Postoperative Left Ventricular Mass Research Articles

The Effects of Laparoscopic Sleeve Gastrectomy on Cardiac Diastolic Function, Aortic Elasticity, and Atrial Electromechanics Delay.

Obesity is a well-known risk factor for cardiovascular diseases. The aim of this study was to prospectively investigate the short-term effects of laparoscopic sleeve gastrectomy (LSG) on cardiac functions. Forty-four morbidly obese patients who underwent LSG were included in the study. The aortic systolic and diastolic diameters, left ventricular (LV) diameter, LV cardiac output and cardiac index, LV ejection fraction, LV septal and lateral wall velocities, deceleration time of the E wave, the LA volume index and atrial mechanic functions, and atrial conduction times were evaluated. The patients' aortic stiffness index showed a significant improvement at postoperative control: 3.23 ± 0.58, 2.49 ± 0.36; p<0.001 for preoperative and postoperative aortic stiffness index, respectively. A significant reduction was observed in the LV mass and relative wall thickness (RWT) of the patients: 182.41 ± 36.87 g, 154.85 ± 24.32 g; p<0.001 and 0.42 ± 0.07, 0.39 ± 0.05; p=0.010 for the preoperative and postoperative LV mass and RWT, respectively. A statistically significant decrease was observed in total atrial conduction time and interatrial and intraatrial conduction time in the postoperative period: 120.95 ± 22.27 ms, 106.57 ± 20.46 ms; p=0.001; 13.82 ± 8.21 ms, 10.66 ± 6.78 ms; p=0.038, and 29.64 ± 14.18 ms, 24.09 ± 10.95 ms; p=0.047 for preoperative and postoperative total atrial conduction time, intraatrial electromechanical delay, and interatrial electromechanical delay, respectively. Weight loss reduced aortic stiffness, IVS and posterior wall thickness, LAV, LAVi, LA passive emptying fraction, and atrial electromechanical delays in morbidly obese patients.

Comparison of the Clinical Outcomes and Hemodynamic Performance between the 19-Mm Mosaic and 19-Mm TrifectaTM Bioprosthesis

Background: We evaluated and compared short- (≤ 3 months) and mid-term (≥ 4 months) clinical outcomes and hemodynamic performances of the 19-mm Mosaic® and 19-mm TrifectaTM bioprostheses for aortic valve replacement. Methods: 193 patients underwent aortic valve replacement: 37 received the 19-mm Mosaic® prosthesis (Group M) and 12 received the 19-mm TrifectaTM prosthesis (Group T). Pre- and postoperative echocardiographic parameters and New York Heart Association classes were evaluated in both groups. Results: Baseline characteristics and preoperative echocardiographic parameters were similar between the groups. The New York Heart Association class improved in both groups. The mean left ventricular-aortic pressure gradient was 22.6 mmHg ± 8.4 mmHg in Group M and 15.0 mmHg ± 6.2 mmHg in Group T. The left ventricular mass index was 99.6 ± 27.6 g/m2 and 99.0 ± 20.0 g/m2 respectively, with significant improvements in both groups. Left ventricular mass index regression during the mid-term period showed no significant difference between the groups, despite a higher-pressure gradient and smaller effective orifice area index in the Mosaic® group. Patient-prosthesis mismatch occurred in 20 patients in the Mosaic® group, with no significant differences in the postoperative left ventricular mass indices and New York Heart Association classes between the patientprosthesis mismatch and no patient-prosthesis mismatch subgroups in the Mosaic® group. Conclusion: Compared with the 19-mm TrifectaTM bioprosthesis, the 19-mm Mosaic® bioprosthesis showed similar satisfactory improvement in the New York Heart Association class grade and reduction in the left ventricular mass index, despite a higher-pressure gradient and smaller effective orifice area index.

