Cor Vasa 2026, 68(4):418-425 | DOI: 10.33678/cor.2026.026

Effect of Prosthesis Orifice Area on Left Ventricular Reverse Remodeling After Surgical Aortic Valve Replacement.

Marián Homola, Tomáš Toporcer, Tomáš Lopuchovský, Anton Bereš, Michal Trebišovský, Štefan Lukačín, Adrián Kolesár
Department of Heart Surgery, East Slovak Institute for Cardiovascular Diseases and Medical Faculty, Pavol Jozef Šafárik University, Košice, Slovakia

Aim: This study aimed to evaluate whether valve prosthesis size after surgical aortic valve replacement (SAVR), even in the absence of patient-prosthesis mismatch, influences the magnitude of reverse left ventricular remodeling.

Material and methods: A total of 216 patients undergoing isolated SAVR for native AS with a single prosthetic valve model and without preoperative or postoperative atrial fibrillation between January 2021 and December 2024 were included. Echocardiographic parameters were assessed preoperatively and at 1-year follow-up. Changes in left ventricular remodeling were analyzed in relation to indexed geometric orifice area (iGOA).

Results: At 1-year follow-up, significant improvement was observed in nearly all echocardiographic parameters. Larger iGOA was significantly associated with an increase in indexed aortic valve area difference (B = 0.321, 95% CI 0.134-0.509; p = 0.004) and greater reductions in indexed left ventricular end-systolic and end-diastolic diameters (iLVeSD and iLVeDD) (B = -6.578, 95% CI -13.071 to -0.086, p = 0.047; B = -2.48, 95% CI -4.815 to -0.144, p = 0.038; respectively). A nonsignificant trend toward greater improvement in left ventricle ejection fraction (LVEF) and greater reductions in left ventricle mass index (LVMi) and left atrium volume index (LAVi) was also observed with larger valve prosthesis.

Conclusion: Larger prosthetic valve size during SAVR is associated with more pronounced reverse left ventricular remodeling, even in the absence of patient-prosthesis mismatch. No statistically significant effect on short-term survival was observed. © 2026, ČKS.

Keywords: Aortic stenosis, Indexed geometric orifice area, Reverse left ventricle remodeling, Surgical aortic valve replacement

Received: February 21, 2026; Revised: February 21, 2026; Accepted: March 14, 2026; Prepublished online: August 18, 2026; Published: August 31, 2026  Show citation

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Homola M, Toporcer T, Lopuchovský T, Bereš A, Trebišovský M, Lukačín Š, Kolesár A. Effect of Prosthesis Orifice Area on Left Ventricular Reverse Remodeling After Surgical Aortic Valve Replacement. Cor Vasa. 2026;68(4):418-425. doi: 10.33678/cor.2026.026.
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