[Dynamics of Quality of Life in Patients With Aortic Stenosis After Aortic Valve Replacement With a Biological or Mechanical Prosthesis].

OBJECTIVE: To assess dynamics of the quality of life (QOL) in patients of the older age group of with initial aortic stenosis in 1, 3, and 5 years after replacement of the aortic valve (AV) with biological or mechanical prosthesis. MATERIALS AND METHODS: QOL was assessed in 282 patients who underwent aortic valve replacement with a biological or mechanical prosthesis. Criterion for inclusion in this retrospective single-center study was primary and elective nature of the operation. Patients with repeated interventions (early postoperative resternotomy, reosteosynthesis, repeat aortic valve surgery) were not included. Using the method of Propensity Score Matching, we distributed 151 patients in whom the long-term results of AV replacement were analyzed according to age, gender, body mass index into groups of AV replacement with biological (group 1, n=74) and mechanical (group 2, n=77) prosthesis. RESULTS: In the early period after operation, there was no significant difference between groups in parameters of quality of life. During the observation period up to 3 years significant increases of parameters bodily pain (BP), vitality (VT), and mental health (MH) occurred in patients with biological prostheses, while physical functioning (PF) was higher in patients with mechanical prostheses. At follow-up to 5 years, indicators such as BP and role emotional functioning (RE) became higher in patients with mechanical prostheses. According to the conducted regression analysis the type of prosthesis affected the quality of life. CONCLUSIONS: 1) AV replacement with mechanical prostheses was associated with lowering of the physical component of health by 81.1%, and of the mental health component - by 56.6% per month; 2) significant difference in QOL between groups of patients with mechanical and biological prostheses could be detected only in 3 years after the operation: parameters BP, VT and MH were significantly higher in patients with biological prostheses, while PF was higher in patients with mechanical prostheses; 3) in the longer observation period (up to 5 years) parameters BP and RE became higher in patients with mechanical prostheses.

[Flowmetric assessment of coronary bypass grafts in the conditions of artificial circulation and on the beating heart].

Advantages and shortcomings of aortocoronary bypass grafting on the beating heart and in the conditions of artificial circulation (AC) have long been discussed. The data on patency of bypass grafts in the remote period are indicative of comparable results of operations with and without AC or advantages of using AC. In order to determine benefits of each method it is necessary to reveal intraoperative predictors of bypass grafts occlusion in the remote period. We analyzed the results of ultrasound flowmetry of the blood flow through the left internal thoracic artery during bypass grafting of the anterior descending artery with the use of AC and on the beating heart. A retrospective study included a total of 352 patients subdivided into 2 groups: Group One was composed of 120 patients undergoing surgery in the conditions of AC and Group Two comprised 232 patients subjected to similar operations on the beating heart. Blood flow was measured with the help of flowmeter VeryQ MediStim® after termination of AC and inactivation of heparin by protamine, with systolic pressure of 100-110 mm Hg. There were no statistically significant differences between the groups by the diameter and degree of stenosis of the anterior descending artery, diameter of the left internal thoracic artery. The mean volumetric blood flow velocity (Qmean) along the shunts in Group One was higher (p=0.01). No statistically significant differences by the pulsatility index (PI) between the groups were revealed (p=0.2). A conclusion was drawn that coronary bypass grafting of the anterior descending artery by the left internal thoracic artery in the conditions of artificial circulation made it possible to achieve higher volumetric velocity of blood flow through the conduit as compared with operations on the beating heart, with similar resistance index. The immediate results of the operations with the use of the both techniques did not differ.