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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

View larger version (14K): [in a new window]   Figure 1 Correlation between mean transvalvular gradient and indexed EOA at rest in patients with a stentless (open circle) or a stented (solid circle) bioprosthesis. Panel A and panel B show this relation for mean gradient measured at rest and during peak exercise, respectively. EOA = effective orifice area.

View larger version (18K): [in a new window]   Figure 2 Correlation between the change in mean transvalvular gradient with maximal exercise and indexed EOA at rest in patients with a stentless (open circle) or a stented (solid circle) bioprosthesis. EOA = effective orifice area.

View larger version (15K): [in a new window]   Figure 3 Mean gradient observed at rest (lower solid line) and during peak exercise (upper solid line) and expected mean gradient at peak exercise (dashed line) as a function of indexed EOA at rest. The exponential curves representing the observed gradient at rest and during peak exercise were constructed using the regression equations given in Figure 1. The curve representing the expected behavior of gradient during maximal exercise (dashed line) was derived from the resting curve (lower solid line) assuming incremental increase in mean flow rate and a constant EOA during exercise. EOA = effective orifice area.

View larger version (15K): [in a new window]   Figure 4 Correlation between mean transvalvular gradients observed in patients and the projected indexed EOA calculated by indexing the normal values of valve EOA for patients’ body surface area. Normal values of EOA were determined for each model and size of prosthesis using a previous study from our laboratory (1). The normal value of EOA for the St-Jude X-Cell stented valve was not available in the published literature. Panel A and panel B show this relation for mean gradient measured at rest and during peak exercise. (open circle) = Stentless bioprostheses; (solid circle) = stented bioprostheses. EOA = effective orifice area.