Diabetes Mellitus Impairs Left Ventricular Mass Regression after Surgical or Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

It is well-documented that persistent myocardial hypertrophy in patients with aortic stenosis is related to suboptimal postoperative outcomes after aortic valve replacement. Although diabetes is known to potentially exacerbate myocardial hypertrophy, it has yet to be examined if it affects postoperative left ventricular mass regression (LVMR). A single-centre, retrospective analysis was performed on 183 consecutive patients who underwent either surgical or transcatheter aortic valve replacement between 2010 and May 2013. Patient demographics, postoperative outcomes and echocardiographic data were obtained preoperatively and a year after surgery. There were 42 diabetic and 141 non-diabetic patients. Preoperative characteristics of diabetic patients were statistically similar to those of non-diabetic patients, except for higher prevalence of hyperlipidaemia (p <0.001) and history of cerebrovascular disorder (p=0.046) in diabetic patients. Median value of postoperative LVMR of all patients was -36.5 g/m(2), and was significantly greater in the non-diabetics compared to the diabetics (-39.1 vs. -22.2 g/m(2), p=0.008). Univariate and multivariate analyses were performed on preoperative variables, and stepwise multiple regression analysis demonstrated that diabetes (standardised partial regression coefficient (SPRC)=-0.187, p=0.018), female gender (SPRC=0.245, p=0.026) and age (SPRC=0.203, p=0.018) were associated with poor postoperative LVMR. Patients with diabetes showed suboptimal postoperative LVMR, and the disease was a prognostic factor that was associated with poor LVMR. These findings suggest that diabetes may predispose the particular group of patients to worse postoperative outcomes.

Enhanced left ventricular mass regression after aortic valve replacement in patients with aortic stenosis is associated with improved long-term survival

Aortic valve replacement in patients with aortic stenosis is usually followed by regression of left ventricular hypertrophy. More complete resolution of left ventricular hypertrophy is suggested to be associated with superior clinical outcomes; however, its translational impact on long-term survival after aortic valve replacement has not been investigated. Demographic, operative, and clinical data were obtained retrospectively through case note review. Transthoracic echocardiography was used to measure left ventricular mass preoperatively and at annual follow-up visits. Patients were classified according to their reduction in left ventricular mass at 1 year after the operation: group 1, less than 25 g; group 2, 25 to 150 g; and group 3, more than 150 g. Kaplan-Meier and multivariable Cox regression were used. A total of 147 patients were discharged from the hospital after aortic valve replacement for aortic stenosis between 1991 and 2001. Preoperative left ventricular mass was 279 ± 98 g in group 1 (n=47), 347 ± 104 g in group 2 (n=62), and 491 ± 183 g in group 3 (n=38) (P<.001). Mean time to last echocardiogram was 6.2 ± 3.2 years. Left ventricular mass at late follow-up was 310 ± 119 g in group 1, 267 ± 107 g in group 2, and 259 ± 96 g in group 3 (P=.05). Transvalvular gradients at follow-up were not significantly different among the groups (group 1, 24.8 ± 23 mm Hg; group 2, 21.4 ± 16 mm Hg; group 3, 14.7 ± 9 mm Hg) (P=.31). There was no difference in the prevalence of other factors influencing left ventricular mass regression such as ischemic heart disease or hypertension, valve type, or valve size used. Ten-year actuarial survival was not statistically different in patients with enhanced left ventricular mass regression when compared with the log-rank test (group 1, 51% ± 9%; group 2, 54% ± 8%; and group 3, 72% ± 10%) (P=.26). After adjustment, left ventricular mass reduction of more than 150 g was demonstrated as an independent predictor of improved long-term survival on multivariate analysis (P=.02). Our study is the first to suggest that enhanced postoperative left ventricular mass regression, specifically in patients undergoing aortic valve replacement for aortic stenosis, may be associated with improved long-term survival. In view of these findings, strategies purported to be associated with superior left ventricular mass regression should be considered when undertaking aortic valve replacement.

Hemodynamic Performance of Mitroflow Aortic Pericardial Bioprosthesis – Optimizing Management for the Small Aortic Annulus

Documentation of the hemodynamics of the Mitroflow aortic pericardial bioprosthesis has been incomplete. The aim of the study was to provide reference effective orifice areas for the implant calculation of effective orifice area indexes to avoid prosthesis-patient mismatch. Echocardiograms were evaluated in 55 patients (39 females, 16 males), mean age 77.0 +/- 6.9 years (range 51-90 years). The mean time of the studies was 11.0 months. The prosthesis sizes and numbers evaluated were 19 mm (n = 13), 21 mm (n = 19), 23 mm (n = 13) and 25 mm (n = 10). Peak aortic velocities averaged from 2.2 to 2.7 m/sec, mean gradients from 10.6 to 15.1 mmHg, peak gradients from 20.7 to 29.7 mmHg, and effective orifice area (EOA) from 1.4 to 1.8 cm (2). When accounting for the subaortic velocity, mean gradients averaged from 7.5 to 10.0 mmHg, and peak gradients averaged 15.1 to 23.5 mmHg. The effective orifice area indexes ranged from 0.8 to 1.0 cm (2)/m (2). The mean postoperative left ventricular mass index was 101.6 gm/m (2). The IN VIVO effective orifice areas by valve size of the Mitroflow aortic pericardial bioprosthesis provide the opportunity of avoiding obstructive characteristics for all valve sizes, including optimizing the management of the small aortic annulus.

