Abstract
Patients with severe aortic stenosis have a high risk of sudden death without surgical treatment, as well as high periand postoperative risk. In the presented study, the data of domestic and world literature are analyzed in the context of the optimal timing of the operation, postoperative complications and predictors of their development at various times after the intervention. The main causes that determine the optimal term of operation include the degree of valve stenosis, the left ventricular dysfunction, and the rate of hemodynamic changes. Concomitant mitral regurgitation, coronary heart disease, severe preoperative left ventricular dysfunction, are the main predictors of morbidity and mortality at different times after aortic valve replacement.
References
- Boсkeria L.A., Boсkeria O.L., Fadeev A.A., Makhachev O.A., Kosareva T.I., Averina I.I. The assessment of mechanical heart valves stenosis in adults after aortic valve replacement: the advantage of full-flow design of mechanical valve. Annals of the Russian Academy of Medical Sciences. 2013; 68 (3): 51–8 (in Russ.). DOI: 10.15690/vramn.v68i3.600
-
Boсkeria O.L., Bazarsadaeva T.S. Sudden cardiac death and mitral and aortic valve defects. Annals of Arrhythmology. 2013; 10 (3): 162–70 (in Russ.). DOI: 10.15275/annaritmol.2013.3.6
-
Kwiecień A., Hrapkowicz T., Filipiak K., Przybylski R., Kaczmarczyk M., Kowalczuk A. et al. Surgical treatment of elderly patients with severe aortic stenosis in the modern era – review. Kardiochir. Torakochir. Pol.2018; 15 (3): 188–95. DOI: 10.5114/kitp.2018.78445
-
Everett R.J., Clavel M., Pibarot P., Dweck M.R. Timing of intervention in aortic stenosis: a review of current and future strategies. Heart. 2018; 104: 2067–76. DOI: 10.1136/heartjnl-2017-312304
-
Pawade T.A., Newby D.E., Dweck M.R. Calcification in aortic stenosis: the skeleton key. J. Am. Coll. Cardiol. 2015; 66: 561–77. DOI: 10.1016/j.jacc.2015.05.066
-
Dweck M.R., Jenkins W.S., Vesey A.T., Pringle M.A., Chin C.W., Malley T.S. et al. 18F-sodium fluoride uptake is a marker of active calcification and disease progression in patients with aortic stenosis. Circ. Cardiovasc. Imaging. 2014; 7: 371–8. DOI: 10.1161/CIRCIMAGING.113. 001508
-
Chin C.W.L., Everett R.J., Kwiecinski J. Myocardial fibrosis and cardiac decompensation in aortic stenosis. JACC Cardiovasc. Imaging. 2017; 10: 1320–33. DOI: 10.1016/j.jcmg.2016.10.007
-
Hein S., Arnon E., Kostin S., Schönburg M., Elsässer A., Polyakova V. et al. Progression from compensated hypertrophy to failure in the pressure-overloaded human heart: structural deterioration and compensatory mechanisms. Circulation. 2003; 107: 984–91. DOI: 10.1161/01.CIR. 0000051865.66123.B7
-
Baumgartner H., Falk V., Bax J., De Bonis M., Hamm C., Holm P.J. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur. Heart J. 2017; 38 (36): 2739–91. DOI: 10.1093/eurheartj/ ehx391
-
Ross J., Braunwald E. Aortic stenosis. Circulation. 1968; 38 (1S5): V-61–0. DOI: 10.1161/01.CIR.38.1S5.V-61
-
Rafique A.M., Biner S., Ray I., Fienstein S.B., Witchger M., Bell M. et al. Meta-analysis of prognostic value of stress testing in patients with asymptomatic severe aortic stenosis. Am. J. Cardiol. 2009; 104: 972–7. DOI: 10.1016/j.amjcard.2009.05.044
