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Long-term results of aortic valve replacement in elderly and senile patients

Authors: Chabaidze T.A., Muratov R.M., Sigaev I.Yu., Keren M.A., Kazumyan B.V., Akbutaeva G.M., Kudashev I.F.

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

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2025-19-2-208-216

For citation: Chabaidze T.A., Muratov R.M., Sigaev I.Yu., Keren M.A., Kazumyan B.V., Akbutaeva G.M., Kudashev I.F. Long- term results of aortic valve replacement in elderly and senile patients. Creative Cardiology. 2025; 19 (2): 208–216 (in Russ.). DOI: 10.24022/1997-3187-2025-19-2-208-216

Received / Accepted:  10.02.2025 / 22.04.2025

Keywords: aortic stenosis mechanical prostheses biological prostheses risk factors



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Abstract

Objective. To study the long-term results of aortic valve replacement in elderly and senile patients, depending on the type of implantable prosthesis (mechanical or biological), with an assessment of risk factors for long-term mortality.

Material and methods. A retrospective analysis of 205 elderly and senile patients (average age – 77 years (Q1–Q3: 74–84), min – 64 years, max – 96 years) who underwent prosthetics in the period from 2005 to 2015 was carried out. The patients were divided into 2 groups depending on the type of implanted prosthesis: MP (mechanical prosthesis) (n=111) and BP (biological prosthesis) (n=94). The results of the interventions were evaluated over a period of 1 to 10 years, with a median follow-up of 5.00 [3.00; 8.00].

Results. The type of prosthesis did not affect long-term survival. The overall long-term mortality was 6.83% (n=14) with no significant differences between the groups (p=0.658). When analyzing the predictors of long-term mortality, the independent risk factors were: Charlson comorbidity index, baseline risk level according to EuroSCORE II, history of myocardial infarction (MI), atrial fibrillation (AF), chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) of functional class IV according to NYHA. When comparing the frequency of valve-dependent non-fatal complications and anticoagulant-dependent non-fatal complications in the studied groups, it was revealed that the group with MP was more likely to experience major bleeding compared with the PD group (5.7% vs. 0%, in MP and PD, respectively, p=0.033), in the group with PD – degeneration The valve was observed in 4.7% of patients (0% versus 4.7% in MP and PD, respectively, p=0.040). During the study follow-up period, the frequency of AK reprosthetics was 6.7% (n=7) in the MP group and 9.3% (n=8) in the PD group (p=0.593).

Conclusion. Implantation of MP and PD during prosthetics of AK in elderly and senile patients demonstrated the same safety profile: the overall long-term mortality during the follow-up period did not differ. Minimizing the risk of anticoagulant- dependent complications remains a priority in elderly patients, which makes PD preferable. Younger patients have a higher long-term survival rate when using MP, despite the risk of bleeding. The decision to choose the type of prosthesis requires an individual assessment of comorbidity and consideration of the patient’s readiness for lifelong anticoagulant therapy.

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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., Professor of Chair, Senior Researcher, Cardiologist; ORCID
  • Bagrat V. Kazumyan, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
  • Gulrukh M. Akbutayeva, Ultrasonic Diagnostician; ORCID
  • Igor F. Kudashev, Cardiovascular Surgeon; ORCID

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


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