DYNAMICS OF SURGICAL INTERVENTIONS IN VALVULAR HEART DESEASES IN THE RUSSIAN FEDERATION (in the period 2004 – 2023)

Highlights

Heart valve surgery is the most effective treatment modality for acquired heart diseases (AHD), which, despite the advancements in diagnosis and treatment, still pose a serious global health challenge.

Aim. To assess the changes in the volume and availability of surgeries for acquired heart diseases in the Russian Federation (in the period 2004–2023), and compare the results with global trends in the development of open and interventional surgery.

Methods. The analysis involved the data published in the annual reports of Russian clinics reflecting the state of the cardiovascular diseases and cardiovascular surgery in the Russian Federation (in the period 2004–2023). Statistical processing of the data was carried out using Microsoft Office Excel. Excel's quartile function was used to group data into periods.

Results. Over a 20-year period, the Russian Federation saw a more than twofold increase in the total number of heart valve surgeries (from 6,542 to 13,514). The availability of surgeries for AHD doubled (from 45.33 to 91.51 per 1 million population). The volume of repairs increased 2.7 times (from 1,526 to 4,107). The proportion of transcatheter valve replacements increased by 38.9 times (from 0.42% to 16.34%) compared to open surgery. The proportion of replacements using bioprostheses increased from 6.0% to 20.5%.

Conclusion. The Russian Federation has made significant progress in the treatment of acquired heart diseases over the past two decades. Valve replacement has become the predominant type of surgery, overtaking valve repairs, whereas the number of transcatheter valve replacements and replacements using bioprostheses has increased significantly. Further development in the field of cardiac surgery in the Russian Federation should be aimed at amplifying these trends, ensuring equal access to high-tech medical care in all regions, as well as the introduction of quality audit systems and evaluation of long-term outcomes.

1. Wang K, Geng B, Shen Q, Wang Y, Shi J, Dong N. Global, regional, and national incidence, mortality, and disability-adjusted life years of non-rheumatic valvular heart disease and trend analysis from 1990 to 2019: Results from the Global Burden of Disease study 2019. Asian Cardiovasc Thorac Ann. 2023 Oct;31(8):706-722. doi: 10.1177/02184923231200695. Epub 2023 Sep 7. PMID: 37674443.

2. Aluru JS, Barsouk A, Saginala K, Rawla P, Barsouk A. Valvular Heart Disease Epidemiology. Med Sci (Basel). 2022 Jun 15;10(2):32. doi: 10.3390/medsci10020032. PMID: 35736352; PMCID: PMC9228968.

3. Zhang S, Liu C, Wu P, Li H, Zhang Y, Feng K, Huang H, Zhang J, Lai Y, Pei J, Lu Z, Zhan J. Burden and Temporal Trends of Valvular Heart Disease-Related Heart Failure From 1990 to 2019 and Projection Up to 2030 in Group of 20 Countries: An Analysis for the Global Burden of Disease Study 2019. J Am Heart Assoc. 2024 Oct 15;13(20):e036462. doi: 10.1161/JAHA.124.036462. Epub 2024 Oct 11. PMID: 39392160; PMCID: PMC11935581.

4. Chambers JB, Prendergast B, Iung B, Rosenhek R, Zamorano JL, Piérard LA, Modine T, Falk V, Kappetein AP, Pibarot P, Sundt T, Baumgartner H, Bax JJ, Lancellotti P. Standards defining a 'Heart Valve Centre': ESC Working Group on Valvular Heart Disease and European Association for Cardiothoracic Surgery Viewpoint. Eur Heart J. 2017 Jul 21;38(28):2177-2183. doi: 10.1093/eurheartj/ehx370. PMID: 28838053.

5. Bartko PE, Heitzinger G, Pavo N, Heitzinger M, Spinka G, Prausmüller S, Arfsten H, Andreas M, Gabler C, Strunk G, Mascherbauer J, Hengstenberg C, Hülsmann M, Goliasch G. Burden, treatment use, and outcome of secondary mitral regurgitation across the spectrum of heart failure: observational cohort study. BMJ. 2021 Jun 30;373:n1421. doi: 10.1136/bmj.n1421. PMID: 34193442; PMCID: PMC8243241.

