CHANGES IN THE PORTRAIT OF PATIENTS WITH ACQUIRED MITRAL AND AORTIC VALVE DISEASE BEFORE IMPLANTATION OF BIOPROSTHETIC HEART VALVES

Highlights

Acquired valvular heart disease (AVHD) is a widespread pathology that remains one of the leading causes of cardiac mortality and disability in the population. The article presents an analysis of the changes in the “portrait” of patients undergoing surgical treatment of AVHD.

Aim. To assess changes from baseline characteristics of patients with acquired mitral valve disease before the implantation of a bioprosthetic heart valve.

Methods. The study included 600 patients admitted in 2000–2020 and undergoing surgical treatment of AVHD using bioprosthesis produced domestically at the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo). The patients` portrait was assessed retrospectively, comorbidities, type and etiology of AVHD in 2000–2010 and 2011–2020 were evaluated. 

Results. The main changes in the “portrait” of patients with AVHD over the past decade are as follows: “aging” of recipients of bioprosthetic heart valves (median age went up from 52 [46; 58] to 68 [64; 71] years (p < 0.001)), an increase in the number of people with ischemic mitral insufficiency by 7.4 times, concomitant coronary artery disease by 4.4 times, and cerebral atherosclerosis by 3.7 times (p < 0.001).

Conclusions. The results of the analysis highlight the changes in the “portrait” of patients undergoing surgical treatment of AVHD. Taking into account all of the above-mentioned, it is necessary to develop patient-oriented approaches to management of patients undergoing surgical treatment of acquired valvular heart disease.

1. Coffey S., Roberts-Thomson R., Brown A., Carapetis J., Chen M., Enriquez-Sarano M., Zühlke L., Prendergast B.D. Global epidemiology of valvular heart disease. Nat Rev Cardiol. 2021; 18(12): 853-864. doi:10.1038/s41569-021-00570-z.

2. Peters A.S., Duggan J.P., Trachiotis G.D., Antevil J.L. Epidemiology of Valvular Heart Disease. Surg Clin North Am. 2022; 102 (3): 517-528. doi:10.1016/j.suc.2022.01.008.

3. Yadgir S., Johnson C.O., Aboyans V., Adebayo O.M., Adedoyin R.A., Afarideh M., Alahdab F., Alashi A., Alipour V, Arabloo J. et al. Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990-2017. Circulation. 2020; 141 (21): 1670-1680. doi: 10.1161/CIRCULATIONAHA.119.043391.

4. Nkomo V.T., Gardin J.M., Skelton T.N., Gottdiener J.S., Scott C.G., Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006; 368: 1005–11. doi:10.1016/S0140-6736(06)69208-8.

5. Virani S.S., Alonso A., Aparicio H.J., Benjamin E.J., Bittencourt M.S., Callaway C.W., Carson A.P., Chamberlain A.M., Cheng S., Delling F.N. et al. Heart disease and stroke Statistics-2021 update: a report from the American heart association. Circulation. 2021; 143: e254–743. doi:10.1161/CIR.0000000000000950.

6. Grigioni F., Enriquez-Sarano M., Ling L.H., Bailey K.R., Seward J.B., Tajik A.J., Frye R.L. Sudden death in mitral regurgitation due to flail leaflet. J Am Coll Cardiol. 1999; 34 (7): 2078-85. doi:10.1016/s0735-1097(99)00474-x.

7. Freed L.A., Levy D., Levine R.A., Larson M.G., Evans J.C., Fuller D.L., Lehman B., Benjamin E.J. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med. 1999; 341: 1–7. doi:10.1056/NEJM199907013410101.

8. Singh J.P., Evans J.C., Levy D., Larson M.G., Freed L.A., Fuller D.L., Lehman B., Benjamin E.J. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham heart study). Am J Cardiol. 1999; 83: 897–902. doi:10.1016/S0002-9149(98)01064-9.

9. Nazarzadeh M., Pinho-Gomes A-C., Smith Byrne K., Canoy D., Raimondi F., Ayala Solares J.R., Otto C.M., Rahimi K. Systolic blood pressure and risk of valvular heart disease: a Mendelian randomization study. JAMA Cardiol. 2019; 4: 788. doi:10.1001/jamacardio.2019.2202.

10. Tung M., Nah G., Tang J., Marcus G., Delling F.N. Valvular disease burden in the modern era of percutaneous and surgical interventions: the UK Biobank. Open Heart. 2022; 9 (2): e002039. doi:10.1136/openhrt-2022-002039