-
Das P., Rimington H., Chambers J. Exercise testing to stratify risk in aortic stenosis. Eur. Heart J. 2005; 26: 1309–13. DOI: 10.1093/eurheartj/ehi250
-
Otto C.M., Burwash I.G., Legget M.E., Munt B.I., Fujioka M., Healy N.L. et al. Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome. Circulation. 1997; 95: 2262–70. DOI: 10.1161/ 01.CIR.95.9.2262
- Paradis J.M., Fried J., Nazif T., De Bonis M., Hamm Ch., Holm P.J. et al. Aortic stenosis and coronary artery disease: what do we know? What don't we know? A comprehensive review of the literature with proposed treatment algorithms. Eur. Heart J. 2014; 35: 2069–82. DOI: 10.1093/eurhe
-
Fairbairn T.A., Steadman C.D., Mather A.N., Motwani M., Blackman D.J., Greenwood S.P. et al. Assessment of valve haemodynamics, reverse ventricular remodelling and myocardial fibrosis following transcatheter aortic valve implantation compared to surgical aortic valve replacement: a cardiovascular magnetic resonance study. Heart. 2013; 99: 1185–91. DOI: 10.1136/heartjnl-2013303927
-
Azevedo C.F., Nigri M., Higuchi M.L., Pablo M.P., Guilherme S.S., Roney O.S. et al. Prognostic significance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease. J. Am. Coll. Cardiol. 2010; 56: 278–87. DOI: 10.1016/j.jacc. 2009.12.074
- Kitai T., Honda S., Okada Y., Tomoko T., Kitae K., Shuichiro K. et al. Clinical outcomes in non-surgically managed patients with very severe versus severe aortic stenosis. Heart. 2011; 97: 2029–32. DOI: 10.1136/ heartjnl-2011-300137
-
Rosenhek R., Klaar U., Schemper M., Christine S., Maria H., Harald G. et al. Mild and moderate aortic stenosis. Natural history and risk stratification by echocardiography. Eur. Heart J.2004; 25: 199–205. DOI: 10.1016/j.ehj.2003.12.002
-
Rosenhek R., Binder T., Porenta G., Irene L., Günther C., Michael S. et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N. Engl. J. Med. 2000; 343: 611–7. DOI: 10.1056/NEJM200008313430903
-
Bergler-Klein J., Mundigler G., Pibarot P., Burwash I.G., Dumesnil J.G., Blais C. et al. B-type natriuretic peptide in low-flow, low-gradient aortic stenosis: relationship to hemodynamics and clinical outcome: results from the Multicenter Truly or Pseudo-Severe Aortic Stenosis (TOPAS) study. Circulation. 2007; 115: 2848–55. DOI: 10.1161/CIRCULATIONAHA.106. 654210
-
Clavel M.A., Malouf J., Michelena H.I., Suri R.M., Jaffe A.S., Mahoney D.W. et al. B-type natriuretic peptide clinical activation in aortic stenosis: impact on longterm survival. J. Am. Coll. Cardiol. 2014; 63: 2016–25. DOI: 10.1016/j.jacc.2014.02.581
-
Taniguchi T., Morimoto T., Shiomi H., Ando K., Kanamori N., Murata K. et al. Initial surgical versus conservative strategies in patients with asymptomatic severe aortic stenosis. J. Am. Coll. Cardiol. 2015; 66: 2827–38. DOI: 10.1016/j.jacc.2015.10.001
-
Malaisrie S.C., McDonald E., Kruse J., Li Z., McGee E.C. Jr, Abicht T.O. et al. Mortality while waiting for aortic valve replacement. Ann. Thorac. Surg. 2014; 98: 1564–71. DOI: 10.1016/j.athoracsur.2014.06.040
-