Postoperative Left Ventricular Mass Regression After Aortic Valve Replacement for Aortic Stenosis

Small valve size and prosthetic patient mismatch are both considered to have harmful effects on residual left ventricular hypertrophy after aortic valve replacement for aortic stenosis. In general, it is believed that the effective orifice area index of the prosthesis must not be less than 0.85 cm(2)/m(2) in order to avoid prosthetic patient mismatch. On the other hand, studies have shown that valve type and valve size had no effects on postoperative left ventricular mass (LVM). The objective of this report was to examine the relationships between patient characteristics or the prosthetic valve and postoperative LVM. To evaluate the factors that influence postoperative LVM, we formulated the hypothesis that postoperative LVM is proportional to the sum total of pressure at the prosthetic valve orifice and inner surface area of the left ventricle in systole. We present a conceptually new index for postoperative LVM and compare the index with postoperative LVM. The results indicated a strong correlation between the new index and postoperative LVM six years after surgery (r(2) =0.67, p < 0.0001). As might be expected, LVM increased gradually as the value of the new index increased. The results of the present study indicate that postoperative left ventricular hypertrophy can be avoided by preventing postoperative hypertension in patients without left ventricular dilatation and an effective orifice area index is greater than 0.77 cm(2)/m(2).

Stentless valves versus stented bioprostheses at the aortic position: Midterm results

Our aim was to compare stentless and stented bioprostheses. Clinical outcomes, hemodynamic performance, and postoperative left ventricular mass regression were the principal outcomes assessed. Sixty-two patients were recruited for the study. Our protocol was to consider all patients older than 55 years for bioprostheses, and also younger patients were implanted with a bioprosthesis if they wanted to avoid anticoagulation. Patients selected for bioprostheses were randomly assigned to receive stentless (group A) and stented (group B) bioprostheses, depending on the treating unit. Patients in groups A and B were further divided into subgroups I and II based on left ventricular ejection fractions of 50% or greater and less than 50%, respectively. At 18 +/- 3 months postoperatively, the effective orifice area was greater in group A versus group B. Left ventricular ejection fraction, left ventricular mass index, functional class, and mean gradient were similar in patients of subgroup I (left ventricular ejection fraction >50%) from both groups. However, there was a significant difference between all except mean gradient in patients of subgroup II (left ventricular ejection fraction <50%) from both groups. Also, in the patient subgroup implanted with valves of less than 19 mm (group A, 4 patients; group B, 3 patients), there was a significant difference in left ventricular mass index and mean gradient. In patients with left ventricular impairment or a small aortic annulus, stentless bioprostheses might allow for greater improvement in left ventricular function postoperatively.

Impact of Valve Prosthesis-Patient Mismatch on Long-Term Survival and Left Ventricular Mass Regression After Aortic Valve Replacement for Aortic Stenosis

The influence of prosthesis-patient mismatch on long-term results after aortic valve replacement remains controversial. The aim of this study was to evaluate the effect of prosthesis-patient mismatch on survival and the extent of left ventricular mass regression after aortic valve replacement for aortic stenosis. We retrospectively reviewed 146 patients who underwent isolated aortic valve replacement for aortic stenosis between 1990 and 2005. Prosthesis-patient mismatch was defined as an effective orifice area/body surface area <or=0.85 cm(2)/m(2). Mean follow-up was 4.5 +/- 3.3 years, with a total follow-up of 650.0 patient-years. In 108 patients, follow-up echocardiography was performed at least 6 months after surgery, and the extent of postoperative left ventricular mass regression was analyzed according to the presence of prosthesis-patient mismatch. Ten years after surgery, there was no significant difference between patients with mismatch and those without mismatch in overall survival (p = 0.345), actuarial freedom from cardiac-related death (p = 0.576), and freedom from any valve-related mortality or morbidity (p = 0.614). Using multivariate analysis, PPM was not a predictor of late cardiac-related death or all deaths. Echocardiographic examination showed that left ventricular wall thickness and left ventricular mass was significantly decreased postoperatively in both groups. However, the absolute and relative left ventricular mass regression was significantly lower in patients with mismatch than in those without mismatch. This study showed no negative effects of prosthesis-patient mismatch on survival at 10 years after aortic valve replacement for aortic stenosis. However, the extent of left ventricular mass regression was significantly lower in patients with mismatch.

