Choosing the valve type for AVR in old patients.

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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.

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

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%

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

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

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.