Long-term results of correction of severe aortic stenosis using cardiac surgical and endovascular methods, as from radiologic control data

Aortic valve (AV) bioprostheses can be divided into framed and frameless, as well as those implanted using surgical and endovascular methods. The study of hemodynamic criteria for the functioning of sutured, seamless and transcatheter biological prostheses, including the dynamics of reverse structural and functional remodeling of the heart in the long term, is necessary to select the most correct and effective treatment tactics.

The aim of the study: to evaluate, using objective radiation methods of research, hemodynamic parameters and the dynamics of reverse structural and functional remodeling of the heart in the late period after correction of degenerative aortic valve defect using cardiac surgery and endovascular methods.

Materials and methods. A comparative, non-randomized, longitudinal study was conducted, including 89 people with severe aortic stenosis, who underwent isolated surgical or endovascular valve replacement. The patients were divided into three groups: a group with AV prosthetics using the method of implantation of a seamless biological prosthesis (n = 23); a group using a sewn-in biological prosthesis (n = 45); a group with a transcatheter aortic valve implantation technique (TAVI) (n = 21). The median age of patients using a sutured biological prosthesis was 71.0 [66.7; 74.0] years, the age of patients with implantation of a seamless biological prosthesis was 73.0 [69.0; 76.8] years (p = 0.055); in the group with a transcatheter technique for implantation of a biological prosthesis, the median age was 75.0 [69.0; 79.0] years (p = 0.013). The female gender was 20 (44.4%), 16 (69.6%), 11 (52.4%) (p = 0.050), respectively. In the dynamics of objective monitoring of the condition and implementation of the study goal, all patients underwent echocardiography (ECHO) according to the generally accepted method.

Results. In three groups, a comparison of structural and functional parameters “before” and “after” the intervention was carried out, and an intergroup comparison was performed between two groups (surgical correction using suture and sutureless bioprostheses), since the initial characteristics of the group with endovascular treatment, in particular, age, differed from the other groups. After correction of aortic stenosis using both cardiac surgery and transcatheter methods, reverse structural and functional remodeling of the heart is observed in the long term. In patients using sutured biological prostheses, LVMM decreased by -22.0 [-28.0; -17.0]% (p = 0.0002), seamless biological prostheses – by -20.0 [-27.0; -13.0]% (p = 0.01), with transcatheter aortic valve implantation – by -16.0 [-22.0; -10.0]% (p = 0.0001); left ventricular (LV) hypertrophy concentricity decreased by -21.0 [-29.0; -14.0]% (p < 0.0001), -24.0 [-31.0; -15.0]% (p = 0.0002), -24.2 [-35.6; -1.1]% (p = 0.002), respectively.

In groups using cardiac surgical methods, an improvement in longitudinal systolic function was demonstrated: absolute values of global systolic longitudinal deformation of the LV, assessed by the speckle-tracking method, increased in patients with implanted biological prostheses by 19.3 [7.5; 54.0]% (p = 0.032), with seamless biological prostheses – by 18.4 [3.3; 42.8]% (p = 0.027), the S’_{lat mv} tissue dopplerography indicator increased – by 36.7 [22.1; 51.3]% (p < 0.0001) and 42.8 [17.5; 57.1]% (p = 0.0005), respectively. In individuals with TAVI, the S’_{lat mv} values increased by 25.0 [14.3; 55.3]% (p = 0.005).

Recovery of left ventricular systolic function in the remote period, established on the basis of the results of 2D speckle tracking echocardiography, was diagnosed in 12 (60.0%) patients with sutured and sutureless biological prostheses.

Conclusion. Correction of severe AS using cardiac surgical and endovascular methods is associated in the long term with favorable indicators of intracardiac hemodynamics and reverse structural and functional remodeling of the LV.

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