CLINICAL STUDIES
Hemodynamic and physical performance during maximal exercise in patients with an aortic bioprosthetic valve
Comparison of stentless versus stented bioprostheses
Philippe Pibarot, DVM, PhD, FACC*  ,
Jean G. Dumesnil, MD, FRCPC, FACC*,
Jean Jobin, PhD, FACSM*,
Paul Cartier, MD, FRCSC, FACS*  ,
George Honos, MD, FRCPC, FACC and
Louis-Gilles Durand, PhD, Eng
* Quebec Heart Institute/Laval Hospital, Laval University, Ste-Foy, Montreal, Quebec, Canada
Laboratoire de génie biomédical, Institut de recherches cliniques de Montréal, Montreal, Quebec, Canada
Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
Manuscript received October 21, 1998;
revised manuscript received May 27, 1999,
accepted June 30, 1999.
Reprint requests and correspondence: Dr. Pibarot, Quebec Heart Institute/Laval Hospital, 2725 Chemin Ste-Foy, Ste-Foy G1V-4G5, Quebec, Canada
philippe.pibarot{at}med.ulaval.ca
OBJECTIVES
The objective of this study was to compare stentless bioprostheses with stented bioprostheses with regard to their hemodynamic behavior during exercise.
BACKGROUND
Stentless aortic bioprostheses have better hemodynamic performances at rest than stented bioprostheses, but very few comparisons were performed during exercise.
METHODS
Thirty-eight patients with normally functioning stentless (n = 19) or stented (n = 19) bioprostheses were submitted to a maximal ramp upright bicycle exercise test. Valve effective orifice area and mean transvalvular pressure gradient at rest and during peak exercise were successfully measured using Doppler echocardiography in 30 of the 38 patients.
RESULTS
At peak exercise, the mean gradient increased significantly less in stentless than in stented bioprostheses (+5 ± 3 vs. +12 ± 8 mm Hg; p = 0.002) despite similar increases in mean flow rates (+137 ± 58 vs. +125 ± 65 ml/s; p = 0.58); valve area also increased but with no significant difference between groups. Despite this hemodynamic difference, exercise capacity was not significantly different, but left ventricular (LV) mass and function were closer to normal in stentless bioprostheses. Overall, there was a strong inverse relation between the mean gradient during peak exercise and the indexed valve area at rest (r = 0.90).
CONCLUSIONS
Hemodynamics during exercise are better in stentless than stented bioprostheses due to the larger resting indexed valve area of stentless bioprostheses. This is associated with beneficial effects with regard to LV mass and function. The relation found between the resting indexed valve area and the gradient during exercise can be used to project the hemodynamic behavior of these bioprostheses at the time of operation. It should thus be useful to select the optimal prosthesis given the patient’s body surface area and level of physical activity.
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Abbreviations and Acronyms
| | EOA | = effective orifice area | | LV | = left ventricular or ventricle | | LVOT | = left ventricular outflow tract | | VO2 | = oxygen consumption |
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