Hemodynamic Changes Following Correction of Severe Aortic Stenosis Using the Cutter-Smeloff Prosthesis

Abstract

Twelve patients with pure or dominant stenosis were studied before and after aortic valve replacement (Cutter-Smeloff). The changes in cardiac output and A-V O 2 difference were small and insignificant, but exercise stroke volume increased from 72 to 96 ml after the surgery. The aortic peak systolic gradient was 92 ± 29 mm Hg before and 4 ± 9.8 mm Hg after surgery. The PA wedge pressure, taken as a measure of the LV diastolic pressure, decreased from 18 mm Hg to 12 mm Hg at rest and 30 mm Hg to 16 mm Hg on exercise. The PA pressures also decreased from 37/18 (mean, 26) to 28/11 (17) mm Hg at rest, and 61/31 (43) to 41/17 (27) mm Hg on exercise, but the PA and PA wedge pressures maintained their tendency to increase in a linear manner with oxygen consumption (Vo 2 ) on exercise after surgery. As a result of decreased wedge pressure, the pulmonary vascular resistance also decreased significantly afterward. The adequacy of cardiac output at rest and on exercise expressed by cardiac output as the linear function of Vo 2 improved toward the normal (values before operation, CO = 2.78 ± 0.0069 Vo 2 , r = 0.84; after operation, CO = 3.80 + 0.0062 Vo 2 , r = 0.91). The exercise factor (ΔCO/ΔVo 2 ) or the regression coefficient, however, was similar before and after surgery. The hemodynamic result was satisfactory although some abnormalities of the left ventricular function persisted after operation.