Comparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation

Relevance.It has been proven that patients with Low Flow Low Gradient (LFLG) after aortic valve replacement with biological or mechanical prostheses have a higher mortality rate and the number of adverse events compared with patients with Normal Flow High Gradient (NFHG). However, there are currentl...

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Autores principales:	Vladlen V. Bazylev, Dmitrii S. Tungusov, Ruslan M. Babukov, Fedor L. Bartosh, Artur I. Mikulyаk, Alena V. Gorshkova
Formato:	article
Lenguaje:	EN RU
Publicado:	Concilium Medicum 2020
Materias:	low flow low gradient ozaki surgery aortic stenosis stroke volume index global longitudinal deformity of the left ventricle Diseases of the circulatory (Cardiovascular) system RC666-701 Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/8f2151a668f34a3fa66024d661cbfcbb
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spelling	oai:doaj.org-article:8f2151a668f34a3fa66024d661cbfcbb2021-12-01T22:07:01ZComparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation2221-71852658-570710.26442/22217185.2020.2.200098https://doaj.org/article/8f2151a668f34a3fa66024d661cbfcbb2020-09-01T00:00:00Zhttps://cardiosomatics.orscience.ru/2221-7185/article/viewFile/46027/31031https://doaj.org/toc/2221-7185https://doaj.org/toc/2658-5707Relevance.It has been proven that patients with Low Flow Low Gradient (LFLG) after aortic valve replacement with biological or mechanical prostheses have a higher mortality rate and the number of adverse events compared with patients with Normal Flow High Gradient (NFHG). However, there are currently no comparative studies of patients with NFHG and LFLG after the Ozaki procedure. The better hemodynamic properties of autopericardial cusps compared with biological prostheses can more favorably influence the results in patients with LFLG in the short and long-term follow-up periods. Aim.1. Compare the hospit and long-term results of patients of the LFLG group with the results of patients of the NFHG group after the Ozaki procedure. 2. Identify predictors of hospital and long-term mortality in patients with LFLG. Materials and methods.All patients have been divided into two groups. Group 1: 137 patients with NFHG and signs of classic aortic stenosis: AVA1 cm2, Gmean40, SV index 35 ml/m2and normal left ventricle (LV) ejection fraction. Group 2. 71 patients with LFLG and underestimation of the average gradient indices (Gmean40) despite a decrease in the aortic valve aperture AVA1 cm2amid a decrease in the index of stroke volume 35 ml/m2and LV systolic function. Results.Hospital mortality after surgical correction of AV stenosis was significantly higher in patients of group 2: 3 (4.2%) patients and 1 (0.7%) patients, respectively (p=0.002). Survival at the maximum follow-up period for patients with LFLG was significantly lower than in the group of patients with NFHG 88.6 (95% confidence interval CI 4449.6) and 97.8 (95% CI 48.951), respectively (p=0.009). According to the results of the Cox regression analysis, the independent predictors of mortality in the long-term follow-up of patients with LFLG are the SV odds ratio 0.8 (95% CI 0.91.1);p=0.008 and the global longitudinal LV deformation (GLS) odds ratio 0.56 (95% CI 0.471.1);p=0.01. Conclusions.1. After the Ozaki procedure, patients with the LFLG group have higher risks of adverse events, both at the hospital stage and in the long-term follow-up, compared to patients with NFHG. 2. The duration of ischemia and LV mass are predictors of hospital mortality in the LFLG group of patients. 3. Predictors of long-term mortality in patients with LFLG are LV stroke volume index and global longitudinal LV deformation.Vladlen V. BazylevDmitrii S. TungusovRuslan M. BabukovFedor L. BartoshArtur I. MikulyаkAlena V. GorshkovaConcilium Medicumarticlelow flow low gradientozaki surgeryaortic stenosisstroke volume indexglobal longitudinal deformity of the left ventricleDiseases of the circulatory (Cardiovascular) systemRC666-701Diseases of the endocrine glands. Clinical endocrinologyRC648-665ENRUКардиоСоматика, Vol 11, Iss 2, Pp 28-34 (2020)
institution	DOAJ
collection	DOAJ
language	EN RU