412 Severe aortic stenosis and functional mitral regurgitation. Incidence, associated factors and prognosis after aortic valve replacement

Eur J Echocardiography Abstracts Supplement, December 2006 rolateral commissure (A2). Based on the interval when a dehiscence was uncovered after the surgery we divided the group into the early and late dehiscences with 3 months cut-off value. In our patients about the two third of dehiscences occurred early after the surgery. Conclusion: Three-dimensional echocardiography is feasible and valuable method in identification of mechanism of residual regurgitation following the mitral valve repair. However to completely describe the repaired valve both data from 2D scans and 3D reconstruction must be considered. The presence of systemic hypertension, a condition frequently associated with valvular aortic stenosis may influence the plasma BNP level after AVR. Aims: To evaluate plasma BNP level in patients with AVR for calcific aortic valve stenosis in elderly and to examine the correlation between BNP and left ventricular mass index, ejection fraction and geometry preoperatively and two month post AVR in patients with and without sistemic hypertension. Method and results: 68 patients over 60 years (17 F/51 M) were included. Plasma BNP, clinical assesment and echocardiographic measurements were performed two month after AVR. BNP was elevated post AVR (200.33±131.7 pg/ml) and hypertensive patients had higher values of BNP compared to normotensives (251.47±151.47 vs 109.44±25.26 pg/ml, p<0.001). Postoperative left ventricular mass (308±116 g) and left ventricular mass index (171±64 g/m2) correlated with BNP (r=0.63 and r=0.65) irrespective of the presence of systemic hypertension. Regarding left ventricular geometry, both preoperative and postoperative eccentric remodeling is characterised by the highest plasma BNP values (280±166 pg/ml and 377±111 pg/ml) independent of left ventricular ejection fraction. No correlation was found between BNP and pre/postoperative transprotetic gradiens or ejection fraction. Conclusion: BNP is increased in elderly patients post AVR for calcific aortic stenosis and hypertensive patients had elevated values compared to normotensives. Plasma BNP level is correlated with pre and postoperative left ventricular mass index and geometry. Associated systemic hypertension seems to contribute to a high BNP level in elderly post AVR for calcific aortic stenosis. Aditional reduction of blood pressure in these patients could favorably influence the regression of BNP but this hipothesis needs further approach.

Indexed effective orifice area after mechanical aortic valve replacement does not affect left ventricular mass regression in elderly

After aortic valve replacement, the effects of a small functional prosthesis on the extent and pattern of regression of left ventricular hypertrophy and on clinical outcomes may be less significant in older patients with low cardiac output requirements. The objective of this study was therefore to determine whether patient-prosthesis mismatch affects left ventricular mass regression in the elderly. The population studied was made up of 88 patients over 65 years of age with pure aortic stenosis who underwent mechanical aortic valve replacement. The effective orifice area index was calculated for each patient on the basis of the projected prosthesis in vivo effective orifice area. It was considered a continuous variable and influence of its entire range of values on the extent of left ventricular mass regression was analyzed in a multivariate prediction model. Even though, in the group with prosthesis-patient mismatch there was a trend for lower postoperative left ventricular mass index (115+/-24 g/m(2) vs 102+/-27 g/m(2), p=0.24) and postoperative peak trans-prosthetic gradients (32+/-9.8 mmHg vs 28.9+/-7.79 mmHg, p=0.35) these differences were not statistically significant. The prevalence of residual left ventricular hypertrophy at follow-up was 50% in the group with patient-prosthesis mismatch and 50% in the group without patient-prosthesis mismatch (p=0.83). In multivariate analysis the only factors associated with indexed left ventricular mass were the follow-up time (p=0.015, r(2)=0.22) and preoperative indexed left ventricular mass (p=0.0012, r(2)=0.11). The major finding of our study is that patient-prosthesis mismatch does not affect left ventricular mass regression in patients older than 65 with pure aortic stenosis who underwent mechanical aortic valve replacement. In older patients with low cardiac output requirements, even a small change in the valve effective orifice area after aortic valve replacement with modern efficient mechanical prosthesis, will result in a marked reduction of pressure gradient and this will be associated with a significant regression of left ventricular mass.