6. Praz F, Borger MA, Lanz J, Marin-Cuartas M, Abreu A, Adamo M, Ajmone Marsan N, Barili F, Bonaros N, Cosyns B, De Paulis R, Gamra H, Jahangiri M, Jeppsson A, Klautz RJM, Mores B, Pérez-David E, Pöss J, Prendergast BD, Rocca B, Rossello X, Suzuki M, Thiele H, Tribouilloy CM, Wojakowski W; ESC/EACTS Scientific Document Group. 2025 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2025 Nov 21;46(44):4635-4736. doi: 10.1093/eurheartj/ehaf194. PMID: 40878295.

7. Barbarash OL, Lyapina IN. Current trends in organizing the care for patients with acquired heart valve disease. Russian Cardiology Bulletin. 2024; 19 (4-1):5–12. (In Russ.). doi: 10.17116/Cardiobulletin2024190415

8. Iung B, Delgado V, Rosenhek R, Price S, Prendergast B, Wendler O, De Bonis M, Tribouilloy C, Evangelista A, Bogachev-Prokophiev A, Apor A, Ince H, Laroche C, Popescu BA, Piérard L, Haude M, Hindricks G, Ruschitzka F, Windecker S, Bax JJ, Maggioni A, Vahanian A; EORP VHD II Investigators. Contemporary Presentation and Management of Valvular Heart Disease: The EURObservational Research Programme Valvular Heart Disease II Survey. Circulation. 2019 Oct;140(14):1156-1169. doi: 10.1161/CIRCULATIONAHA.119.041080. Epub 2019 Sep 12. PMID: 31510787.

9. Brennan JM, Lowenstern A, Sheridan P, Boero IJ, Thourani VH, Vemulapalli S, Wang TY, Liska O, Gander S, Jager J, Leon MB, Peterson ED. Association Between Patient Survival and Clinician Variability in Treatment Rates for Aortic Valve Stenosis. J Am Heart Assoc. 2021 Aug 17; 10 (16):e020490. doi: 10.1161/JAHA.120.020490. Epub 2021 Aug 13. PMID: 34387116; PMCID: PMC8475044.

10. Izumi C, Matsuyama R, Asaoka M, Iwasaki K, Takeshima T, Murphy S, Teng L, Igarashi A. Valvular heart disease in Japan: Characteristics and treatment of patients in acute care hospitals in 2019. J Cardiol. 2023 Jul;82(1):29-34. doi: 10.1016/j.jjcc.2023.03.007. Epub 2023 Mar 22. PMID: 36963659.

11. Bockeria L.A., Gudkova R.G. Cardiovascular Surgery – 2004. Diseases and congenital anomalies of the circulatory system. Moscow; 2005. p. 117 (in Russ.).

12. Bockeria L.A., Gudkova R.G. Cardiovascular Surgery – 2005. Diseases and congenital anomalies of the circulatory system. Moscow; 2006. p. 114 (in Russ.).

13. Bockeria L.A., Gudkova R.G. Cardiovascular Surgery – 2006. Diseases and congenital anomalies of the circulatory system. Moscow; 2007. – p. 118 (in Russ.).

14. Bockeria L.A., Gudkova R.G. Cardiovascular Surgery – 2007. Diseases and congenital anomalies of the circulatory system. Moscow; 2008. — p. 144 (in Russ.).

15. Bockeria L.A., Gudkova R.G. Cardiovascular Surgery – 2008. Diseases and congenital anomalies of the circulatory system. Moscow; 2009. — p. 162 (in Russ.).

16. Bockeria L.A., Gudkova R.G. Cardiovascular Surgery – 2009. Diseases and congenital anomalies of the circulatory system. Moscow; 2010. — p. 180 (in Russ.).

17. Bockeria L.A., Gudkova R.G. Cardiovascular Surgery – 2010. Diseases and congenital anomalies of the circulatory system. Moscow; 2011. — p. 192 (in Russ.).

18. Bockeria L.A., Gudkova R.G. Cardiovascular Surgery – 2011. Diseases and congenital anomalies of the circulatory system. Moscow; 2012. – p. 196 (in Russ.).

