Abstract
Although a small percentage of patients with critical aortic stenosis do not develop left ventricle hypertrophy, increased ventricular mass is widely observed in conditions of increased afterload. There is growing epidemiological evidence that hypertrophy is associated with excess cardiac mortality and morbidity not only in patients with arterial hypertension, but also in those undergoing aortic valve replacement. Valve replacement surgery relieves the aortic obstruction and prolongs the life of many patients, but favorable or adverse left ventricular remodeling is affected by a large number of factors whose specific roles are still a subject of debate. Age, gender, hemodynamic factors, prosthetic valve types, myocyte alterations, interstitial structures, blood pressure control and ethnicity can all influence the process of left ventricle mass regression, and myocardial metabolism and coronary artery circulation are also involved in the changes occurring after aortic valve replacement. The aim of this overview is to analyze these factors in the light of our experience, elucidate the important question of prosthesis-patient mismatch by considering the method of effective orifice area, and discuss surgical timings and techniques that can improve the management of patients with aortic valve stenosis and maximize the probability of mass regression.
Highlights
aortic valve stenosis (AS) is a common disorder and the most frequent acquired valvular disease in developed countries
Less mass, more concentric hypertrophy, less wall tension, fewer alterations in passive elastic properties, higher ejection fractions and smaller left ventricle (LV) volumes [20,21,22]. The effect of these gender-related differences in hypertrophy patterns on the recovery and regression of the LV mass index is still being debated. In their medium-term study, Hanayma et al found that the LV hypertrophy index of females was less likely to regress incompletely [14], and we have found that female gender is an independent predictor of greater LV mass regression except in the particular subgroup of patients with prosthesis-patient mismatch (PPM), in whom it plays no predictive role [18,19]
Using more accurate 3-D echocardiography, Kühl et al consistently observed that normalization of the LV mass index after one year was not related to age at the time of surgery [16], but the results of studies by Lund et al, who developed a preoperative prognostic index conceived for patients with AS undergoing Aortic valve replacement (AVR) that included age, indirectly suggest that age is associated with the LV mass index after 10 years: the higher scores correlated with a higher LV mass index during the postoperative course [17]
Summary
AS is a common disorder and the most frequent acquired valvular disease in developed countries. (page number not for citation purposes) http://www.cardiovascularultrasound.com/content/4/1/25 ticenter randomized comparisons there were similar reductions in LV mass at 12 months with both stented and stentless valves despite significant differences in indexed EOA and peak flow velocity in favor of the stentless valves [Circ 2005].
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