Impact of the Improvement of Valve Area Achieved With Aortic Valve Replacement on the Regression of Left Ventricular Hypertrophy in Patients With Pure Aortic Stenosis

Previous studies have reported that patient-prosthesis mismatch may be associated with lesser regression of left ventricular hypertrophy. However, among the patients with mismatch, the extent of left ventricular mass regression varied markedly from one patient to another, and we hypothesized that it could be related to the magnitude of the increase in valve area achieved with aortic valve replacement. Our aim was to examine the relationship between the improvement in valve effective orifice area obtained with aortic valve replacement and the extent of postoperative left ventricular mass regression in patients with patient-prosthesis mismatch. Preoperative and postoperative measurements of valve effective orifice area, transvalvular pressure gradient, and left ventricular mass were obtained by Doppler echocardiography in 111 patients with pure aortic stenosis who were found to have patient-prosthesis mismatch based on an indexed effective orifice area of 0.8 cm2/m2 or less after operation. On average, the valve effective orifice area increased by 0.45 +/- 0.24 cm2/m2 with operation, and mean transvalvular pressure gradients decreased by -31.6 +/- 13.5 mm Hg. The absolute and relative differences between preoperative and postoperative left ventricular mass were -28 +/- 30 g and -17% +/- 18%, respectively. In multivariate analysis, higher preoperative left ventricular mass (p < 0.0001) and larger increase in indexed valve effective orifice area with operation (p = 0.019) were independently associated with greater left ventricular mass regression. This study shows that in patients with patient-prosthesis mismatch, the degree of left ventricular mass regression is influenced by the increase in valve effective orifice area achieved by aortic valve replacement.

Survival after aortic valve replacement for aortic stenosis: does left ventricular mass regression have a clinical correlate?

The effects of post-operative left ventricular mass regression (LVMR) on clinical outcome after aortic valve surgery remains to be established. This study was intended to establish the impact of patient characteristics on post-operative survival in patients referred for aortic valve replacement (AVR), with particular regard to LVMR. Two hundred and sixty consecutive cases submitted to aortic valve replacement for valvular stenosis were prospectively followed for a mean of 28+/-9 months. Baseline, characteristics and extent of LVMR were tested for association with survival by uni- and multivariable analysis. Ten deaths occurred during hospital stay and 52 during out-of-hospital follow-up. Mean left ventricular mass decreased from 190+/-43 to 158+/-70 g/m2 (P<0.001). Older age, advanced functional class, hypertension, reduced left ventricle ejection fraction, and high pre-operative left ventricular mass index were associated with reduced survival. Overall the extent of LVMR did not influence the clinical results, while only early (<6 months) LVMR was weakly associated with mid-term outcome. Survival after aortic valve surgery is mainly determined by the pre-operative functional cardiac and systemic status. The extent of LVMR does not correlate with clinical outcome, whereas aggressive treatment of hypertension may improve post-operative survival.

Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevant

Background. Although small valve size and patient-prosthesis mismatch are both considered to decrease long-term survival, little direct evidence exists to support this hypothesis. Methods. To assess the prevalence of patient-prosthesis mismatch and the influence of small valve size on survival, we prospectively studied 1,129 consecutive patients undergoing aortic valve replacement between 1990 and 2000. Mean and peak gradients and indexed effective orifice area were measured by transthoracic echocardiography postoperatively (3 months to 10 years). Abnormal postoperative gradients were defined as those patients with mean or peak gradient above the 90th percentile (mean gradient ≥ 21 or peak gradient ≥ 38 mm Hg). Patient-prosthesis mismatch was defined as those patients with indexed effective orifice area below the 10th percentile (< 0.60 cm 2/m 2). Results. A multivariable analysis identified internal diameter of the implanted valve as the only independent predictor of abnormal gradients postoperatively. However, there was no significant difference in actuarial survival between normal and abnormal gradient groups (7 years: 91.2% ± 1.5% versus 95.0% ± 2.2%; p = 0.48). Freedom from New York Heart Association class III or IV (7 years: 74.5% ± 3.1% versus 74.6% ± 6.2%; p = 0.66) and left ventricular mass index were not different between normal and abnormal gradient groups. Patients with and without patient-prosthesis mismatch were similar with respect to postoperative left ventricular mass index, 7-year survival (95.1% ± 1.3% versus 94.7% ± 3.0%; p = 0.54), and 7-year freedom from New York Heart Association class III or IV (79.3% ± 6.6% versus 74.5% ± 2.5%; p = 0.40). In patients with patient-prosthesis mismatch and abnormal gradients, the majority had prosthesis dysfunction owing to degeneration. Conclusions. Severe patient-prosthesis mismatch is rare after aortic valve replacement. Patient-prosthesis mismatch, abnormal gradient, and the size of valve implanted do not influence left ventricular mass index or intermediate-term survival.

