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LEFT VENTRICULAR MASS REGRESSION AFTER TWO ALTERNATIVE SUTURELESS AORTIC BIOPROSTHESES.
Giovanni Concistrč1, Steffen Pfeiffer1, Giuseppe Santarpino1, Francesca Chiaramonti2, Antonio Miceli2, Marco Solinas2, Mattia Glauber2, Theodor Fischlein1.
1Klinikum, Nuremberg, Germany, 2Ospedale del cuore "G.Pasquinucci" - Fondazione Monasterio - CNR, Massa, Italy.

OBJECTIVE: Left ventricular (LV) hypertrophy in aortic stenosis (AS) is considered a compensatory response helping to maintain systolic function, but it constitutes a risk factor for cardiac morbidity and mortality. The aim of this study was to investigate the degree of LV mass regression after aortic valve replacement (AVR) with 2 alternative sutureless self-expanding strategies: PercevalTM S (Sorin Group, Saluggia, Italy) (“P”) and 3f Enable (Medtronic, ATS Medical, Minneapolis, MN) (“E”) aortic bioprostheses
METHODS: Between March 2010 and December 2011, 129 patients with symptomatic AS underwent AVR with the Perceval STM or 3f Enable bioprostheses in 2 Cardiac Surgery Departments (Nuremberg, Germany - Massa, Italy). We analyzed 45 patients in Group P and 19 in Group E undergoing isolated AVR with a six-months clinical and echocardiographic follow-up. The LV mass was calculated using the Devereux formula and was indexed to body surface area.
RESULTS: Baseline patient characteristics showed not significant differences between groups. There were no in-hospital deaths. Two patients in P died at follow-up vs. zero in E (p=0.49). Mean LV mass index decreased from 146.6 ± 78 g/m2 at baseline to 123.3 ± 63 g/m2 at follow-up (p<0.001) in P and from 146.1 ± 47.6 g/m² to 118.1 ± 39.8 g/m² (p=0.003) in E with no significant difference between the 2 groups (p=0.315). LV ejection fraction did not change significantly over time. Mean indexed effective orifice area at follow-up was 1.34 cm2/m2 in P and 1.27 cm2/m2 in E (p=0.74). Mean transaortic gradient decreased to 10.4 ± 4.3 mmHg in P and to 12.2 ± 5.3 mmHg in E-Group (p=0.184). This effect was accompanied by significant clinical improvement.
CONCLUSIONS: In isolated aortic stenosis, AVR with sutureless bioprostheses determines a significant regression in LV mass at six-month follow-up. Not significant differences were present with the 2 alternative sutureless strategies. However, regression needs an evaluation with long-term echocardiographic examinations.


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