EUROMEDICA  Hanover 23-24  Mai 2011	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover

Home

Abstracts

Contact

Disclaimer

The estimation of preoperative indicators characterizing postoperative prognosis, can be useful to preoperative stratification of risk. Object of the research was the estimation of influence of initial anatomic-functional and hemodynamic indicators at prognosing of the nearest results at patients after prosthetics AV.

Material and methods: The research analysis is spent at 394 patients by whom isolated prosthetics AV has been executed. From them men 311, women 83, middle age has made 36,9 ± 1,3 years. In I Functional Class on New York Heart Association was 14 (3,6 %) patients, in II - 42 (10,7 %), III - 296 (75,0 %), IV - 42 (10,7%). Patients have been parted according to hemodynamic implication of defect on two groups: I - with an aortal stenosis and combined aortal defect with prevalence of a stenosis (АS) - 165 (41,9 %) patients and II - with aortal insufficiency and combined aortal defect with prevalence of insufficiency (AI) - 229 (58,1 %) patients. The reasons of aortal defect (AD) were: rheumatic disease in 74,8 % of cases, an infectious endocarditis (IE) - 16,3 %, congenital defect AV - 8,5 %, an atherosclerotic degeneration and a calcification - 0,4 %. To all patients carried out standard kinds of research. Patient status at baseline was a landmark to determine all totality of defect pathogenetic disorders, and evaluation of the factors affecting the separate components of complete clinical picture creation permitted to consider specially the causes, conditions and consequences of systemic positions. Calculations were performed using «STATISTICA for Windows», v.6.0 and original programs developed in “Excel - 2000” on “Visual Basic for Application” integrated computer language.

Results: The correlation analysis has shown, that at patients with smaller signs of insufficiency of blood circulation (r =-0,346), being in a smaller functional class was the favorable prognosis of operation above. Thus the big importance of these indicators for the operation prognosis was at patients with AI (r=0,707), than in group with АS (r=0,580). The prognosis of operation was better at patients being in smaller age group (r =-0,626), with smaller Ketle index (r =-0,324), having smaller cardiothoracic index (r =-0,584). Thus dependence of the prognosis of operation from CTI more came to light at patients with AI (r =-0,567). Whereas influence of an indicator of the area of a surface of a body on the operation prognosis was shown more at patients with AS (r=0,363). Influence of indicators characterizing a functional condition of central hemodynamics had moderate correlation connection with the operation prognosis (r=0,424). One of significantly influencing the prognosis of operation of anatomic-functional indicators in both hemodynamic groups was SV (r=0,596). The fraction of emission LV more influenced the operation prognosis in group of patients with AI (r=0,402), than in group with AS (r=0,284). The most significant influence rendered indicators characterizing degree of hypertrophies of a myocardium (r=0,839), testifying that most of all initial myocardium conditions influence the operation prognosis. Expressiveness of hypertrophy dIVST (r =-0,407) was bad sign, both at aortal stenosis, and at its insufficiency. The expressiveness calcification AV (r =-0,563), degree of regurgitation on AV (r = 0,639), organic changes arising at long defect on MV (r =-0,298) and TV (r =-0,631), expressiveness initial systolic pressure gradient (r =-0,649) negatively affected on the prognosis. All it speaks well for necessity of performance of operative treatment at early stages of display of defect, before development of expressed central hemodynamics infringements, morphological changes and a pathological hypertrophy of a myocardium.

Conclusion: the account results defined during research of the anatomic-hemodynamic sizes influencing on results prosthetics of aortic valve will allow improving of operation, which depends on due time executed correction of defect. Patients with aortal stenosis are group with less favorable prognosis of operation, than with aortal insufficiency, because of more expressed morphological changes of a myocardium both АV in the form of a hypertrophy and calcification, with transition on fibrous ring aortas, with the expressed value systolic pressure gradient.