J Thorac Cardiovasc Surg 2006;132:726-727
© 2006 The American Association for Thoracic Surgery
The effect of aortic valve replacement on coronary flow reserve
Attila Nemes, MD, PhD, FESCa,b,
Tamás Forster, MD, PhD, DSc, FESCa,
Marcel L. Geleijnse, MD, PhDb,
Folkert J. ten Cate, MD, PhD, FESC, FACCb,
Miklós Csanády, MD, PhD, DSc, FESC, FACCa
a Second Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Medical and Pharmaceutical Center, University of Szeged, Szeged, Hungary
b Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands
To the Editor:
We read with great interest and congratulate Bakhtiary and colleagues1
on the study entitled "Stentless Bioprostheses Improve Postoperative Coronary Flow More Than Stented Prostheses After Valve Replacement for Aortic Stenosis." This intriguing magnetic resonance imaging study found that patients receiving stentless valves showed a normal coronary flow reserve (CFR) 6 months after aortic valve replacement (AVR), whereas those receiving stented valves demonstrated a slightly reduced CFR. However, we feel that a few additional comments are necessary.
In recent echocardiographic studies, reduced CFR has been demonstrated in aortic stenosis (AS) patients regardless of the presence or absence of coronary artery disease.2–6 We found a CFR improvement in AS patients 15 months after AVR with mechanical valves.4 This CFR improvement paralleled the regression of left ventricular hypertrophy. However, CFR did not reach normal values, thus suggesting that other factors also play a role in CFR impairment in AS. This has been strengthened by our more recent findings that CFR improvement 3 years after AVR was transient despite unchanged left ventricular mass.5
Overall, these results suggest that AVR with mechanical valves is associated with coronary microvascular functional alterations. Further studies in larger AS populations are warranted using more reliable techniques for CFR evaluation (such as magnetic resonance imaging) to verify our disappointing long-term results. Also, potential differences between different kinds of mechanical valves and bioprostheses should be investigated to identify the optimal therapy for coronary circulation.
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References
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- Bakhtiary F, Schiemann M, Dzemali O, Wittlinger T, Doss M, Ackermann H, et al. Stentless bioprostheses improve postoperative coronary flow more than stented prostheses after valve replacement for aortic stenosis. J Thorac Cardiovasc Surg. 2006;131:883-888.[Abstract/Free Full Text]
- Nemes A, Forster T, Varga A, Vass A, Borthaiser A, Palinkas A, et al. How can coronary flow reserve be altered by severe aortic stenosis?. Echocardiography. 2002;19:655-659.[Medline]
- Nemes A, Forster T, Thury A, Kovacs Z, Boda K, Csanady M. The comparative value of the aortic atherosclerosis and the coronary flow velocity reserve evaluated by stress transesophageal echocardiography in the prediction of patients with aortic stenosis with coronary artery disease. Int J Cardiovasc Imaging. 2003;19:371-376.[Medline]
- Nemes A, Forster T, Kovacs Z, Thury A, Ungi I, Csanady M. The effect of aortic valve replacement on coronary flow reserve in patients with a normal coronary angiogram. Herz. 2002;27:780-784.[Medline]
- Nemes A, Forster T, Kovacs Z, Csanady M. Is the coronary flow velocity reserve improvement after aortic valve replacement for aortic stenosis transient? Results of a 3-year follow-up. Heart Vessels 2006;21:157-161.[Medline]
- Nemes A, Forster T, Csanady M. Decreased aortic distensibility and coronary flow velocity reserve in patients with significant aortic valve stenosis with normal epicardial coronary arteries. J Heart Valve Dis. 2004;13:567-573.[Medline]
Related Article
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Reply to the Editor
- Farhad Bakhtiary, Omer Dzemali, Thomas Wittlinger, Anton Moritz, and Peter Kleine
J. Thorac. Cardiovasc. Surg. 2006 132: 727-728.
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