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Residual Left Ventricular Hypertrophy after Aortic Valve Replacement in the Elderly. A long term follow-up
U. Benedetto, G. Melina, A. Roscitano, B. Fiorani, F. Capuano, C. Simon, A. Miceli, E. Tonelli, R. Sinatra. Division of Cardiac Surgery-St.Andrew Hospital-University of Rome, rome, Italy,
Background: Patient-prosthesis mismatch (PPM) has been inconsistently reported to be a predictor of residual left ventricular hypertrophy (LVH) after aortic valve replacement (AVR). The effect of PPM after AVR on LVM regression should be analyzed using homogeneous criteria in terms of population
Methods: The study population is made up of eighty-eight patiens over 65 years of with pure aortic stenosis who underwent mechanical AVR All patients underwent to a long term follow-up echocardiography. Residual LVH was defined as an indexed left ventricular mass (ILVM) more than 131 g/m2 in males and more than 100 g/m2 in females. In order to estimate the impact of pre-operative ILVM on the incidence of residual LVH, we considered the value of absolute LVH (a-LVH) defined as ILVM -131 g/m2 in males and ILVM - 100 g/m2 in females.
Results: Patients with residual LVH at follow-up had a higher preoperative ILVM (175 ± 25 vs 148 ± 22 g/m2; p = 0.01), a higher preoperative a-LVH (67.4 ± 29.9 vs 27.2 ± 20.1 g/m2; p = 0.0014). At multivariate analysis, a pre-operative ILVM higher than 160 g/m2 in males and 129 g/m2 in females separed patients with and without residual LVH after AVR.
Conclusions: We are unable to find any correlation between hemodynamic variables related to valve prostheses as well as the type of prostheses and the extent of left ventricular mass regression postoperatively. We have demonstrated that the most important independent predictor of incomplete regression of hypertrophy following aortic valve replacement, was the extent of the preoperative indexed left ventricular mass.
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