LONG-TERM RESULTS OF AORTIC VALVE REPLACEMENT WITH BIOLOGICAL PROSTHESES IN PATIENTS WITH AORTIC VALVE STENOSIS

Background: This article presents hospital and long-term (1 year after the intervention) results of aortic valve replacement with biological valves of different size in patients with critical aortic valve stenosis. Objective: To evaluate hemodynamic parameters on the implanted biological aortic valve prostheses depending on the size, as well as to study left ventricular (LV) remodeling after surgery for aortic valve stenosis in the early and late periods. Material and methods: The study included 171 patients who were performed isolated or combined with the correction of concomitant pathology (coronary bypass surgery, mitral valve plasty, tricuspid valve plasty) aortic valve replacement with biological prostheses with landing sizes of 19-25 mm. Carprotier-Edwards PERIMOUNT, Carpentier-Edwards PERIMOUNT MAGNA, Medtronic Mosaic, St.Jude Medical Epic and TLPB Labcor bioprostheses were used for prosthetics. Results: The prosthesis-patient mismatch (PPM) phenomenon of a moderate (effective hole area index (iEHA) less than 0.85 cm2/m2) and severe degree (iEHA less than 0.65 cm2/m2) was observed in patients with implanted bioprostheses size 19 and 21. When PPM occurred, the peak and average transprosthetic gradients were lower than on the affected valve prior to surgery. The occurrence of PPM did not lead to complete remodeling of the left ventricle in the long-term period. Conclusions: In patients with implanted biological prostheses size 23 and 25 the prosthesis-patient mismatch phenomenon was not observed in the hospital and long-term period; a reverse left ventricular remodeling was detected in the long-term. The analysis showed that when using biological prostheses of standard sizes 19 and 21 iEHA in most cases was less than 0.85 cm2/m2. In these groups, it can be argued about the presence of a patient-prosthesis mismatch of varying severity.