ЗАДАТЬ ВОПРОС РЕДАКТОРУ РАЗДЕЛА (ответ в течение нескольких дней)

17 декабря 2001 00:00 | Aldo D. Milano, MDa, Claudio Blanzola, MDa, Gianclaudio Mecozzi,

Hemodynamic performance of stented and stentless aortic bioprostheses

Aldo D. Milano, MD^a, Claudio Blanzola, MD^a, Gianclaudio Mecozzi, MD^a, Alessandro D’Alfonso, MD^a, Marco De Carlo, MD^b, Carmela Nardi, MD^b, Uberto Bortolotti, MD^a ^a Division of Cardiac Surgery, Cardiac and Thoracic Department, University of Pisa Medical School, Pisa, Italy
^b Division of Cardiology, Cardiac and Thoracic Department, University of Pisa Medical School, Pisa, Italy

Accepted for publication March 27, 2001.

Address reprint requests to Dr Bortolotti, U.O. Cardiochirurgia, Ospedale Cisanello, Via Paradisa 2, 56124 Pisa, Italy
e-mail: u.bortolotti@cardchir.med.unipi.it

Background. This study compares the hemodynamic performanceof stented and stentless bioprostheses used for aortic valvereplacement in patients with aortic stenosis and small aorticroot.

Methods. Between 1995 and 1998, 37 patients with a 21−mm aorticannulus (group 1) underwent aortic valve replacement with eithera 21−mm Edwards Perimount or a 23−mm St. Jude Toronto bioprosthesiswhereas 47 patients with a 23−mm aortic annulus (group 2) receivedeither a 23−mm Medtronic Mosaic or a 25−mm Edwards Prima bioprosthesis.In each group mean and peak gradients, effective orifice areaindex, and left ventricular mass index were compared duringfollow-up.

Results. Group 1 patients showed a significant reduction ofmean (p < 0.001) and peak gradients (p = 0.001) during follow-up,more evident for St. Jude Toronto versus Edwards Perimount (p= 0.02 and p = 0.05, respectively). Group 2 patients showeda significant reduction of mean and peak gradients (p < 0.001),more evident for Edwards Prima versus Medtronic Mosaic (p <0.001 and p = 0.07, respectively). Effective orifice area indexsignificantly increased only in group 1 (p = 0.005). Left ventricularmass index significantly decreased in all patients regardlessof the type of valve (p < 0.001). Patients with Edwards Primashowed a trend to a higher regression of left ventricular massindex versus Medtronic Mosaic recipients (p = 0.07).

Conclusions. After aortic valve replacement, stented and stentlessbioprostheses exhibited similar results with a more evidenthemodynamic improvement during follow-up in the stentless valves.Stented bioprostheses of new generation, however, may parallelthe hemodynamic performance of stentless valves and appear tobe a valid alternative for aortic valve replacement in elderlypatients with a small aortic annulus.

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