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Original Articles: Adult Cardiac

Longitudinal Study of the Profile and Predictors of Left Ventricular Mass Regression After Stentless Aortic Valve Replacement

^a Departments of Cardiac Surgery and Echocardiography, Royal Brompton Hospital, London
^b Department of Mathematics and Statistics, University of Lancaster, Lancaster, United Kingdom

Accepted for publication February 6, 2008.

^_* Address correspondence to Prof Pepper, Department of Cardiac Surgery, Royal Brompton Hospital, Sydney St, London SW3 6NP, United Kingdom (Email: m.shah{at}rbht.nhs.uk).

Background: The aim of this study was to evaluate the long-term profile and determine the factors that would influence the effect and rate of ventricular mass regression with time after aortic valve replacement with a stentless or a homograft valve.

Methods: We studied 300 patients during a 10-year period with at least a year of follow-up with a total of 1,273 serial echocardiographic measurements. Left ventricular mass was calculated from M-mode recordings and indexed to body surface area. Longitudinal data analysis was performed using a linear mixed effects model.

Results: The mean age (± standard deviation) was 65 (±14) years, consisting of 216 (72%) males. A stentless valve was implanted in 156 (52%), and a homograft in 144 (48%). The median time (interquartile range) to follow-up was 4.7 (2.8 to 6.6) years. The greatest rate of left ventricular mass regression occurred in the first year after surgery. On multivariable modeling, independent predictors of left ventricular mass were valve size (p = 0.011), left ventricular function (moderate impairment, p = 0.418; severe impairment, p = 0.011), and baseline left ventricular mass (middle tercile, p < 0.001; highest tercile, p < 0.001). Only baseline ventricular mass influenced the rate of subsequent left ventricular mass regression; the greatest rate of regression occurred in patients with the highest baseline values of ventricular mass (p < 0.001).

Conclusions: The greatest rate of left ventricular mass regression occurs in the first year with baseline left ventricular mass as the strongest predictor and the only identified variable that influenced the rate of left ventricular mass regression.

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