19. Bockeria L.A., Gudkova R.G. Cardiovascular Surgery – 2012. Diseases and congenital anomalies of the circulatory system. Moscow; 2013. – p. 208 (in Russ.).

20. Bockeria L.A., Gudkova R.G. Cardiovascular Surgery – 2013. Diseases and congenital anomalies of the circulatory system. Moscow; 2014. — p. 220 (in Russ.).

21. Bockeria L.A., Gudkova R.G. Cardiovascular Surgery – 2014. Diseases and congenital anomalies of the circulatory system. Moscow; 2015. — p. 226 (in Russ.).

22. Bockeria L.A., Gudkova R.G. Cardiovascular Surgery – 2015. Diseases and congenital anomalies of the circulatory system. Moscow; 2016. — p. 208 (in Russ.).

23. Bockeria L.A., Gudkova R.G., Milievskaya E.B., Kudzoeva Z.F., Pryanishnikov V.V. Cardiovascular Surgery – 2016. Diseases and congenital anomalies of the circulatory system. Moscow; 2017. — p. 228 (in Russ.)

24. Bockeria L.A., Milievskaya E.B., Kudzoeva Z.F., Pryanishnikov V.V. Cardiovascular Surgery – 2017. Diseases and congenital anomalies of the circulatory system. Moscow; 2018. — p. 252 (in Russ.).

25. Bockeria L.A., Milievskaya E.B., Kudzoeva Z.F., Pryanishnikov V.V., Skopin A.I., Yurlov I.A. Cardiovascular Surgery – 2018. Diseases and congenital anomalies of the circulatory system. Moscow; 2019. — p. 270 (in Russ.).

26. Bockeria L.A. (ed.). Cardiovascular Surgery – 2019. Moscow; 2020. — p. 294 (in Russ.).

27. Bockeria L.A., Milievskaya E.B., Pryanishnikov V.V., Yurlov I.A. Cardiovascular Surgery – 2020. Diseases and congenital anomalies of the circulatory system. Moscow; 2021. — p. 294 (in Russ.).

28. Bockeria L.A., Milievskaya E.B., Pryanishnikov V.V., Yurlov I.A., Kudzoeva Z.F. Cardiovascular Surgery – 2021. Diseases and congenital anomalies of the circulatory system. Moscow; 2022. — p. 294 (in Russ.).

29. Bockeria L.A., Milievskaya E.B., Pryanishnikov V.V., Yurlov I.A. Cardiovascular Surgery – 2022. Diseases and congenital anomalies of the circulatory system. Moscow; 2023. — p. 344 (in Russ.).

30. Bockeria L.A., Milievskaya E.B., Pryanishnikov V.V., Yurlov I.A. Cardiovascular Surgery – 2023. Diseases and congenital anomalies of the circulatory system. Moscow; 2024. — p. 368 (in Russ.).

31. Coffey S, Roberts-Thomson R, Brown A, Carapetis J, Chen M, Enriquez-Sarano M, Zühlke L, Prendergast BD. Global epidemiology of valvular heart disease. Nat Rev Cardiol. 2021 Dec;18(12):853-864. doi: 10.1038/s41569-021-00570-z. Epub 2021 Jun 25. PMID: 34172950.

32. Shah SMI, Bin Zafar MD, Yasmin F, Ghazi EM, Jatoi HN, Jawed A, Nadeem A, Khan Z, Anas Z, Siddiqui SA. Exploring the impact of the COVID-19 pandemic on cardiac surgical services: A scoping review. J Card Surg. 2021 Sep;36(9):3354-3363. doi: 10.1111/jocs.15746. Epub 2021 Jun 16. PMID: 34137067; PMCID: PMC8447444.

33. Bonalumi G, di Mauro M, Garatti A, Barili F, Gerosa G, Parolari A; Italian Society for Cardiac Surgery Task Force on COVID-19 Pandemic. The COVID-19 outbreak and its impact on hospitals in Italy: the model of cardiac surgery. Eur J Cardiothorac Surg. 2020 Jun 1;57(6):1025-1028. doi: 10.1093/ejcts/ezaa151. PMID: 32301984; PMCID: PMC7184374.

34. COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg. 2020 Oct;107(11):1440-1449. doi: 10.1002/bjs.11746. Epub 2020 Jun 13. PMID: 32395848; PMCID: PMC7272903.

35. Kuzmina O.K., Stasev A.N., Dvadtsatov I.V., Blinova A.V., Osintsev E.S., Evtushenko A.V., Barbarash O.L., Barbarash L.S. Comparative analysis of mitral valve repair and replacement using biological prosthesis in elderly patients (PSM method). Complex Issues of Cardiovascular Diseases. 2024;13(2): 50-59. doi: 10.17802/2306-1278-2024-13-2-50-59

36. Dvadtsatov I.V., Evtushenko A.V., Kuzmina O.K., Barbarash L.S. Comparative analysis of mid-term outcomes of Rigid and NeoRing support rings in mitral regurgitation surgery: a prospective randomized trial. Complex Issues of Cardiovascular Diseases. 2022;11(4): 62-71. doi: 10.17802/2306-1278-2022-11-4-62-71

37. Thyregod HGH, Jørgensen TH, Ihlemann N, Steinbrüchel DA, Nissen H, Kjeldsen BJ, Petursson P, De Backer O, Olsen PS, Søndergaard L. Transcatheter or surgical aortic valve implantation: 10-year outcomes of the NOTION trial. Eur Heart J. 2024 Apr 1;45(13):1116-1124. doi: 10.1093/eurheartj/ehae043. PMID: 38321820; PMCID: PMC10984572.

38. Lodo V, Italiano EG, Weltert L, Zingarelli E, Pietropaolo C, Buono G, Centofanti P. Transcatheter aortic valve implantation versus surgery in low-risk patients: in-hospital and mid-term outcomes. Interdiscip Cardiovasc Thorac Surg. 2025 May 6;40(5):ivaf103. doi: 10.1093/icvts/ivaf103. PMID: 40293726; PMCID: PMC12085224.

39. Ganyukov V.I., Tarasov R.S., Kolesnikov A.Yu., Ganyukov I.V. Transcatheter aortic valve replacement: from idea to implementation. Complex Issues of Cardiovascular Diseases. 2024;13(1): 152-164. doi: 10.17802/2306-1278-2024-13-1-152-164

40. Goldstone AB, Chiu P, Baiocchi M, Lingala B, Patrick WL, Fischbein MP, Woo YJ. Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement. N Engl J Med. 2017 Nov 9;377(19):1847-1857. doi: 10.1056/NEJMoa1613792. PMID: 29117490; PMCID: PMC9856242.

41. Gammie JS, Sheng S, Griffith BP, Peterson ED, Rankin JS, O'Brien SM, Brown JM. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg. 2009 May;87(5):1431-7; discussion 1437-9. doi: 10.1016/j.athoracsur.2009.01.064. PMID: 19379881.

42. Kuzmina O.K., Stasev A.N., Tsenter I.M., Evtushenko A.V., Barbarash O.L., Barbarash L.S. Changes in the portrait of patients with acquired mitral and aortic valve disease before implantation of bioprosthetic heart valves. Complex Issues of Cardiovascular Diseases. 2024;13(4): 6-12. doi: 10.17802/2306-1278-2024-13-4-6-12

43. Bowdish ME, Mehaffey JH, Chang SC, O'Gara PT, Mack MJ, Goldstone AB, Chikwe J, Gillinov AM, Wu C, Fontana GP, Bavaria JE, Malaisrie CS, Kaneko T, Sultan IS, Wyler von Ballmoos MC, Harrington KB, Jacobs JP, Thourani VH, Szeto WY, Sabik JF, Habib RH, Badhwar V. Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients 40 to 75 Years of Age. J Am Coll Cardiol. 2025 Apr 1;85(12):1289-1298. doi: 10.1016/j.jacc.2025.01.013. Epub 2025 Jan 25. PMID: 40139884.

