**4. Discussion**

146 Aortic Valve Surgery

Almost all indicators of myocardial function parameters **(F5)** had average return correlation

**idPLVWT**

Prognosis *Avppg*

0 20 40 60 80 100

Fig. 5. Influence of an index of myocardium mass on the operation forecast

Fig. 4. Correlation of an indicator with the forecast and a systolic gradient of pressure

*0.692 0.663*

*-0.603 -0.608 -0.631 -0.641 -0.627*

**dIVST**

**idVST**

**Prognosis, %**

*0.797 0.773*

*0.839*

**2HD**

close to a strong one (r <-0,603) (Fig. 4).

*0.267 0.247*

*-0.427*

**LVMM**

*-0.469*

0

100

200

300

iLVMM

400

500

**iLVMM**

**dPLVWT**

Revealing of the indicators, which reference values can define the percent of a favorable outcome of operation, prognosticate possible complications, as well as an estimation of

Forecasting of the Possible Outcome of Prosthetics of the Aortal Valve on

Microsoft Excel - 2003 in a package «Microsoft Office 2003».

**5. Conclusions** 

**6. References** 

Heart J 2000; 21:1032-1033.

<http://intl-ejcts.ctsnetjournals.org/cgi/ijlink?

Preoperational Anatomo-Functional Hemodynamics and According to Heart Indicators 149

operation forecast was shown more among patients with АS (r=0,363). Influence of indicators characterising a functional condition of the central hemodynamics had moderate correlation with the operation forecast (r=0,424). One of significantly influencing the operation forecast is anatomo-functional indicators in both hemodynamic groups was SV (r=0,596). The ejection fraction of LV influenced the operation forecast in group of patients with АI (r=0,402) more, than in group with АS (r=0,284). The most significant influence was exerted by the indicators characterizing the degree of a myocardium hypertrophies(r=0,839), testifying that the operation forecast is mainly influenced by the condition of initial myocardium. IVST hypertrophy expression (r =-0,407) is a bad prognostic sign, both in case of stenosis of the aortal valve, and at its insufficiency. Calcification expression АV (r =- 0,563), regurgitation degree on АV (r = 0,639), changes in MV (r =-0,298) and ТV (r =-0,631), expression of an initial systolic gradient of pressure (r =-0,649) negatively affect the operation forecast. As a result of the carried out research there is the prognostic model with calculation of14 various indicators, with prediction reliability of 75-90 % on the basis of which «the Program of forecasting of probability of a favorable outcome of surgical treatment of defects of the aortal valve» in medium "Excel - 2000" has been made and tested. This model is also devoted to forecasting of the surgical treatment results. Type of the realizing COMPUTER - personal computer Intel Celeron (2500 GHz), the programming language - "Visual Basic for Application", a kind and the version of operational system -

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.

[1] Braunwald E. Aortic valve replacement: an update at the turn of the millennium. Eur

[2] Cohen G, David TE, Ivanov J, Armstrong S, Feindel CM. The impact of age, coronary

valve replacement. J Thorac Cardiovasc Surg 1999; 117:273-284.

linkType=ABST&journalCode=jtcs&resid=117/2/273>

artery disease, and cardiac comorbidity on late survival after bioprosthetic aortic

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 operation forecast was shown more among patients with АS (r=0,363). Influence of indicators characterising a functional condition of the central hemodynamics had moderate correlation with the operation forecast (r=0,424). One of significantly influencing the operation forecast is anatomo-functional indicators in both hemodynamic groups was SV (r=0,596). The ejection fraction of LV influenced the operation forecast in group of patients with АI (r=0,402) more, than in group with АS (r=0,284). The most significant influence was exerted by the indicators characterizing the degree of a myocardium hypertrophies(r=0,839), testifying that the operation forecast is mainly influenced by the condition of initial myocardium. IVST hypertrophy expression (r =-0,407) is a bad prognostic sign, both in case of stenosis of the aortal valve, and at its insufficiency. Calcification expression АV (r =- 0,563), regurgitation degree on АV (r = 0,639), changes in MV (r =-0,298) and ТV (r =-0,631), expression of an initial systolic gradient of pressure (r =-0,649) negatively affect the operation forecast. As a result of the carried out research there is the prognostic model with calculation of14 various indicators, with prediction reliability of 75-90 % on the basis of which «the Program of forecasting of probability of a favorable outcome of surgical treatment of defects of the aortal valve» in medium "Excel - 2000" has been made and tested. This model is also devoted to forecasting of the surgical treatment results. Type of the realizing COMPUTER - personal computer Intel Celeron (2500 GHz), the programming language - "Visual Basic for Application", a kind and the version of operational system - Microsoft Excel - 2003 in a package «Microsoft Office 2003».
