Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2015 Vol. 23 No 1

GENERAL AND SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2015.1.44   |  

V.V. PODPALOV

THE LONG-TERM RESULTS OF SURGICAL REPAIR OF AORTIC STENOSIS

SE "Republican Scientific and Practical Centre "Cardiology", Minsk
The Republic of Belarus

Objectives. To analyze the survival rate after surgery in patients with severe aortic stenosis (AS) complicated by atrioventricular valves insufficiency and to evaluate importance of echocardiographic parameters for estimating the prognosis of 5-year mortality in the ginen patients category.
Methods. A prospective study has been conducted. Out of all patients treated at the Center in 2005-2007 yrs., 198 patients with severe stenosis of the aortic valve and relative insufficiency of the mitral and tricuspid valves have been included in the study. The patients were divided into 2 groups: the 1st group 46 patients not operated for different reasons; the 2nd group 152 patients who had undergone aortic valve replacement (AVR) combined with the atrioventricular valves plasty. Follow-up period made up 5 years.
Results. The average age of 198 patients was 59,16 years, proportion of men 67%. Hospital mortality of operated patients was 0,7%. Within 5 years 35 patients (76,1%) died in the 1st group and 28 persons (18.4%) in the 2nd group, that was significantly lower after adjusting for age and sex (p=0,0001). Considering age, sex and effect of surgery the statistically significant correlation was detected between the increasing of 5-year mortality and the following echocardiographic parameters changes by: the increasing of maximal (p=0,0008) and average (p=0,0011) gradients; left atrium diameter (p=0,0023); end-diastolic (p=0,0355), end-systolic (p=0,0021) of left ventricular (LV) diameters; end-diastolic (p=0,0001), end-systolic (p=0,0001) LV volumes; LV myocardial mass (p=0,0001); pulmonary artery systolic pressure (p=0,0001); right ventricle diameter (p=0,0001); reduction of LV ejection fraction (p=0,0076).
Conclusion. Aortic valve replacement (AVR) in combination with the atrioventricular valves plasty reliably improves the survival rate in the late postoperative period in patients with severe AS complicated by atrioventricular valves insufficiency. Presented echocardiographic parameters statistically significantly affect the risk of 5-year mortality in these patients.

Keywords: aortic stenosis, aortic valve replacement, mitral regurgitation, mitral valve plasty, long-term results
p. 44-50 of the original issue
References
  1. Osnabrugge RL, Mylotte D, Head SJ, Van Mieghem NM, Nkomo VT, LeReun CM, Bogers AJ, Piazza N, Kappetein AP. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol. 2013 Sep 10;62(11):1002-12
  2. Thaden JJ, Nkomo VT, Enriquez-Sarano M. The Global Burden of Aortic Stenosis. Prog Cardiovasc Dis. 2014 May-Jun;56(6):565-71.
  3. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Burden of valvular heart diseases: a population-based study. Lancet. 2006 Sep 16;368(9540):1005-11.
  4. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003 Jul;24(13):1231-43.
  5. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, et al. Heart disease and stroke statistics2013 update: a report from the American Heart Association. Circulation. 2013;(1):e6-e245.
  6. Sliwa K, Carrington M, Mayosi BM, Zigiriadis E, Mvungi R, Stewart S. Incidence and characteristics of newly diagnosed rheumatic heart disease in urban African adults: insights from the heart of Soweto study. Eur Heart J. 2010 Mar;31(6):719-27.
  7. Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM.Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997 Mar 1;29(3):630-34.
  8. Bech-Hanssen O, Caidahl K, Wall B, Mykén P, Larsson S, Wallentin I. Influence of aortic valve replacement, prosthesis type, and size on functional outcome and ventricular mass in patients with aortic stenosis. J Thorac Cardiovasc Surg. 1999 Jul;118(1):57-65.
  9. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012;(4):S1-S44.
  10. Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for themanagement of patients with valvular heart disease: a repor of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2008;(13):e1-e142.
  11. Tribouilloy C, Lévy F, Rusinaru D, Guéret P, Petit-Eisenmann H, et al. Outcome after aortic valve replacement for low-flow/low-gradient aortic stenosis without contractile reserve on dobutamine stress echocardiography. J Am Coll Cardiol. 2009 May 19;53(20):1865-73.
  12. Quere JP, Monin JL, Levy F, Petit H, Baleynaud S. Influence of preoperative left ventricular contractile reserve on postoperative ejection fraction in low-gradient aortic stenosis. Circulation. 2006 Apr 11;113(14):1738-44.
Address for correspondence:
220036, Respublika Belarus, g. Minsk,
ul. R. Lyuksemburg, d. 110,
GU "Respublikanskiy nauchno-prakticheskiy
tsentr "Kardiologiya",
3-e kardiohirurgicheskoe otdelenie,
tel. office: +375 17 208-67-35,
e-mail: v.podpalov@gmail.com,
Podpalov Vladislav Vladislavovich
Information about the authors:
Podpalov V.V. An junior researcher of SE "Republican Scientific and Practical Centre "Cardiology", Minsk.
Contacts | ©Vitebsk State Medical University, 2007