Standard versus Hemodynamic Plus 19-mm St Jude Medical aortic valves

Objective: We reviewed our experience with aortic valve replacement using 19-mm St Jude Medical prostheses (St Jude Medical, Inc, St Paul, Minn) in 119 patients, among which 68 (group A) had a Standard model and 51 (group B) had a Hemodynamic Plus model. Methods: Comparison between the 2 models included analysis of early and late mortality and all valve-related complications. Postoperative echocardiography was performed to evaluate the hemodynamic performance of both prosthetic models. Laboratory tests were performed to evaluate the amount of red blood cell damage caused by the transprosthetic turbulent flow. Results: Average body surface area was 1.66 ± 0.14 m2 in group A and 1.65 ± 0.16 m2 in group B (P =.72). There was no statistically significant difference between the 2 groups in terms of preoperative variables (sex, cardiac rhythm, body surface area, preoperative gradients, and New York Heart Association class). Five-year follow-up was 100% complete. Although group A patients had significantly higher postoperative peak and mean gradients (P =.0001) and a lower effective orifice area (P =.0001), no statistical differences were found in terms of late (5-year) survival (P =.6) and postoperative complications (P =.09). Moreover, postoperative left ventricular mass was found to be similar in the 2 groups (P =.18). Hematologic evaluation did not show any significant difference between the 2 groups as to incidence of hemolysis. Conclusions: Aortic valve replacement with 19-mm aortic prostheses in patients with a body surface area of less than 1.7 m2 allows good results. Although Hemodynamic Plus models have better hemodynamic results, no significant difference was found in terms of clinical results and clinical hemolysis. (J Thorac Cardiovasc Surg 2001;121:723-8)

The effect of aortic valve replacement on left ventricular mass assessed by echocardiography.

The aim of the study was to investigate whether aortic valve replacement (AVR) has different effects on the left ventricular mass (LVM) in patients with different types of aortic valve disease, i.e. aortic stenosis (AS), aortic regurgitation (AR), or combined disease. We studied 100 patients with AS; (n=57), AR; (n=22), and combined disease; (n=21). Each patient was evaluated before and up to 8.7 years (mean follow-up period 1.42 +/- 1.65 years) after operation by transthoracic echocardiography. LVM was calculated based on echocardiographic parameters. Following AVR, the LVM for the entire group decreased from 373 +/- 145 g to 280 +/- 102 g (P=0.0001). The AS subgroup lost 13.7 +/- 30.7% from the preoperative LVM, compared to 28.8 +/- 24.8% in the AR subgroup (P<0.05) and 23.1 +/- 33.1% in the combined subgroup. The preoperative LVM was higher among patients with AR vs. AS patients (501 +/- 173 g vs. 319 +/- 100 g respectively, P<0.05). The decrease in LVM was significantly higher in patients with preoperative AR compared to AS patients (165 +/- 150 g vs. 58 +/- 96 g, respectively, P<0.05). However, the postoperative LVM remained higher among the former. The only preoperative parameter (of the LVM formula) that was different between AR and AS patients was the left ventricular end diastolic diameter (68 +/- 11 mm vs. 51 +/- 7 mm, respectively, P<0.05). No significant differences were found in wall thickness among the groups studied. Univariate analysis showed that gender (male), type of aortic valve disease (AR vs. AS), and larger prosthetic valve diameter correlated significantly with greater decrease in postoperative LVM. In multivariate analysis comparing the above variables between AS and AR subgroups, only the patient's gender (i.e. male) was identified as an independent predictor of LVM regression. Patients with AR have a greater decline in LVM compared with patients with AS following AVR. The postoperative decline in LVM is higher among males and those with larger prosthetic valve diameter.