CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 96 AFRICA Investigation of left ventricular changes according to valve type in patients with surgical replacement due to isolated aortic stenosis Abdullah Güner, Mehmet Işık, Ömer Tanyeli, Serkan Yıldırım, Erdal Ege, Volkan Burak Taban Abstract Objective: The aim of this study was to investigate postoperative left ventricular changes [left ventricular mass (LVM), left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), patient–prosthesis mismatch (PPM), pulmonary artery pressure (PAP), gradients, and ejection fraction (EF)] according to the valve type used in patients undergoing aortic valve replacement (AVR) due to isolated aortic stenosis. Methods: A total of 199 patients with isolated AVR due to aortic stenosis between 2010 and 2020 was retrospectively investigated. Four groups were identified according to the valve type used (mechanical, bovine pericardium, porcine and sutureless). Pre-operative and first year postoperative transthoracic echocardiography findings for the patients were compared. Results: Mean age was 64.4 ± 13.0 years, while the gender distribution was 41.7% women and 58.3% men. Of the valves used in patients, 39.2% were mechanical, 18.1% were porcine, 8.5% were bovine pericardial and 34.2% were sutureless valves. Analysis independent of the valve groups observed LVEDD, LVESD, maximum gradient, mean gradient, PAP, LVM and LVMI values reduced significantly postoperatively (p < 0.001). EF was observed to increase by 2.1% (p = 0.008). Comparisons of the four valve groups revealed that LVEDD, LVESD, maximum gradient, mean gradient, LVM and LVMI significantly decreased in all groups. EF significantly increased only in the sutureless valve group (p = 0.006). Analysis of PPM groups showed that LVESD, maximum gradient, mean gradient, PAP, LVM and LVMI were significantly reduced in all groups. In the normal PPM group, there was an improvement in EF, which was significantly different to the other groups (p = 0.001), while in the severe PPM group, EF appeared to be reduced (p = 0.19). Keywords: left ventricular mass, left ventricular mass index, aortic stenosis, aortic valve replacement, patient–prosthesis mismatch Submitted 9/12/22, accepted 1/3/23 Published online 5/5/23 Cardiovasc J Afr 2024; 35: 96–101 www.cvja.co.za DOI: 10.5830/CVJA-2023-012 In developed countries, aortic stenosis is the valve disease requiring most frequent intervention.1 The prevalence of aortic stenosis in patients between 60 and 74 years of age is reported to be 2.8%, and 13.1% in people aged 75 years and older.2 Left ventricular hypertrophy linked to aortic stenosis causes the development of symptoms and side effects characterising the later stages of this disease. Even successful aortic valve replacement (AVR) after severe left ventricular hypertrophy is associated with a worse left ventricular function, and higher early and late mortality rates.3,4 Regression of left ventricular mass (LVM) reaches a plateau in the first year after AVR.5 Inadequate postoperative regression of left ventricular hypertrophy may be an indication of irreversible remodelling and hence a worse prognosis.6,7 Regression of left ventricular hypertrophy was shown to be associated with improved long-term survival.8,9 Some factors involved in regression of left ventricular hypertrophy have been reported. Among these are age, gender, hypertension, diabetes, coronary artery disease, atrial fibrillation (AF), prosthetic valve type used and degenerative myocardial changes.8 Additionally, the effect of patient–prosthesis mismatch (PPM) on left ventricular remodelling is controversial. In this study, the aim was to investigate postoperative left ventricular changes [LVM, left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), PPM, pulmonary artery pressure (PAP), gradient, and ejection fraction (EF)] according to the valve type used in patients undergoing AVR due to isolated aortic stenosis. Methods A total of 290 patients with AVR due to isolated aortic stenosis from January 2010 to January 2020 in our clinic was retrospectively investigated. Patients with a previous history of cardiac operation with additional procedures (coronary artery bypass graft, ascending aorta replacement and aortic root expansion), pregnant and/or breastfeeding, under 18 years of age, with emergency procedures performed, and those with a primary diagnosis of aortic regurgitation were excluded from the study. The study included 199 adult patients with a main diagnosis of isolated aortic stenosis. Detailed characteristics of the patients were obtained from file records and the hospital software system. Department of Cardiovascular Surgery, Konya Health Sciences University, Beyhekim Training and Research Hospital, Konya, Turkey Abdullah Güner, MD, guner_426@hotmail.com Department of Cardiovascular Surgery, Necmettin Erbakan University, Meram Faculty of Medicine Hospital, Konya, Turkey Mehmet Işık, MD Ömer Tanyeli, MD Serkan Yıldırım, MD Erdal Ege, MD Volkan Burak Taban, MD
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