Usefulness of Exercise Echocardiography for Evaluation of Aortic Bioprostheses Under Stress.
Guglielmo Stefanelli1, fabrizio pirro, md1, clorinda labia, md1, gianpiero patrizi, md2, luca weltert, md3, andrea barbieri, md4.
1Hesperia Hospital, Modena, IT, Modena, ITALY, Italy, 2Carpi Hospital, Modena, ITALY, Italy, 3European Hospital, Rome, ITALY, Italy, 4University Hospital, Modena, ITALY, Italy.
Objective. Aim of this study was to evaluate by transthoracic echo the haemodynamic behaviour and the changes in dimensional data of a stentless aortic bioprosthesis between rest and exercise conditions.
Methods.184 patients out of 254 who received a Sorin Pericarbon Freedom (SPF) aortic valve at our institution between 2003 and 2010 and were alive and capable of sustaining an exercise test 7 years after surgery,were enrolled in the study.All patients were evaluated by transthoracic echocardiography in order to assess hemodynamics at the time of hospital discharge and after 7years. Follow-up control consisted of clinical examination and rest and exercise echocardiographic evaluation using a semi-supine bicycle with a workload of 25w every two minutes,increasing up to 100w.
Results.Comparing rest to exercise,mean gradient increased from 7.8±3.3mmHg to 11.6±4.0mmHg and peak gradient from 14.9±5.2mmHg to 21.6±6.5mmHg at maximum stress, without significant differences between valve sizes.Concurrently EOA and EOAi raised from 1.86±0.69cm² to 1.96±0.71 cm²(p<0.0001),and from 1.05±0.37cm² to 1.10±0.38cm²(p<0.0001) respectively, without significant differences between the implanted valve sizes.Intraaortic regurgitation was absent or trivial in 98% of patients, and did not change with exercise.
Conclusions:Use of exercise echocardiography to assess changes in hemodynamics and valve function of aortic bioprostheses can be helpful in the choice of the most suitable device for a given patient. From our study, SPF stentless valve has demonstrated favourable hemodynamic behaviour that remains consistent during time and exercise ,similar to native aortic valve, thus making this prosthesis a good choice in young and active patients,or in cases of small aortic annulus.
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