The reductionofan effective orifice area is associated with the development of the phenomenon of prosthesis-patient mismatch (PPM). The purpose of this study was to evaluate the impact of PPM on the immediate results of surgical treatment in patients with aortic valve stenosis. The study included 50 patients who underwent aortic valve replacement. All patients were divided into 2 groups: with PPM (27 patients) and without it (23 patients). Immediate postoperative results were not statistically different. Analysis of echocardiographic data showed worse results in patients with PPM. It was marked reduction of LV EDV on 23.43 ± 8.93 ml in the group without PPM and on 16.5 ± 1.76 ml in patients with PPM (p<0.05). Also it was noted a greater decrease of pulmonary artery pressure (16.56 ± 12.94 mm Hg) compared with the group with PPM (8.44 ± 7.38 mm Hg), p<0.05. The presence of PPM in patients after aortic valve replacement leads to a slower reverse remodeling of the myocardium.

Surgical treatment of patients with aortic valve disease and concomitant mitral insufficiency remains debatable. We analyzed early postoperative results of surgical treatment of 80 patients depending on type of surgery. All patients were divided into three groups: the 1st - aortic valve replacement in patients without mitral valve dysfunction (control group) (n=44); the 2nd - isolated aortic valve replacement in patients with concomitant mitral regurgitation degree 2-3 (n=18), the 3rd - simultaneous aortic and mitral valve replacement (n=18). Combined valve replacement was associated with more intraoperative blood loss (852.78±442.08 ml) compared with aortic valve replacement (658.7±374.09 ml), p<0.05. In patients with mitral regurgitation greater hematocrit decrease was observed (22.13±3.6% in group 2 and 21.4±4.48 in group 3) in comparison with control group (24.17±3.72% in group 1), p<0.05. Incidence of postoperative complications did not differ in all groups. Mortality rate was 6.8% in group 1 and 11.1% in group 3, there were no deaths in group 2. Both valves correction provided faster myocardial remodeling. Left ventricular end-diastolic volume decreased on 50 ml in group 3, on 33.67 ml in group 2 and on 50.73 ml in group 1 (p<0.05). Pulmonary pressure decreased on 20 mm Hg in group 3, on 13 mm Hg - in group 2 and on 12.57 mm Hg - in group 1, p<0.05. In groups 1 and 3 pulmonary pressure became normal after operation, in group 2 signs of pulmonary hypertension were observed (pressure - 35.3 mm Hg). Analysis of the results showed that simultaneous mitral and aortic valves replacement initiates normalization of intracardiac hemodynamics in early postoperative period.