Use of mechanical and biological prostheses in the aortic valve position in elderly and older patients: immediate results

Authors: Chabaidze T.A., Muratov R.M., Sigaev I.Yu., Keren M.A., Zhelikhazheva M.V., Tsiskaridze I.M.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2024-18-3-362-373

For citation: Chabaidze T.A., Muratov R.M., Sigaev I.Yu., Keren M.A., Zhelikhazheva M.V., Tsiskaridze I.M. Use of mechanical and biological prostheses in the aortic valve position in elderly and older patients: immediate results. Creative Cardiology. 2024; 18 (3): 362–373 (in Russ.). DOI: 10.24022/1997-3187-2024-18-3-362-373

Received / Accepted:  20.06.2024 / 31.07.2024

Keywords: prosthetics aortic valve age patients mechanical prostheses biological prostheses aortic valve prostheses aortic stenosis



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Abstract

Objective. The purpose of the research is to evaluate the immediate results of aortic valve replacement using mechanical and biological prostheses in elderly and senile patients.

Material and methods. A retrospective non-randomized research included 489 patients aged 60 years and older with aortic valve defect, in accordance with the inclusion and exclusion criteria, two observation groups were formed: group 1 – patients who had aortic valve replacement (AVR) using mechanical prostheses (n = 256); group 2 – patients who underwent AVR using biological prostheses (n = 233). The immediate results after aortic valve replacement in elderly and senile patients were assessed. Endpoints: all-cause death, valve-related complications: lethal and non-lethal (prosthetic valve thrombosis, prosthetic endocarditis, small and large haemorrhage, paraprosthetic fistulae, thromboembolic complications, prosthetic valve dysfunction). Additionally, during the hospital follow-up period, the frequency of postoperative complications (acute heart failure, stroke, myocardial infarction, multiple organ failure, acute bleeds, etc.) was evaluated, a risk of lethal outcome was assessed depending on the type of implanted prosthesis, as well as fatal and non-fatal risk factors.

Results. The type of implanted valve prosthesis (mechanical or biological) doesn’t affect the incidence of lethal outcome and valve-related non-fatal complications in the immediate postoperative period, elderly and senile age wasn’t an operational risk factor for patients referred for aortic valve replacement with cardiopulmonary bypass. Elderly and senile age wasn’t an operational risk factor for patients who needed aortic valve replacement with cardiopulmonary bypass. Independent risk factors for in-hospital mortality are: class IV chronic heart failure (NYHA) (odds ratio (OR) 27.938; confidence interval (CI) 95% 3.304–236.276, p = 0.002), previous myocardial infarction (OR 4,253; CI 95% 1.765–10.247, p = 0.001), previous acute cerebrovascular disease (OR 4.022; CI 95% 1.477–10.957, p = 0.006), chronic kidney disease stage 3b (GFR<60 ml/min/1.73m2) (OR 3.279; CI 95% 1.504–7,149, p = 0.003), radiation therapy in the anamnesis (OR 17.333; CI 95% 1.046–287.436, p = 0.046).

Conclusion. The type of implanted prosthesis and the elderly age of the patient weren’t statistically significant risk factors. Concomitant diseases affecting the postoperative period were significant risk factors of hospital mortality.

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About Authors

  • Tamara A. Chabaidze, Cardiologist; ORCID
  • Ravil M. Muratov, Dr. Med. Sci., Professor, Head of Department, Cardiovascular Surgeon; ORCID
  • Igor Yu. Sigaev, Dr. Med. Sci., Professor, Head of Department, Cardiovascular Surgeon; ORCID
  • Milena A. Keren, Dr. Med. Sci., Senior Researcher, Professor, Cardiologist; ORCID
  • Madina V. Zhelikhazheva, Dr. Med. Sci., Senior Researcher, Cardiologist; ORCID
  • Irma M. Tsiskaridze, Cand. Med. Sci., Leading Researcher, Cardiovascular Surgeon; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery