Comparative assessment of the effectiveness of mechanical and biological heart valve prostheses in reverse remodeling of the left ventricle after aortic valve surgery (propensity score matching analysis and clinical-experimental comparison)

• Evtushenko A.V.
• Rogulina N.V.
• Sizova I.N.
• Klyshnikov K.A.
• Ovcharenko E.A.
• Barbarash L.S.

Abstract

Aim of the study – comparative assessment of left ventricular remodeling after correction of aortic valve (AV) stenosis using biological (BP) and mechanical (MP) heart valve.

Material and methods. In the Scientific Research Institute for Complex Problems of Cardiovascular Diseases (Kemerovo, Russia) from 01/01/2011 to 01/01/2019 surgical correction of the aortic stenosis was performed in 576 patients. 174 observations were selected for the study after they were evaluated for inclusion and exclusion criteria (see below): xenopericardial bioprostheses “UniLine”(“Neocor”, Russia) in 108 cases, bileaflet mechanical valve “Medeng-2” in 66 cases. We used propensity score matching with the nearest neighbor search method (1:1 ratio) to assess selected groups. On the basis of known (sex, age, body surface area) and expected (prosthesis size) cofounders 19 pairs of BP and MP were formed. Hemodinamics test benches of these prostheses were carried out in the Vivitro pulsating flow installation (Vivitro Labs, Canada), simulating the function of the left ventricle, left atrium and aorta, with additional inclusion of peripheral flow resistance model. Test benches were used to explain the obtained clinical results.

Results. Before surgery the specified parameters did not differ in the groups. After the intervention, left ventricular remodeling parameters were positive in both groups. In the BP group, the end-diastolic size of the left ventricle was less, than in MP group (р≤0.050). Left ventricular wall thickness (LVW), myocardial mass and mass index left ventricular myocardium (LV MM, LV IMM) in relation to the preoperative value statistically significant (р≤0.050) decreased during the first month after surgery in both groups, without intergroup differences (р>0.050) throughout the entire period observations. The regression of left ventricular myocardial mass index was more significant in BP “UniLine” recipients and after 2-year observation period its median was 58.8 (-31%) compared with 52.6 g/m² (-28%) in MP “Medeng” recipients, respectively (р=0.047). As a result of test bench, a significantly larger diastolic flow on a mechanical (5.53 ml/cycle) versus biological aortic valve prosthesis (2.26 ml/cycle).

Conclusion. Implantation of “UniLine” biological prosthesis provides more favorable conditions for reverse remodeling of the left ventricular myocardium in comparison with mechanical prosthesis "Medeng-2" implantation during the first two years after surgery for the isolated aortic valve stenosis. 

Keywords:left ventricular remodeling; aortic valve stenosis; biological prosthesis; mechanical prosthesis; left ventricular hypertrophy; myocardial mass; echocardiographic parameters; propensity score matching

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