CALCIFIED AORTIC STENOSIS IN THE STRUCTURE OF AORTIC VALVE PATHOLOGY

Abstract

Abstract: Relevance. The last decade has been characterized by a steady increase in the incidence of calcified aortic stenosis. For a long time, rheumatic lesion was considered the main cause of aortic valve damage, however, in the course of our study, it was revealed that the incidence of aortic stenosis by etiology has changed significantly over the past ten years. Aim. To evaluate the frequency of occurrence of prosthetic defects of the aortic valve (AV) and their etiology in a cardiac surgery hospital over a 10-year period in order to improve the provision of care to this category of patients and outcomes. Material and methods. A retrospective study of the results of AV prosthetics performed in the cardiosurgical hospital was performed. We studied 849 cases of aortic valve replacement (626 (74%) men, 223 (26%) women). Average age of patients: 51.8±9.7 years. Results. Based on the analysis of the aortic valve prosthetics operations of the cardiac surgical hospital of the Military Medical Academy, the following ratio of causes of aortic stenosis in frequency of occurrence was revealed: calcification of the aortic valve is 70% (95% CI: 63.0 - 74.8%), infectious endocarditis is 17% (95% CI: 11.5 - 21%), rheumatic genesis is 13% (95% CI: 8.2 — 16.4%) and bicuspid aortic valve according to our data is 0 - 2% of all causes of aortic stenosis. The prevalence of calcified aortic stenosis in the structure of aortic valve pathology has led to a revision of the problem of aortic stenosis as a whole. The absence of etiotropic treatment makes it impossible to slow down the progression of the disease and prevent the development of severe stages of stenosis requiring surgical intervention. The presence of such forms as low-current low-gradient aortic stenosis with preserved and/or reduced ejection fraction is characterized by significant difficulties in adequately assessing the severity of aortic stenosis, due to the fact that these forms of stenosis do not fit the criteria of modern classification by severity. At the same time, underestimating the severity of aortic stenosis can lead to incorrect tactics for further management of the patient. Conclusions. Having investigated the frequency of occurrence of various causes of aortic stenosis over the past ten years, a significant increase in the frequency of occurrence of calcified aortic stenosis was revealed. This trend is accompanied by a number of problems directly related to calcified aortic stenosis and uncharacteristic for rheumatic genesis, which for a long time occupied a leading position in the structure of aortic valve pathology.