Naples, Italy

Received for publication April 22, 2004; accepted for publication July 2, 2004.

^* Address for reprints: Cristiano Amarelli, MD, Via Cesario Console 3, 80132, Naples, Italy (E-mail: cristiano.amarelli{at}ospedalemonaldi.it).

OBJECTIVE: The present study investigated the outcomes of aortic valve replacement with 17-mm mechanical prostheses in patients with isolated aortic stenosis.

METHODS: Between January 1997 and January 2003, 35 patients (mean age, 63.4 ± 17 years; median age, 70 years; age range, 16-84 years) underwent isolated aortic valve replacement with a 17-mm St Jude Medical Hemodynamic Plus (16 [45.7%] patients) or a St Jude Medical Regent prosthesis (19 [54.3%] patients). The paired Student t test or the paired Wilcoxon rank sum test were used to compare preoperative with follow-up echocardiographic measurements.

RESULTS: Thirty-two (91.4%) patients were female, mean height was 154.4 ± 8.3 cm, mean weight was 62.2 ± 9.2 kg, and mean body surface area was 1.59 ± 0.13 m². The preoperative average New York Heart Association class was 2.8 ± 0.8. The mean preoperative left ventricular mass index was 135.2 ± 31 g/m². Preoperative echocardiography showed an average gradient of 65.7 ± 19.2 mm Hg (mean) and 103.6 ± 30.7 mm Hg (peak) and a mean indexed effective orifice area of 0.40 ± 0.1 cm²/m². Echocardiographic follow-up time averaged 28.2 ± 22.7 months (range, 13-72 months). Follow-up was 100% complete (1131.7 patient-months). Hospital mortality was 8.6% (3 patients). Actuarial 5-year survival was 94.7%. The mean postoperative New York Heart Association class was 1.13 ± 0.34 (P < .001), with 27 (87.1%) patients in class I and 4 patients in class II. A significant regression of the indexed left ventricular mass was found (postoperative mean value, 107.8 ± 22.8 g/m²; P < .0001), despite a mean indexed effective orifice area of 0.67 ± 0.14 cm²/m² (median, 0.66 cm²/m²).

CONCLUSIONS: Selected patients with aortic stenosis can experience satisfactory clinical improvement and significant indexed left ventricular mass regression after aortic valve replacement with modern small-diameter bileaflet prostheses.

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