Comparative assessment of the effectiveness of mechanical and biological heart valve prostheses in reverse remodeling of the left ventricle after aortic valve surgery (propensity score matching analysis and clinical-experimental comparison)
Abstract
Aim of the study – comparative assessment of left ventricular remodeling
after correction of aortic valve (AV) stenosis using biological (BP) and
mechanical (MP) heart valve.
Material and
methods. In the Scientific Research Institute for Complex
Problems of Cardiovascular Diseases (Kemerovo, Russia) from 01/01/2011 to
01/01/2019 surgical correction of the aortic stenosis was performed in 576
patients. 174 observations were selected for the study after they were
evaluated for inclusion and exclusion criteria (see below): xenopericardial
bioprostheses “UniLine”(“Neocor”, Russia) in 108 cases, bileaflet mechanical valve
“Medeng-2” in 66 cases. We used propensity score matching with the nearest
neighbor search method (1:1 ratio) to assess selected groups. On the basis of
known (sex, age, body surface area) and expected (prosthesis size) cofounders
19 pairs of BP and MP were formed. Hemodinamics test benches of these
prostheses were carried out in the Vivitro pulsating flow installation (Vivitro
Labs, Canada), simulating the function of the left ventricle, left atrium and
aorta, with additional inclusion of peripheral flow resistance model. Test
benches were used to explain the obtained clinical results.
Results. Before surgery the specified parameters did not differ in the groups.
After the intervention, left ventricular remodeling parameters were positive in
both groups. In the BP group, the end-diastolic size of the left ventricle was
less, than in MP group (р≤0.050). Left
ventricular wall thickness (LVW), myocardial mass and mass index left
ventricular myocardium (LV MM, LV IMM) in relation to the preoperative value
statistically significant (р≤0.050) decreased during the first month after surgery in both groups,
without intergroup differences (р>0.050) throughout the entire period observations. The regression of
left ventricular myocardial mass index was more significant in BP “UniLine”
recipients and after 2-year observation period its median was 58.8 (-31%)
compared with 52.6 g/m2 (-28%) in MP “Medeng” recipients,
respectively (р=0.047). As a result
of test bench, a significantly larger diastolic flow on a mechanical (5.53
ml/cycle) versus biological aortic valve prosthesis (2.26 ml/cycle).
Conclusion. Implantation of “UniLine” biological prosthesis provides more favorable
conditions for reverse remodeling of the left ventricular myocardium in
comparison with mechanical prosthesis "Medeng-2" implantation during
the first two years after surgery for the isolated aortic valve stenosis.
Keywords:left ventricular remodeling; aortic valve stenosis; biological prosthesis; mechanical prosthesis; left ventricular hypertrophy; myocardial mass; echocardiographic parameters; propensity score matching
Funding. The study had no sponsor support.
Conflict of
interest. The authors declare no conflict of interest.
For citation: Evtushenko A.V., Rogulina N.V., Sizova I.N., Klyshnikov K.A.,
Ovcharenko E.A., Barbarash L.A. Comparative assessment of the effectiveness of
mechanical and biological heart valve prosthe-ses in reverse remodeling of the
left ventricle after aortic valve surgery (propensity score matching analysis
and clinical-experimental comparison). Clinical and Experimental Surgery.
Petrovsky Journal. 2024; 12 (1): 40–51. DOI: https://doi.org/10.33029/2308-1198-2024-12-1-40-51
(in Russian)
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