COMPARATIVE ASSESSMENT OF CLINICAL AND HEMODYNAMIC OUTCOMES AFTER AORTIC HEART VALVE REPLACEMENT WITH XENOAORTIC AND XENOPERICARDIAL BIOLOGICAL PROSTHESES FOR DEGENERATIVE AORTIC VALVULAR DISEASE

Aim. To assess clinical and hemodynamic outcomes of aortic valve replacement with xenoaortic biological prosthesis “Aspire Vascutek” and xenopericardial biological prosthesis “UniLine”. Methods. 130 patients who underwent aortic valve replacement with bioprostheses in the period from October 2012 to March 2016 were included in the study. All patients were enrolled into two groups according to the model of the implanted device. 65 recipients of xenoaortic bioprostheses “Aspire Vascutek” were included in Group 1, whereas patients (n = 65) xenopericardial bioprostheses “UniLine” were assigned in Group 2. Males prevailed in Group 1 (63%, the mean age - 66.4±5.5 years). 85% of Group 1 patients had heart failure Strazhesko-Vasilenko IIA grade and 94% of patients had chronic heart failure NYHA III. Similarly, male patients (58%) prevailed in Group 2. The mean age of Group 2 patients was 66.5±3.65 years. All patients in Group 2 II had heart failure Strazhesko-Vasilenko IIA grade and chronic heart failure NYHA III. Results Two patients in Group 1 died in the early postoperative period (the overall mortality was 1.5%). All patients had chronic heart failure NYHA I-II at discharge. Peak transvalvular pressure gradient significantly decreased in the in-hospital period, particularly in Group 2 patients (82,3±22,7 mm Hg vs. 28.8±7.6 mm Hg). 88% of Group 1 patients underwent the 60-month follow-up, and 96% of Group 2 patients - the 48-month follow-up. Transvalvular pressure gradients decreased progressively in both study groups within 60 months follow-up. This decrease was more pronounced in recipients of xenopericardial biological prostheses. Conclusion. Aortic valve replacement with xenopericardial bioprostheses “UniLine” and xenoaortic bioprostheses “Aspire Vascutek” for aortic valvular disease allows treating intracardiac hemodynamic derangements and achieving good clinical and hemodynamic outcomes.

1. Petty G.W., Khandheria B.K., Wisnant J.P., Sicks J.D., O’Fallon W.M., Wiebers D.O. Predictors of cerebrovascular events and death among patients with valvular heart disease. Stroke 2000; 31: 2628-2635.

2. Peltier M., Trojette F., Sarano M.E., Grigioni F., Slama M.A., Tribouilloy C.M. Relation between cardiovas- cular risk factors and nonrheumatic severe calcfic aortic stenosis among patients with a three-cuspid aortic valve. Am J Cardiol. 2003; 91: 97-99.

3. Pellikka P.A., Sarano M.E., Nishimura R., Malouf J.F., Bailey K.R., Scott C.G., Barnes M.E., Tajik A.J. Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up. Circulation. 2005; 111: 3290-3295. doi: 10.1161/CIRCULATIONAHA.104.495903

4. Goldbarg S.H., Elmariah S., Miller M. Fuster V. Insights Into Degenerative Aortic Valve Disease. J Am Coll Cardiol. 2007; 50 (13) : 1205-1213. doi: 10.1016/j.jacc.2007.06.024

5. Mursalimova A.I., Gendlin G.E., Storozhakov G.I. Osobennosti techeniya i diagnostiki aortalnogo stenoza. Atmosfera. Novosti kardiologii. 2013; 1: 10-13 (in Russian).

6. Egorov I.V. Istoriya izucheniya aortal’nogo stenoza (k 100 letiyu publikacii I. Menkeberga). Terapevticheskij arhiv. 2004; 8: 90-92 (in Russian).

7. Lindroos M., Kupari M., Valvanne J., Strandberg T., Heikkilä J., Tilvis R. Factors associated with calcific aortic valve degeneration in the elderly. Eur Heart J. 1994; 15: 865-870.

8. Stewart B.F., Siscovic D., Lind B.K., Gardin J.M., Gottdiener J.S., Smith V.E., Kitzman D.W., Otto C.M. Clinical factors associated with calcific aortic valve disease. J Am Coll Cardiol. 1997; l29: 630-634.

9. Iung B., Baron G., Butchart E.G. A prospective survey of patients with valvu- lar heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24:1231—43.

10. Barbarash S. L., Juravleva I. Ju. Bioprostheses for cardiovascular surgery. Bulletin of the Siberian branch of the Russian Academy of medical Sciences 2000; 96(2): 113-118 (in Russian).

11. Gendlin G.E., Tronina O.A., Mursalimova A. I. Aortal’nyĭ stenoz i arterial’naya gipertenziya. Medicinskij vestnik. 2011; 10 (551): 9 (in Russian).

12. Dzemeshkevich S. L. Poroki aortal’nogo klapana u vzroslyh: sovremennaya patologiya i pokazaniya k operacii. Atmosfera. Kardiologiya. 2003; 2: 2–4 (in Russian).

13. Yakovlev V.A., Korolev B.E. Degenerativnyj aortal’nyj stenoz ugroza XXI veka (lekciya 2) // Novye Sankt-Peterburgskie vrachebnye vedomosti. 2007; 1: 21-28 (in Russian).

14. Borisov I. A., Blecken A. N., Savichev D. D. Biological prosthetic heart valve in modern cardiac surgery. Clinical medicine. 2012; 2: 4-8 (in Russian).

15. Hadjinikolaou L.L., Boehm M.C., Ganner C., Kendall S.W., Rosin M.D., Goldsmith I.R., Spyt T.J. Aspire por- cine bioprosthesis: ten years’ experience. J Heart Value Dis. 2005; 14(1): 47–53.

16. Barbarash L.S., Barbarash N.A., Zhuravleva I.Yu. Bioprotezy klapanov serdca: problemy i perspektivy. Kemerovo, 1995 (in Russian).

17. Fedorov S.A., Chiginev V.A., Zhurko S.A., Gamzaev A.B., Medvedev A.P. Сlinical and hemodynamic results of applying different biological prosthesis models for correction of calcific aortic valve disease. Sovremennye tehnologii v medicine. 2016; 8 (4): 292–296 (in Russian).

18. Shabalin A.V., Chibisova E. A., Vereshchagin G. N. The combination of calcined aortic valve stenosis degenerative origin and arterial hypertension: current understanding of the prognostic significance. Bulletin of the Siberian branch of the Russian Academy of medical Sciences. 2008; 3(131): 5-8 (in Russian).

19. Medvedev A.P., Skopin I.I., Chiginev V.A., Trofimov N.A., Fedorov S.A., Zhiltsov D. D., Zemskova E.N. Key aspects of the development of modern valvular heart surgery. Medical almanac. 2015; 3 (38): 32-37. (in Russian).