No abstract

Background. Despite numerous studies, ambiguity remains at present regarding the impact of prosthesis-patient mismatch (PPM) on long-term outcomes after aortic valve (AV) replacement. Objective. This study evaluates the effect of PPM on long-term results in patients after AV replacement with a biological prosthesis. Material and methods. We retrospectively analyzed the data of 231 patients who underwent AV replacement with a biological prosthesis from 2010 to 2018 at the Penza Federal Center of Cardiovascular Surgery. Patients were implanted with the following biological prostheses: Medtronic Mosaic, Edwards PERIMOUNT, Biocor. Results. Moderate PPM was present in 131 patients (56%), and severe PPM in 1 patient (0.7%). The mean follow-up was 78.832 months. There were no significant differences in hospital mortality in patients with and without PPM, 4 (3%) and 3 (2,9%), respectively, p=0.9. In the long-term period, patients with PPM showed a slower regression of left ventricle (LV) mass and recovery of LV contractile function than patients without PPM, p=0.05. There was no significant difference in survival in the long-term follow-up period between patients with and without PPM long-term survival, 77.7% and 79%, respectively, p=0.6. Also, there were no significant differences in major adverse cardiac events and the freedom from adverse events was 90% and 91%; p=0.7. However, there was a tendency to more frequent hospitalization for chronic heart failure (CHF) exacerbation in the patient group with PPM than in those without PPM, 63.8% and 78%; HR 1.6; 95% CI 0.932.1, p=0.007. There was also a tendency for an increased biological valve structural degeneration in the group with PPM than in the group without PPM 76% and 87%, HR 1.4; 95% CI 1.43.1, p=0.01 According to the Cox regression, the overall postoperative mortality predictors were diabetes mellitus, vascular atherosclerosis HR 5; 95% CI 1.222, p=0.04 and HR 2.9; 95% CI 1.46.6, p=0.01 respectively. Predictors of the risk of hospitalization due to CHF exacerbation were previous myocardial infarction and PPM HR 0.4; 95% CI 0.20.9, p=0.04 and HR 1,5; 95% CI 0.92; p=0.005, respectively PPM HR 2; 95% CI 0.854.1, p=0.01. Conclusion. PPM is a common complication after AV replacement with a biological prosthesis. It is associated with a slower regression of LV mass, an increased risk of structural valve degeneration, and hospitalizations for exacerbated heart failure.

Objective. We aimed to compare the diagnostic capabilities of the ratio of acceleration time to total left ventricular ejection time (AT/ET) in determining the severity of aortic stenosis (AS) in patients with bicuspid and tricuspid aortic valves (AV). Material and methods. We retrospectively analyzed the data of 187 patients with moderate and severe AS who underwent diagnostic examination at the Penza Federal Center for Cardiovascular Surgery. The patients were divided into 2 groups based on whether their AV was tricuspid or bicuspid. Visual assessment of the AV structure was performed using transthoracic echocardiography (TTE). In indeterminate cases, computed tomography was used for the assessment. Results. A comparative analysis of the echocardiographic characteristics of patients with tricuspid and bicuspid AV did not reveal a statistically significant difference between the patient groups (p 0.05). Linear regression analysis in patients with a tricuspid AV demonstrated a statistically significant correlation between AT/ET scores and peak gradient (Gmax) (r=0.68, р=0.03), mean gradient (Gmean) (r=0.78, р=0.01), effective orifice area (EOA) (r=0.7, р=0.03), and doppler velocity index (DVI) scores (r=0.72, р=0.02). In patients with a bicuspid AV, a similarly significant correlation was found between the AT/ET index and Gmax (r=0.67, р=0.02), Gmean (r=0.8, р 0.001), EOA (r=0.72, р=0.04), and DVI (r=0.75, р=0.01). The receiver operating characteristic analysis demonstrated a high predictive ability of AT/ET for severe aortic valve stenosis (with a value 0.35). The area under the curve in patients with tricuspid and bicuspid AV was 84 (p 0.001) and 86 (p 0.001), respectively. For determining severe AV stenosis in patients with a tricuspid AV, the sensitivity and specificity of AT/ET 0.35 was 84% and 75%, respectively; and in patients with a bicuspid AV, it was 87% and 78%, respectively. Conclusion. The AT/ET ratio has comparable diagnostic capabilities in determining severe AS in patients with tricuspid and bicuspid AV structures. The AT/ET 0.35 is a highly sensitive parameter for defining severe AS for both morphologies of AV.

Purpose: comparison of hemodynamic parameters of transaortic blood flow in patients with aortic stenosis depending on the bivalve or tricuspid structure of the aortic valve.Materials and methods. A study of 180 patients with isolated aortic valve stenosis (AC) with two – and threeleaf structure was conducted. Patients were ranked into 3 comparison subgroups by the area of the effective AC opening from 4 to 1.5 cm2; 1.5 to 1 cm2 and less than 1 cm2. An echocardiographic study was performed with the calculation of all the necessary parameters for the study.Results. The comparison subgroups were comparable in terms of effective orifice area (AVA), effective orifice area index (IAVA), body mass index (BMI), LV UO index, and LV FV (p > 0.05). However, the indicators Vmax, Gmean, and AT in patients with a bivalve AK structure in all comparison subgroups were significantly higher than in patients with a tricuspid structure. Comparison subgroup with AVA from 4 to 1.5 cm2: Vmax 2.8 ± 9 m/s and 2.5 ± 6 m/s p = 0.02. Gmean 18.6 ± 7.2 mm Hg and 15 ± 6 mm Hg p = 0.03, AT 82 ± 12 ms and 70 ± 10 ms p = 0.002. Comparison subgroup with AVA from 1.5 to 1 cm2: Vmax 3.7 ± 0.8 m/s and 3.5 ± 0.6 m/s p = 0.02. Average transaortic gradient 37 ± 10 mm Hg and 29 ± 5 mm Hg p = 0.04, AT 103 ± 11 ms and 94 ± 10 ms p = 0.02. Comparison subgroup with an effective area of less than 1 cm2: Vmax 5.7 ± 1.2 m/s and 4.7 ± 0.7 m/s p = 0.001, Gmean 54 ± 15 and 43 ± 11 mm Hg p < 0.001, AT 127 ± 20 ms and 112 ± 10 ms p = 0.002.Conclusion. Echocardiographic indicators of Vmax and Gmean in patients with bivalve AC structure have higher values than in patients with tricuspid AC structure with a comparable opening area.