LONG-TERM RESULTS OF AORTIC VALVE REPLACEMENT

Abstract

Valvular heart disease makes up about 25% of all heart diseases. Of all the valvular heart diseases, aortic valvular disease is reported as more common. According to data from surgical hospitals, isolated aortic stenosis occurs in 44-68% of cases of aortic defects. Among patients with aortic valvular disease of non-rheumatic genesis, mesenchymal dysplasia causes the defect in 20% of cases, and in Europe and the United States, up to 10% of the population suffers from this disease. Aortic defects lead to the occurrence and progression of heart failure, cardiac arrhythmias and, as a consequence, a decrease in the life quality and life expectancy. Heart valve replacement is the most effective method for correcting heart defects that enables to eliminate the substrate of pathological changes, improve intracardiac hemodynamics and the life quality of patients. The evolution of various models of artificial valves creates conditions for the choice of surgical approaches to the treatment of aortic defects and a decrease in postoperative mortality rates in patients in the remote. At the same time, there are no large-scale studies in the scientific space of our country devoted to investigating the long-term consequences of aortic valve replacement by modern valve prostheses. There are questions whether it is appropriate to perform on the Ross operation in adults that entails the necessity of constant reoperations on the pulmonary artery valve and progressive dysfunction of the transplanted pulmonary valve in the high pressure areas of the arterial circle.
 The aim of this study is to investigate the characteristics of aortic valve replacement and the quality of life of the operated patients in long-term period.
 The study group included 634 patients with isolated aortic failure, who were operated on at N.N. Amosov National Institute of Cardiovascular Surgery from January 1, 2005 to January 1, 2007. The average follow-up period was 11.3 ± 0.9 years. The main indicators studied for the 15-year period were as follows: survival rate, stability of good and satisfactory results, incidence of thromboembolic complications, and reoperations.
 The study has demonstrated the following results for 15 year period: survival rate is 57.4%, stability of good results is 35.3%, incidence rate of thromboembolic events is 79.7%, and reoperations were required in 95.4% of all cases. The maze procedure was performed on in 21 (6,9%) patients. Concomitant CABG was observed in 93 (5.0%) patients. Reoperations were performed in cases of risks for thrombosis (panus, paraprost. fistula) of aortic prostheses (n=5), endocardytis (n=3); A-V blockade (pacemaker) was performed in 11 (1.6%) patients
 Best results of aortic valve replacement were observed in remote period in patients with II-III NYHA class with presence of sinus rhythm. The patients, who are at high risk of cardiovascular events, must be under close followed-up. The level of thromboembolic complications did not differ in terms of the type of implanted prosthesis. Labyrinth surgery should be performed on to restore sinus rhythm, as well as to reduce the progress of heart failure and prevent thromboembolic complications.
 Aortic valve replacement with the maze operation enables to renew sinus rhythm at the hospital stage quite successfully.