EARLY LEFT VENTRICULAR MYOCARDIAL REMODELING AFTER CORRECTION OF AORTIC VALVE MALFORMATION: A COMPARISON OF NEOCUSPIDIZATION AND FRAME PROSTHESES

Komarov R. N., Tkachev M. I., Savina V. A., Bashmakov N. S.

Objectives: Valve replacement is the "gold" standard in the correction of aortic valve defects. Currently, various correction options are available: mechanical or biological prosthesis implantation, transcatheter aortic valve implantation, aortic homografts, pulmonary autografts, autopericardium neocuspidation. The main objective of this study is to assess the impact of AC prosthetics using autopericardial neocuspidization (AVNeo) on LV reverse remodeling in the immediate postoperative period by conducting a comparative evaluation of postoperative results of symmetric, asymmetric autopericardial neocuspidization and AC prosthetics with mechanical and biological prostheses. Methods: To assess the results of the interventions, a retrospective comparative study of 60 patients operated on for isolated AV malformation at the cardiac surgical department of the University Clinical Hospital No 1 of the Russian Ministry of Health (Sechenov University) from 2017 to 2022 was performed. The mean age of the patients was 60 ± 9 years (from 39 to 77 years). Gender distribution in the total group: male 75% (n = 45), female 25% (n = 15). Group 1 patients underwent AC replacement using symmetrical neocusps (according to the Sechenov University method) (n = 15): from group 2 - AV prosthesis with asymmetric neocusps from autologous pericardium (according to the classic Ozaki technique using original templates) (n = 15); from group 3 - AV prosthesis with implantation of a biological prosthesis (n = 15); from group 4 - AV prosthesis with implantation of a mechanical prosthesis (n = 15). Preoperative transthoracic echocardiography data and the last follow-up before discharge were analyzed. Decreased LV mass and LV myocardial mass index and relative wall thickness were used as an indicator of reverse LV remodeling. Results: According to EchoCG data, left ventricular myocardial mass decreased from 216.69 ± 38.57 to 197.42 ± 40.98 g (p = 0.057) by the time of hospital discharge in group 1 patients (Komarov) myocardial mass decreased from 217.59 ± 72.22 to 180.13 ± 34.86 g in group 2 patients (Ozaki) (p = 0.075); Group 3 patients (biological prosthesis) myocardial mass decreased from 294.89 ± 110.112 to 257.197 ± 80.676 g (p = 0.096); Group 4 patients (mechanical prosthesis) myocardial mass decreased from 246.57 ± 60.49 to 215.35 ± 56.17 g (p = 0.118) Conclusions: In our study, we were able to observe a decrease in LV myocardial mass as early as the first weeks after surgery; there was also a significant, almost symmetrical, decrease in LV wall thickness and indexed myocardial mass. It can be noted that after autopericardial neocuspidization (AVNeo) and AV prosthesis with biological valve there is a greater regression of myocardial mass compared with mechanical prostheses. This is associated with suboptimal hemodynamic indices of the prostheses.

Keywords:left ventricular remodeling, aortic valve neocuspidization (AVNeo), mechanical (mAVR) prosthesis, biological (bAVR) prosthesis, the Ozaki procedure