Clinical and hemodynamic results of the correction of aortic valve disease in elderly patients: stentless and stented of the biological prosthesеs, analysis prospective randomized study results
Abstract
The number of operations with the use of biological prostheses in recent years significantly
increased in patients of all age groups. The aim of our research is to study and evaluate clinical and hemodynamic results of surgery in patients exposed to aortic valve replacement with
stentless biological prosthesis. The use of a stentless biological prosthesis is intended to reduce the amount prosthetic gradient and improve cardiac hemodynamics.
Material and methods. A prospective study was performed from 2011 to 2015. 114 patients
were randomized (1:1). Group 1 underwent implantation of a stentless biological prosthesis, group 2 – implantation of stented xenopericardial prosthesis. The primary endpoint of the
study was to assess the value of the peak prosthesis gradient in a year after surgery, secondary endpoints: dysfunction of the implanted biological prosthesis and patients’ mortality after
the operation. The patients’ mean age was 71.5±4 (65–84) years (p=0.017). Ejection fraction
of the left ventricle was 65.5% (40–86) (p=0.41). Logistic Euroscore – 5.4±1.3 (1.4–12.4)
(p=0.4).
Results. Peak prosthesis aortic gradient in group 1 was 16.3±4.4 (8–29), in group 2 – 24.7±4.7 (14.4–
34) mm Hg (p=0.006), mean prosthesis gradient in group 1 was 7.5±2.7 (4–16), in 2 group – 13.9±3.4
(7–21) mm Hg (p=0.04). The area of the aortic orifice in group 1 – 2.14±0.16 (1.67–2.41),
in group 2 – 2.12±0.21 cm2 (of 1.77 and 2.7) (p=0.3). The effective orifice area of the aortic valve
in group 1 was 1.31±0.11 (1.17–1.62), in group 2 – 1.27±0.18 (1.09–2.13) cm2/m2 (p=0.07).
Conclusion. Stentless xenopericardial biological prostheses in comparison with stented prostheses demonstrate better hemodynamic characteristics after aortic valve replacement in elderly patients. Peak prosthesis gradient in a year after implantation in group with stentless
biological prostheses was 30 % lower than that in the group with stented prostheses.
Keywords:aortic valve disease, aortic valve replacement, biological prosthesis, heart failure
Clin. Experiment. Surg. Petrovsky J. 2017; 5 (2): 57–65.
DOI: 10.24411/2308-1198-2017-00034
Received: 09.03.2017. Accepted: 19.04.2017.
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