44. Bockeria L.A., Milievskaya E.B., Stupakov I.N., Golubev N.A., Pryanishnikov V.V. Surgical treatment of acquired heart defects in Russian Federation (1996–2020). Russian Journal of Thoracic and Cardiovascular Surgery. 2021; 63 (6): 485–503 (in Russ.). doi: 10.24022/0236-2791- 2021-63-6-485-50349

45. https://www-genesis.destatis.de/datenbank/online/table/23141-0101/table-toolbar (date of request: 05.12.2025)

46. https://nationsgeo.com/population/europe/de/(date of request: 05.12.2025)

47. Carroll JD, Mack MJ, Vemulapalli S, Herrmann HC, Gleason TG, Hanzel G, Deeb GM, Thourani VH, Cohen DJ, Desai N, Kirtane AJ, Fitzgerald S, Michaels J, Krohn C, Masoudi FA, Brindis RG, Bavaria JE. STS-ACC TVT Registry of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2020 Nov 24;76(21):2492-2516. doi: 10.1016/j.jacc.2020.09.595. PMID: 33213729.

48. Beckmann A, Meyer R, Eberhardt J, Gummert J, Falk V. German Heart Surgery Report 2023: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg. 2024 Aug;72(5):329-345. doi: 10.1055/s-0044-1787853. Epub 2024 Jul 30. PMID: 39079552.

49. Goldstone AB, Chiu P, Baiocchi M, et al. Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement. N Engl J Med. 2017;377(19):1847-1857. doi: 10.1056/NEJMoa1613792

50. Bowdish ME, Mehaffey JH, Chang SC, et al. Bioprosthetic vs Mechanical Aortic Valve Replacement in Patients 40 to 75 Years of Age. J Am Coll Cardiol. 2025;85(12):1289-1298. doi: 10.1016/j.jacc.2025.01.013

51. Björn R, Lehto J, Malmberg M, Anttila V, Airaksinen KEJ, Gunn J, Kiviniemi T. An-tithrombotic Medication and Major Complications After Mechanical Aortic Valve Replacement. Am J Cardiol. 2023 Oct 1;204:185-194. doi: 10.1016/j.amjcard.2023.07.097. Epub 2023 Aug 4. PMID: 37544143.

52. Bavaria JE, Griffith B, Heimansohn DA, Rozanski J, Johnston DR, Bartus K, Girardi LN, Beaver T, Takayama H, Mumtaz MA, Rosengart TK, Starnes V, Timek TA, Boateng P, Ryan W, Cornwell LD, Blackstone EH, Borger MA, Pibarot P, Thourani VH, Svensson LG, Puskas JD; COMMENCE Trial Investigators. Five-year Outcomes of the COMMENCE Trial In-vestigating Aortic Valve Replacement With RESILIA Tissue. Ann Thorac Surg. 2023 Jun;115(6):1429-1436. doi: 10.1016/j.athoracsur.2021.12.058. Epub 2022 Jan 20. PMID: 35065065.

53. Kudryavtseva Yu.A., Ovcharenko E.A., Klyshnikov K.Yu., Antonova L.V., Senokosova E.A., Ponasenko A.V., Barbarash O.L., Barbarash L.S. Biological prostheses for cardiovascular surgery – a half-century history and development prospects. Complex Issues of Cardiovascular Diseases. 2024;13(1): 196-210. DOI: 10.17802/2306-1278-2024-13-1-196-210

54. Krishnaswamy A., Yun J., et al. Five-Year Outcomes of Valve-in-Valve TAVR Versus Native Valve TAVR: Analysis from the STS/ACC TVT Registry // JACC: Cardiovascular Inter-ventions. – 2025. – Vol. 18 (16). – P. 1989-2000.

55. Hans Gustav Hørsted Thyregod, Troels Højsgaard Jørgensen, Nikolaj Ihlemann, Daniel Andreas Steinbrüchel, Henrik Nissen, Bo Juel Kjeldsen, Petur Petursson, Ole De Backer, Peter Skov Olsen, Lars Søndergaard, Transcatheter or surgical aortic valve implantation: 10-year out-comes of the NOTION trial, European Heart Journal, Volume 45, Issue 13, 1 April 2024, Pages 1116–1124, https://doi.org/10.1093/eurheartj/ehae043

56. Barbarash OL, Lyapina IN. Current trends in organizing the care for patients with acquired heart valve disease. Russian Cardiology Bulletin. 2024;19(4-1):5–12. (In Russ.). doi: 10.17116/Cardiobulletin2024190415