Gender-associated differences in left ventricular geometry in patients with aortic valve disease and effect of distinct overload subsets.

Gender-associated differences may play an important role in the way the left ventricle adapts to overload. The purpose of this study is to evaluate left ventricular (LV) geometry in patients referred for aortic valve replacement with distinct overload subsets. The echocardiograms of 128 patients with isolated aortic stenosis (n = 44), mixed aortic valvular disease (n = 51), and pure aortic regurgitation (n = 33) before aortic valve replacement were evaluated. Women had better LV function as measured by ejection fraction (58% vs 52%; p = 0.01) and were slightly older (67 vs 62 years, p = 0.11). LV dimensions and volumes indexes were distinctively smaller in women irrespective of the subgroups analyzed. Men had larger LV mass and LV mass index, but women had higher LV mass/volume ratio. Gender-related differences in LV mass/volume ratio were most prominent in the aortic stenosis patients (3.1 g/ml for women vs 2.3 g/ml for men; p = 0.001), tended to decrease in mixed aortic disease (2.3 g/ml for women vs 1.8 g/ml for men; p = 0.01), and were not present in patients with pure aortic regurgitation (1.7 g/ml for women vs 1.7 g/ml for men; p = 0.83). Multivariate analysis showed that gender was independently associated with LV mass/volume ratios, after adjusting for the severity of the valvular lesion, age, LV function, and concomitant coronary bypass graft surgery. Thus, in a selected population of patients with severe aortic valvular disease, there were significant gender-related differences in LV geometry, mainly in patients exposed to chronic pressure overload.

Reduced mortality and morbidity for ascending aortic aneurysm resection regardless of cause.

BACKGROUND: This study was done to answer the question, "What is the current risk of resection of ascending aortic aneurysms regardless of acuity or cause?" METHODS: One hundred fifteen consecutive patients who underwent ascending aortic aneurysm repair from January 1, 1990, to July 1, 1995, were retrospectively reviewed, excluding those with acute ascending aortic dissection. The mean age was 59 years; 55% were male. Concomitant procedures included coronary artery bypass in 23 (20%) and arch repair in 12 (10%). In group 1, 54 patients had replacement of the aortic valve, root, and ascending aorta with a valve-graft conduit using the "Bentall" technique, and of these 19 (35%) had Marfan's syndrome. In group II, 44 patients had separate aortic valve repair or replacement and supracoronary ascending aortic replacement. In group III, 17 patients had supracoronary ascending aortic replacement, without aortic valve operation. Operative techniques included frequent use of (1) intraoperative transesophageal echocardiography or epiaortic ultrasound scanning of the ascending and descending thoracic aorta to help guide arterial cannulation, avoid atherosclerotic embolization, and assess the repair; (2) antegrade and retrograde multidose cold blood cardioplegia for myocardial protection; (3) exclusion and button anastomotic techniques to ensure secure suture lines; (4) antifibrinolytic agents and collagen-impregnated aortic grafts to reduce bleeding; and (5) deep hypothermic circulatory arrest and the open distal anastomotic technique in patients with distal ascending and arch aortic disease. RESULTS: Operative mortality overall was 2/115 (1.7%). Mortality was 1/54 (1.8) in group I and 1/44 (2%) in group II, and there was no mortality in group III. The overall postoperative morbidity was 3% due to bleeding, 2% due to stroke, and 1% due to myocardial infarction. The length of stay in the past year has decreased to less than 7 days. CONCLUSIONS: The current risk for ascending aortic aneurysm repair is low (< 2%) whether or not the aortic root or valve also needs repair, regardless of the cause of the aneurysm.