**5. Conclusions**

148 Aortic Valve Surgery

Fig. 6. Influence of a systolic gradient of pressure on the operation forecast

condition gravity in the preoperative period of patients to be operated is one of actual directions of modern cardio surgery. There are scales of risk estimation which sometimes limit an exact prediction of risk or which overrate the risk among patients who undergo valve surgery with or without coronary shunting [9,12,13,14,15].There are intro-operative factors worsening the operation forecast: age, female gender, fraction of LV emission, HF, FC on NYHA, chronic obstructive diseases of lungs, a diabetes, chronic renal insufficiency [3,4].There is convincing data, which say the risk of an early lethality increases if there is immediate surgery among patients of the senior age group and patients with an a trial clottage [5]. These indicators allow estimating results of a wide number of operations on heart. However the analysis and the account of indicators according to which it would be possible to estimate the forecast of operation of АV prosthetics in the postoperative period, taking into account initial data and specificity of operation are poor enough [10,11]. In our research 68 initial anatomic-functional indicators have been the subject of the correlation analysis. The carried analysis has allowed to group indicators in 7 basic groups of factors (F) and to define their influence on the operation forecast: the factor of disturbance of blood circulation (F1) - 4,9 %; the factor of anthropometrical indicators (F2) - 13,8 %; the factor of indicators of the central hemodynamic (F3)-24,2 %; the factor of anatomo-functional indicators of heart (F4)-26,5 %; the factor of indicators of myocardium LV (F5)-8,5 %; the factor of morphology of valves (F6)-6,9%, the factor of valves indicators (F7)-15,2 %. The correlation analysis has shown, that patients with less signs of heart failure (r =-0,346), being in a smaller functional class, have more favorable the operation forecast. Thus these indicators for the operation forecast for patients with АI (r=0,707) was more important, than for group with AS (r=0,580).Patients of a smaller age group (r =-0,626), with smaller Кеtle index (r =-0,324),having smaller value of a cardiothoracic index (r =-0,584) had better operation forecast. Thus dependence on the forecast of operation from CTI was more among patients with АI (r =-0,567).Whereas the influence of an indicator of body surface area on the

Thus, the carried out analysis of influence of initial anatomic-functional indicators on forecasting of results of the aortal valve prosthetics of has shown, that patients with an aortal stenosis and the prevalence of a stenosis are more serious group of defect with less favorable operation forecast, than patients with aortal insufficiency or prevalence of insufficiency. The reason of it is the expressed hypertrophy of LV and IVST having pathological character, with rasping morphological changes in АV in the form of calcification, with transition to FC aortas, the high indicators of a systolic gradient of pressure, with a forwardness of disturbances on a small circle of a blood circulation. Diameter of FC aortas of 2,3-3,5 sm is defined as the optimal size when АV prosthetics will give the best operation forecast as it will allow to implant the adequate prosthesis in both hemodynamic groups. With a smaller size of diameter of an aorta fibrous ring it is necessary to survey adequacy of the effective area of an implanted prosthesis. Value of a transprosthetic gradient of pressure less than 35-40 mm Hg after operation is considered to be optimum indicators which leads to positive results of prosthetics of the aortal valve.

#### **6. References**


**9** 

**Aortic Valve Surgery and** 

*Innsbruck Med. Univ.* 

*Austria* 

**Reduced Ventricular Function** 

Dominik Wiedemann, Nikolaos Bonaros and Alfred Kocher

*Dep. of Cardiac Surgery, Vienna Med. Univ. & Univ. Clinic of Cardiac Surgery,* 

Aortic valve disease is a fatal disease with but a single cure. Removal of the mechanical obstruction in aortic stenosis (surgery or TAVI) and replacement of an incompetent valve

While aortic valve replacement in patients with isolated valve disease and normal pumpfunction of the heart has become a routine procedure and is performed with excellent results all over the world, it can be a rather challenging procedure in severely ill patients with heart failure and comorbidities. Patients with low ejection fraction are one of the most challenging

According to the guidelines for the management of patients with valvular heart disease as recommended by all major heart associations including the European Society of Cardiology, American College of Cardiology, American Heart a ventricular function reduced to below 50% ejection fraction is considered a class I, level of evidence B and C indication respectively

Management of Patients With Valvular Heart Disease, Bonow et al., 2006) Despite this fact there is a high number of patients presenting with severely reduced ventricular function for

In aortic insufficiency 70% have a function reduced to below 50% and around 10% present with a significantly reduced function of less than 30% EF. In case of aortic stenosis the numbers are a less dramatic but still more than 40 % of patients referred for valve surgery

This is due to the fact that aortic valve disease can go unnoticed for a very long time resulting in heart failure at time of presentation. Another fact is that at least some patients

Apart from that, due to the demographic development there is an increasing number of patients with aortic valve disease and advanced age resulting in a high number of elderly

In the scientific literature there are various definitions with different thresholds describing impaired ventricular function in patients undergoing aortic valve surgery. Ali and co-workers

are treated conservatively for a too long period of time until their EF deteriorates.

**1. Introduction** 

aortic valve surgery.

(so far only surgery) are the only treatment options.

for aortic valve surgery. (ACC/AHA 2006 Guidelines for the

patients with more comorbidities and reduced ejection fraction.

patient groups in cardiac surgery.

have an ejection fraction below 50%.

**2. Impaired ventricular function** 