Flores-Marín A., Gómez-Doblas J.J., CaballeroBorrego J., Cabrera-Bueno F., Rodríguez-Bailón I., Melero J.M. et al. Long-term predictors of mortality and functional recovery after aortic valve replacement for severe aortic stenosis with left ventricular dysfunction. Rev. Esp. Cardiol.2010; 63: 36–45. DOI: 10.1016/S18855857(10)70007-4
-
Monin J.L., Quéré J.P., Monchi M., Petit H., Baleynaud S., Chauvel Ch. et al. Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation. 2003; 108: 319–24. DOI: 10.1161/01.CIR.0000079171.43055.46
-
Chin C.W., Messika-Zeitoun D., Shah A.S., Lefevre G., Bailleul S., Yeung N.W. et al. A clinical risk score of myocardial fibrosis predicts adverse outcomes in aortic stenosis. Eur. Heart J. 2016; 37: 713–23. DOI: 10.1093/ eurheartj/ehv525
-
Ionescu A., Fraser A.G., Butchart E.G. Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography. Heart. 2003; 89: 1316–21. DOI: 10.1136/heart.89.11.1316
-
O'Rourke D.J., Palac R.T., Malenka D.J., Marrin C.A., Arbuckle B.E., Plehn J.F. Outcome of mild periprosthetic regurgitation detected by intraoperative transesophageal echocardiography. J. Am. Coll. Cardiol. 2001; 38: 163–6. DOI: 10.1016/s0735-1097(01)01361-4
-
Suh Y.J., Hong G.R., Han K., Im D.J., Chang S., Hong Y.J. Assessment of mitral paravalvular leakage after mitral valve replacement using cardiac computed tomography: comparison with surgical findings. Circ. Cardiovasc. Imaging. 2016; 9 (6). DOI: 10.1161/ CIRCIMAGING.115.004153
- De Cicco G., Lorusso R., Colli A., Nicolini F., Fragnito C., Grimaldi T. Aortic valve periprosthetic leakage: anatomic observations and surgical results. Ann. Thorac. Surg. 2005; 79: 1480–5. DOI: 10.1016/j.athoracsur. 2004.11.058
-
Pham N., Zaitoun H., Mohammed T.L., De La PenaAlmaguer E., Martinez F., Novaro G.M. Complications of aortic valve surgery: manifestations at CT and MR imaging. Radiographics. 2012; 32: 1873–92. DOI: 10.1148/rg.327115735
- Rizzoli G., Russo R., Valente S., Mazzucco A., ValfréC., Brumana T. et al. Dehiscence of aortic valve prostheses: analysis of a ten-year experience. Int. J. Cardiol. 1984; 6 (2): 207–21. DOI: 10.1016/0167-5273(84)90355-3
- Fagman E., Perrotta S., Bech-Hanssen O., Flinck A., Lamm C., Olaison L. ECG-gated computed tomography: a new role for patients with suspected aortic prosthetic valve endocarditis. Eur. Radiol. 2012; 22: 2407–14. DOI: 10.1007/s00330-012-2491-5
-
Koo H.J., Lee H.N., Anh T.T., Kang J.W., Yang D.H., Song J.K. et al. Postoperative complications after surgical aortic valve replacement. Cardiovasc. Imaging Asia. 2017; 1 (4): 222–30. DOI: 10.22468/cvia.2017.00115
-
Huang G., Schaff H.V., Sundt T.M., Rahimtoola S.H. Treatment of obstructive thrombosed prosthetic heart valve. J. Am. Coll. Cardiol. 2013; 62: 1731–6. DOI: 10.1016/j.jacc.2013.07.075
-
Sakamoto Y., Hashimoto K., Okuyama H., Ishii S., Shingo T., Kagawa H. Prevalence of pannus formation after aortic valve replacement: clinical aspects and surgical management. J. Artif. Organs.2006; 9: 199–202. DOI: 10.1007/s10047-006-0334-3
-
Ueda T., Teshima H., Fukunaga S., Aoyagi S., Tanaka H. Evaluation of prosthetic valve obstruction on electrocardiographically gated multidetector row computed tomography – identification of subprosthetic pannus in the aortic position. Circ. J. 2013; 77: 418–23. DOI: 10.1253/ circj.CJ-12-0290
