RESULTS OF PROSTHETIC AORTIC STENOSIS IN PATIENTS AFTER IMPLANTATION OF AORTIC ALLOGRAFT

Objective: To evaluate hemodynamic parameters on an implantable allograft, as well as to study left ventricular (LV) remodeling, various complications arising in patients after allograft implantation in aortic valve stenosis in the early and late periods. Material and Methods: From February 2009 to July 2017, aortic valve replacement using allografts was performed in 33 patients. The function of allograft and LV was evaluated in patients in the postoperative period on the 7–10th day and after 3, 6 months, 1, 2, 3 years in the late postoperative period. Results: Implanted allografts in the aortic position with aortic stenosis show satisfactory hemodynamic parameters in all implantable sizes in both the early and late postoperative periods. At the same time, the area of the effective hole did not change in any size of the allografts during the study period. At the same time, there was a significant decrease in the maximum speed of blood flow on the aortic allografts, which led to suboptimal indicators of systolic and average gradients in the early postoperative period, which decreased to normal values for the native aortic valve in the period from 3 months to 2 years. The LV remodeling that occurred led to a significant improvement in the quality of life of patients, assessed using the MLHFQ questionnaire, as well as up to 3 months after the implantation of allografts into the aortic position. Conclusions: The use of allografts of 21-27 standard size in the aortic position in case of aortic stenosis makes it possible to substantially approach the parameters of the functioning of the native valve in both the early and long-term (3 years) periods. The phenomenon of “patient prosthesis-mismatch” was not observed even with the implantation of 21 size of allograft. It was also noted that even with the implantation of an allograft of 19 standard size (1 case), it was possible to obtain satisfactory results: the effective hole area was 1.3 cm2, which for this patient corresponded to the normal value of the patient-prosthesis conformity index (0.87 cm2 / m2).