The effectiveness and safety of the aortic valve implantation in people over 75 years old

BACKGROUND. Stenosis of the aortic valve is the most common heart disease that requires surgical intervention. A feature of this vice is a long asymptomatic period. After decompensation, five-year survival in these patients without surgery decreases to 1–5%.

OBJECTIVE. Assessment of the effectiveness and safety of transcatheter implantation of the aortic valve with critical aortic stenosis in senile patients compared to patients under 75 years of age.

MATERIALS AND METHODS. The team of authors analyzed the results of 72 transcate implant operations of aortic valve in patients with critical aortic stenosis performed in the Clinical Hospital №1for the period from 2015 to 2024. All patients were divided into 2 groups depending on age. The first group included 39 patients over 75 years old (the average age of patients is (80,69 ± 3,80) year). For comparison, a control group of 33 patients under 75 years old was formed (the average age was (66,18 ± 6,17) year).

RESULTS. In all patients of the studied group in the postoperative period, there was a significant decrease in the maximum gradient on the aortic valve to the reference values of the residual gradient on the aortic valve with (83, 54 ± 24, 55) mm Hg up to (19,78 ± 5,75) mm Hg. In the comparison group, a decrease in the gradient of systolic pressure on the aortic valve was observed from (89,58 ± 30,76) mm Hg to (20,75 ± 6,95) mm Hg. It should be noted a reliable increase in left ventricular ejection fraction on average by 2,7% (p <0,05) immediately after the valve implantation in patients of both groups. Additionally, a statistically significant decrease in pulmonary artery systolic pressure by (7±4) mm Hg was noted, which reduced the proportion of patients with pulmonary hypertension by 10% in patients in the main group and by 33% in patients under 75 years of age. In the early postoperative period in patients of both groups, a decrease in hemoglobin was observed (on average by 19,64 g/l in the main and 16,22 g/l in group 2), red blood cells (by 0,62*10 ¹²/l and 0,51*10 ¹²/l). At the same time, there was a slight decrease in the level of creatinine and the increase in the glomerular filtration rate in both groups, which indicates an improvement in the function of the kidneys after the correction of the aortic defect. This indicates the success of the operation and the achievement of clinical goals immediately after the intervention. In total, one person in a group over 75 years old died in the analyzed contingent of patients (2,5% mortality). The total number of complications was often found in senile patients (the installation of pacemaker 10% vs. 9% of cases, bleeding 10% vs. 3%, rhythm disorders 59% vs. 47%, atrial fibrillation 16% vs. 6%).

CONCLUSION. Transcatether implantation of the aortic valve is an effective and safe treatment for aortic stenosis in patients with high and moderate risk of surgical intervention, including senile people, being a worthy alternative to the classical «open» surgery. A decrease in the number of complications can be achieved by using more modern prosthesis models that allow safe and, if necessary, multiple repositioning of the prosthesis.