VASCULAR WALL RIGIDITY IN PATIENTS WITH DEGENERATIVE AORTIC STENOSIS BEFORE AND AFTER AORTIC VALVE SURGICAL PROSTHESIS

Abstract

Introduction. The most common cause of aortic valve surgery is aortic stenosis. So far, the focus has been on evaluating the valve itself, while increasing aortic stiffness increases the load on the left ventricle, contributing to greater impairment of cardiovascular function. Arterial stiffness is a well-established predictor of cardiovascular complications. Objective: To evaluate the dynamics of aortic stiffness in patients with degenerative aortic stenosis against the background of surgical correction of the defect. Material and methods. The study included 33 patients referred for surgical treatment of the defect. Among them, men predominated somewhat (57.6%). All patients were diagnosed with severe aortic stenosis - the area was 0.74 (0.60; 0.90) cm2, the peak and mean pressure gradients on the aortic valve were 85.5 (72.0; 98) mm Hg. Art. and 50.2 (41.0; 56.0) mm Hg. Art. respectively. 22 patients (66.7%) underwent aortic valve replacement with a mechanical prosthesis, the rest of the patients underwent operations combined with coronary artery bypass grafting or prosthetics of the ascending aorta. All patients underwent a study of aortic stiffness indicators, namely: pulse wave velocity in the carotid-radial (CR PWS) and carotid-femoral segments (CF PWS), central systolic pressure in the aorta (CSBP), central diastolic pressure in the aorta (CDAP), aortic central pulse pressure (CPAP), aortic pressure augmentation (AP), augmentation index normalized to heart rate 75 (AIx75). The parameters were measured before the operation and 7-14 days after it. The registration of the pulse wave was carried out by a non-invasive method of applanation tonometry using the SphygmoCor device (AtCor Medical Inc., Australia). Mean values are presented as median and interquartile range. Mean differences in dependent groups were assessed using the Wilcoxon test. Results. CR PWV in the postoperative period decreased and amounted to 7.2 (6.4; 7.5) m/s versus 7.9 (6.6; 9.4) m/s before surgery (p=0.03). There was no significant decrease in PWV CF after aortic valve replacement, however, there was a tendency to decrease (8.1 (6.7; 9.4) m/s before surgery versus 7.4 (6.4; 7.6) m/s). s after surgery, p=0.07). After surgery, CBP decreased and amounted to 103.8 (97; 113) mm Hg. Art. against the original 117.8 (102; 132) mm Hg. Art., (p<0.001). CDAP also decreased and amounted to 69.4 (66; 74) mm Hg. Art. after surgery, while the initial CDBP was 74.8 (70; 81) mm Hg. Art. after surgery (p=0.01). The CPA indicators decreased and amounted to 36 (27; 44) mm Hg after the operation. Art. against the initial value of 43 (31; 53) mm Hg. Art. (p=0.03). There was also a decrease in AIx75 from 31.7 (19.5; 43)% to 17.5 (7; 25)% (p < 0.001) and AR from 16.4 (7; 24.5) mm Hg. Art. up to 10.2 (6; 12) mm Hg Art. (p=0.002). Conclusion. Thus, in patients with degenerative aortic stenosis after its surgical correction, the following indicators of vascular stiffness decrease: carotid-radial pulse wave velocity, central systolic and diastolic pressure in the aorta, index and augmentation pressure. There was no statistically significant dynamics of the carotid-femoral velocity of pulse wave propagation.