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Volume 14
Issue 21
10.3390/jcm14217627
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Echocardiographic Hemodynamics After Aortic Valve Replacement, Wheat, and Bentall Procedure

by
Wakana Niwa
,
Yoshiyuki Takami
*,
Atsuo Maekawa
,
Koji Yamana
,
Kiyotoshi Akita
,
Kentaro Amano
,
Kazuki Matsuhashi
,
Yasushi Takagi
and
Tomonobu Abe
Department of Cardiac Surgery, Fujita Health University School of Medicine, Toyoake 470-1192, Japan
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(21), 7627; https://doi.org/10.3390/jcm14217627 (registering DOI)
Submission received: 1 September 2025 / Revised: 23 October 2025 / Accepted: 24 October 2025 / Published: 27 October 2025
(This article belongs to the Section Cardiology)
Versions Notes

Abstract

Background: Compared with isolated aortic valve replacement (AVR), echocardiographic hemodynamics after Wheat and Bentall procedures, both involving replacement of the proximal ascending aorta with a smaller-diameter graft, have been less thoroughly investigated. Methods: We analyzed 213 patients who received 21 mm or 23 mm aortic bioprostheses (AVR, n = 138; Wheat, n = 43; Bentall, n = 32). Transthoracic echocardiography was performed before and after surgery, and the proximal ascending aortic area (Aa) was assessed using contrast-enhanced computed tomography. Results: The maximal pressure gradient (PG max), derived from the simplified Bernoulli equation, was significantly lower in the Bentall group, whereas pressure recovery (PR), calculated using Voelker’s equation, was lower in the AVR group. A smaller Aa was associated with a higher PG max in the AVR group. The Bentall group exhibited significantly lower energy loss (EL). In propensity score-matched analyses to minimize potential confounding factors, the AVR group showed a significantly lower PR and higher EL than the Wheat group; a significantly higher PG max, lower PR, and higher EL than the Bentall group; and a significantly similar PR but lower EL in the Bentall group compared with the Wheat group. Conclusions: Although limited to bioprosthetic valves, caution is warranted when interpreting echocardiographic PG max after AVR in patients with a small ascending aorta. However, overestimation of PG max was not observed in either the Wheat or Bentall groups, even though both demonstrated higher PR and lower EL compared with the AVR group.
Keywords: aortic prosthetic valve; aortic valve replacement; echocardiography; Wheat procedure; Bentall procedure aortic prosthetic valve; aortic valve replacement; echocardiography; Wheat procedure; Bentall procedure

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MDPI and ACS Style

Niwa, W.; Takami, Y.; Maekawa, A.; Yamana, K.; Akita, K.; Amano, K.; Matsuhashi, K.; Takagi, Y.; Abe, T. Echocardiographic Hemodynamics After Aortic Valve Replacement, Wheat, and Bentall Procedure. J. Clin. Med. 2025, 14, 7627. https://doi.org/10.3390/jcm14217627

AMA Style

Niwa W, Takami Y, Maekawa A, Yamana K, Akita K, Amano K, Matsuhashi K, Takagi Y, Abe T. Echocardiographic Hemodynamics After Aortic Valve Replacement, Wheat, and Bentall Procedure. Journal of Clinical Medicine. 2025; 14(21):7627. https://doi.org/10.3390/jcm14217627

Chicago/Turabian Style

Niwa, Wakana, Yoshiyuki Takami, Atsuo Maekawa, Koji Yamana, Kiyotoshi Akita, Kentaro Amano, Kazuki Matsuhashi, Yasushi Takagi, and Tomonobu Abe. 2025. "Echocardiographic Hemodynamics After Aortic Valve Replacement, Wheat, and Bentall Procedure" Journal of Clinical Medicine 14, no. 21: 7627. https://doi.org/10.3390/jcm14217627

APA Style

Niwa, W., Takami, Y., Maekawa, A., Yamana, K., Akita, K., Amano, K., Matsuhashi, K., Takagi, Y., & Abe, T. (2025). Echocardiographic Hemodynamics After Aortic Valve Replacement, Wheat, and Bentall Procedure. Journal of Clinical Medicine, 14(21), 7627. https://doi.org/10.3390/jcm14217627

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