- Gündüz S., Özkan M., Kalc ,ik M., Gürsoy O.M., Astarciog ˇlu M.A., Karakoyun S. et al. Sixty-four-section cardiac computed tomography in mechanical prosthetic heart valve dysfunction: thrombus or pannus. Circ. Cardiovasc. Imaging. 2015; 8: e003246. DOI: 10.1161/ CIRCIMAGING.115.003246
-
Berdajs D.A., Trampuz A., Ferrari E., Ruchat P., Hurni M., von Segesser L.K. Delayed primary versus late secondary wound closure in the treatment of postsurgical sternum osteomyelitis. Interact. Cardiovasc. Thorac. Surg. 2011; 12: 914–8. DOI: 10.1510/icvts.2010.263483
-
Zacharias A., Habib R.H. Factors predisposing to median sternotomy complications. Deep vs superficial infection. Chest. 1996; 110: 1173–8. DOI: 10.1378/chest. 110.5.1173
- Misawa Y., Fuse K., Hasegawa T. Infectious mediastinitis after cardiac operations: computed tomographic findings. Ann. Thorac. Surg. 1998; 65: 622–4. DOI: 10.1016/s0003-4975(97)01339-8
-
Habib G., Hoen B., Tornos P., Thuny F., Prendergast B., Vilacosta I. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur. Heart J. 2009; 30: 2369–413. DOI: 10.1093/eurheartj/ ehp285
-
Cahill T.J., Prendergast B.D. Infective endocarditis. Lancet. 2016; 387: 882–93. DOI: 10.1016/S0140-6736 (15)00067-7
-
Piper C., Körfer R., Horstkotte D. Prosthetic valve endocarditis. Heart. 2001; 85: 590–3. DOI: 10.1136/ heart.85.5.590
-
Heras M., Chesebro J.H., Fuster V., Penny W.J., Grill D.E., Bailey K.R. High risk of thromboemboli early after bioprosthetic cardiac valve replacement. J. Am. Coll. Cardiol. 1995; 25: 1111–9. DOI: 10.1016/0735-1097(94) 00563-6
- Kiernan T.J., Flynn A.M., Kearney P., Le-Feng Wang, Xin-Chun Yang. Coronary embolism causing myocardial infarction in a patient with mechanical aortic valve prosthesis. Int. J. Cardiol.2006; 112: e14–e16. DOI: 10.1016/ j.ijcard.2006.01.038
- Kodolitsch Y., Simic O., Schwartz A., Dresler C., Loose R., Staudt M. Predictors of proximal aortic dissection at the time of aortic valve replacement. Circulation. 1999; 100 (Suppl.): II287–II294. DOI: 10.1161/01.cir. 100.suppl_2.ii-287
-
Vánky F.B., Ha °kanson E., Svedjeholm R. Long-term consequences of postoperative heart failure after surgery for aortic stenosis compared with coronary surgery. Ann. Thorac. Surg. 2007; 83 (6): 2036–43. DOI: 10.1016/ j.athoracsur.2007.01.031
-
Vánky F.B., Ha °kanson E., Tamas E., Svedjeholm R. Risk factors for postoperative heart failure in patients operated on for aortic stenosis. Ann. Thorac. Surg. 2006; 81: 1297–1304. DOI: 10.1016/j.athoracsur.2005.11.036
- Gjertsson P., Caidahl K., Farasati M., Oden A., BechHanssen O. Preoperative moderate to severe diastolic dysfunction: a novel Doppler echocardiographic longterm prognostic factor in patients with severe aortic stenosis. J. Thorac. Cardiovasc. Surg. 2005; 129: 890–6. DOI: 10.1016/j.jtcvs.2004.09.004
-
Blais C., Dumesnil J.G., Baillot R., Simard S., Doyle D., Pibarot P. Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Circulation. 2003; 108: 983–8. DOI: 10.1161/01.CIR. 0000085167.67105.32
About the authors
- Leo A. Bockeria, Dr. Med. Sc., Professor, Academician of Russian Academy of Sciences and Russian Academy of Medical Sciences, Director; orcid.org/0000-0002-6180-2619
- Irakliy D. Paskhalov, Postgraduate, Cardiac Surgeon