topic	low flow low gradient ozaki surgery aortic stenosis stroke volume index global longitudinal deformity of the left ventricle Diseases of the circulatory (Cardiovascular) system RC666-701 Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	low flow low gradient ozaki surgery aortic stenosis stroke volume index global longitudinal deformity of the left ventricle Diseases of the circulatory (Cardiovascular) system RC666-701 Diseases of the endocrine glands. Clinical endocrinology RC648-665 Vladlen V. Bazylev Dmitrii S. Tungusov Ruslan M. Babukov Fedor L. Bartosh Artur I. Mikulyаk Alena V. Gorshkova Comparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation
description	Relevance.It has been proven that patients with Low Flow Low Gradient (LFLG) after aortic valve replacement with biological or mechanical prostheses have a higher mortality rate and the number of adverse events compared with patients with Normal Flow High Gradient (NFHG). However, there are currently no comparative studies of patients with NFHG and LFLG after the Ozaki procedure. The better hemodynamic properties of autopericardial cusps compared with biological prostheses can more favorably influence the results in patients with LFLG in the short and long-term follow-up periods. Aim.1. Compare the hospit and long-term results of patients of the LFLG group with the results of patients of the NFHG group after the Ozaki procedure. 2. Identify predictors of hospital and long-term mortality in patients with LFLG. Materials and methods.All patients have been divided into two groups. Group 1: 137 patients with NFHG and signs of classic aortic stenosis: AVA1 cm2, Gmean40, SV index 35 ml/m2and normal left ventricle (LV) ejection fraction. Group 2. 71 patients with LFLG and underestimation of the average gradient indices (Gmean40) despite a decrease in the aortic valve aperture AVA1 cm2amid a decrease in the index of stroke volume 35 ml/m2and LV systolic function. Results.Hospital mortality after surgical correction of AV stenosis was significantly higher in patients of group 2: 3 (4.2%) patients and 1 (0.7%) patients, respectively (p=0.002). Survival at the maximum follow-up period for patients with LFLG was significantly lower than in the group of patients with NFHG 88.6 (95% confidence interval CI 4449.6) and 97.8 (95% CI 48.951), respectively (p=0.009). According to the results of the Cox regression analysis, the independent predictors of mortality in the long-term follow-up of patients with LFLG are the SV odds ratio 0.8 (95% CI 0.91.1);p=0.008 and the global longitudinal LV deformation (GLS) odds ratio 0.56 (95% CI 0.471.1);p=0.01. Conclusions.1. After the Ozaki procedure, patients with the LFLG group have higher risks of adverse events, both at the hospital stage and in the long-term follow-up, compared to patients with NFHG. 2. The duration of ischemia and LV mass are predictors of hospital mortality in the LFLG group of patients. 3. Predictors of long-term mortality in patients with LFLG are LV stroke volume index and global longitudinal LV deformation.
format	article
author	Vladlen V. Bazylev Dmitrii S. Tungusov Ruslan M. Babukov Fedor L. Bartosh Artur I. Mikulyаk Alena V. Gorshkova
author_facet	Vladlen V. Bazylev Dmitrii S. Tungusov Ruslan M. Babukov Fedor L. Bartosh Artur I. Mikulyаk Alena V. Gorshkova
author_sort	Vladlen V. Bazylev
title	Comparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation
title_short	Comparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation
title_full	Comparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation
title_fullStr	Comparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation
title_full_unstemmed	Comparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation
title_sort	comparison of the results in normal flow high gradient and low flow low gradient patients after correction of pronounced aortic stenosis with ozaki procedure in the long-term observation
publisher	Concilium Medicum
publishDate	2020
url	https://doaj.org/article/8f2151a668f34a3fa66024d661cbfcbb
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Comparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation

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