1. Choosing the valve type for AVR in old patients.
VI International Congress «Current Trends of Modern Cardio-Thoracic Surgery»
St. Petersburg, June 9-11.
Choosing the valve type for AVR in old patients.
Mandrika Central Military Clinical Hospital
Moscow, Russia
Borisov I, Dalinin V, Uymanova M.

2. Evolution of using different types of prosthetic valves in old patients
2000…
1980…
2007…
2014…

4. Patient’s data St-AVR gr. (n=35) Sutureless gr. (n=20) Age (mean) 72
Effective opening area < 1 cm2
80%
Concomitant CAD
69 (60 %)
Diabetes mellitus
16 (13,5 %)
Rhythm disorders
30%
MV disease
3 (2,6 %)
TIA history
3 (2,6%)
EF% (mean)
55%
Peripheral arteries disease
17%
EuroSCORE II (mean)
5,1
NYHA class (mean)
3,2
Creatinine ≥ 120 mmol/l
20%
St-AVR gr.
(n=35)
Sutureless gr.
(n=20)
Age (mean) 72 69
Sex (m/f)
60%
10%
AV – atherosclerosis, calcification
40%
AV – degenerative 2
CAD
70%
AF (paroxysmal)
Other rhythm disorders
15%
13%

5. SURGERY DATA min Literature data Our data sternotomy Isolated AVR
Non-isolated AVR
X-clamp time (min)
31.0±11.0
52.2±24.2
CPB time (min)
51.3±19.8
80.6±34.5
sternotomy
Isolated AVR
Non-isolated AVR
X-clamp time (min)
35.0±11.0
55.2±24.2
CPB time (min)
55.3±19.8
86.6±34.5
«off-label» - bicuspid valve +/-
- aortic insufficiency +/-
- total calcification of the fibrous ring with its deformation +/-
- aortic root dilatation or other mismatch
Postop complications
St-AVR
Sutureless p
AV block (temporary)
10%
p<0,05
Rhythm disorders AF)
60%
Cognitive disorders
40% 1%
Embolic events
p<0,1
Pericarditis
Hospital mortality 3%
ICU staying (days)
3,5
2,2
Learning curve
min

6. Before surgery
at discharge
(or 30-day)
3-6 months
12 months
24 months
EF lv% (mean)
60.1 ± 11. 6
58.4 ± 11.2
60.7 ± 9.9
61.4 ± 9.9
60.0 ± 8.5
Gr-t. mean (mm.Hg)
42.9 ± 16.4
10.3 ± 4.4
8.9 ± 4.3
8.9 ± 4.7
8.8 ± 3.9
Gr-t. max (mm. Hg)
74.0 ± 25.6
20.4 ± 8.5
17.8 ± 7.7
15.7 ± 8.0
12.0 ± 7.9
EOS см2 (mean)
0.72 ± 0.23
2.52 ± 0.39
2.51 ± 0.37
2.55 ± 0.37
2.70 ± 0.46
LV weight (g) (mean)
254.5 ± 77.6
238.6 ± 74.3
216.2 ± 66.5
216.6 ± 70.6
188.6 ± 66.1

7. CRITERIA FOR VALVE SELECTING
age > 65 years
Dilatation of aortic root
Fibrous ring 19-27
age > 65 years
Normal aortic root
Fibrous ring 19-27
Conclusion
Sutureless biological valves has real advantage in old patients and its reflected on postop period and during follow-up.
WetLab training is more than enough for experienced in AVR surgeons.
Balloon-adjustment of the valve is the factor witch influenced on indications for implantation.
We still have to work on the indications for implantation of such type of the valves.
Valve type selection depends not only on indications. It depends on surgeon’s experience and hospital funding.