Website is intended for physicians
Search:

 

Abstract:

Introduction: incidence of aortic valve stenosis is 3rd in the group of cardio-vascular diseases. Most important questions of aortic valve replacement (AVR) are: prosthesis effective orifice area (EOA) sufficiency for certain patient and need of posterior aortoplasty (PA). Each prosthesis of certain number has technical data and size. Reasonable frequency of posterior aortoplasty is a discussed question.

Aim: was to analyze echocardiographic data in two groups: isolated AVR and AVR + PA in order to study the reasonable frequency of posterior aortoplasty application while using stented bioprosthesis NeoCor-21 «UniLine».

Materials and methods: 99 patients with bioprosthesis NeoCor-21 «UniLine» implantation were enrolled in study for investigation of problem of aortoplasty need. According to application/absence of posterior aortoplasty patients were divided in two groups. In postoperative period groups were compared in echocardiographic data calculations: left ventricle end-diastolic volume (LV EDV), ejection fraction (LV EF), stroke volume (LV SV), peak and mean valve gradients. Indexes were calculated and compared: stroke volume index (SVI) and prosthesis effective orifice area index (EOAI).

Results: the group of AVR + PA consisted of 14 (14,14%) patients. Immediate postoperative echocardiographic calculations revealed no statistic difference between two groups: in left ventricle end diastolic volume (LV EDV), ejection fraction (LV EF), stroke volume (LV SV), peak and mean valve gradients, stroke volume index (SVI) and valve effective orifice area index (EOAI). Group without posterior aortoplasty had slightly higher end diastolic volume (LV EDV), stroke volume (LV SV), peak and mean valve gradients. Opposite patients with posterior aortoplasty had slightly higher ejection fraction (LV EF), stroke volume index (SVI), slightly less peak and mean valve gradients. Left ventricle function was more optimal in the posterior aortoplasty group.

Conclusion: in our practice, incidence of posterior aortoplasty in using stented bioprosthesis NeoCor-21 «UniLine» was 14,14%. Echocardiographic calculations of postoperative data demonstrated that this frequency was reasonable. Probably posterior aortoplasty is to be applied more frequently.

Conflict of interest: the authors declare no conflict of interest.

 

References

1.     Bokeriya LA, Belaya G. Methods of echocardiographic assessment of aortic valve hemodynamics after prosthetics: methods and precautions. Kreativnaya kardiologiya-Creative cardiology. 2012; 6(1): 73-79 [In Russ].

2.     Iqbal A, Panicker VT, Karunakaran J. Patient prosthesis mismatch and its impact on left ventricular regression following aortic valve replacement in aortic stenosis patients. Indian J Thorac Cardiovasc Surg. 2019; 35: 6-14.

https://doi.org/10.1007/s12055-018-0706-3

3.     Malhotra A. Prosthesis patient mismatch: myth or reality? Indian J Thorac Cardiovasc Surg. 2019; 35: 3-5.

https://doi.org/10.1007/s12055-018-0708-1

4.     Rashimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation. 1978; 58: 20-24.

5.    Sazonenkov MA, Ismatov KhH, Prisyazhnyuk EI, et al. Comparison of the manufacturers technical specification with postoperative results in four types of stented bioprostheses in the aortic position. Actualnye problemy mediciny. 2020; 43(1): 113-123 [In Russ].

6.     Klyshnikov KYu, Ovcharenko EA, Shcheglova NA, Barbarash L.S. Functional characteristics of Uniline bioprostheses. Kompleksnye problemy serdechno-sosudistykh zabolevaniy. 2017; 3: 6-12 [In Russ].

https://doi.org/10.17802/2306-1278-2017-6-3-6-12

7.     Manufacturers information. ZAO «NeoCor» 1978-2020 [In Russ].

https://neocor.ru/aortalnyyklapan-3

8.     Nicks R, Cartmill T, Bernstein L. Hypoplasia of the aortic root. The problem of aortic valve replacement. Thorax. 1970; 25(3): 339-346.

9.     Rittenhouse EA, Sauvage LR, Stamm SJ, et al. Radical enlargement of the aortic root and outflow tract to allow valve replacement. Ann Thorac Surg. 1979; 27(4): 367-73.

10.   Clinical guidelines: Aortic stenosis. Association of Cardiovascular Surgeons of Russia. Moscow 2020 [In Russ].

11.   Manouguian S, Seybold-Epting W. Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique. J Thorac Cardiovasc Surg. 1979; 78(3): 402-412.

12.   Belov YuV, Charchyan ER, Katkov AI, et al. Influence of the discrepancy between the diameter of the prosthesis and the patient's body surface area on the long-term results of aortic valve replacement. Kardiologiya i serdechno-sosudistaya khirurgiya. 2016; 9 (2): 46-51 [In Russ].

https://doi.org/10.17116/kardio20169246-51

13.   Pibarot P, Magne J, Leipsic J, et al. Imaging for Predicting and Assessing Prosthesis-Patient Mismatch After Aortic Valve Replacement. JACC Cardiovasc Imaging. 2019; 12(1): 149-162.

https://doi.org/10.1016/j.jcmg.2018.10.020

14.   Tam DY, Dharma C, Rocha RV, et al. Early and late outcomes of aortic root enlargement: a multicenter propensity score-matched cohort analysis. J Thorac Cardiovasc Surg. 2020; 160: 908-19.

https://doi.org/10.1016/j.jtcvs.2019.09.062

15.   Concistr? G, Dell'aquila A, Pansini S, et al. Aortic valve replacement with smaller prostheses in elderly patients: does patient prosthetic mismatch affect outcomes? J Card Surg. 2013; 28(4): 341-7.

16.   Dumani S, Likaj E, Dibra L, et al. Aortic Annular Enlargement during Aortic Valve Replacement. Open Access Maced J Med Sci. 2016; 15; 4(3): 455-457.

https://doi.org/10.3889/oamjms.2016.098

17.   S? MP, Zhigalov K, Cavalcanti LRP, et al. Impact of aortic annulus enlargement on the outcomes of aortic valve replacement: a meta-analysis. Semin Thorac Cardiovasc Surg. 2021; 33(2): 316-325.

18.   Yu W, Tam DY, Rocha RV, et al. Aortic Root Enlargement Is Safe and Reduces the Incidence of Patient-Prosthesis Mismatch: A Meta-analysis of Early and Late Outcomes. Can J Cardiol. 2019; 35(6): 782-790.

ANGIOLOGIA.ru (АНГИОЛОГИЯ.ру) - портал о диагностике и лечении заболеваний сосудистой системы