CALCIFIC AORTIC STENOSIS: MARKERS OF SEVERITY AND APPROACHES TO THE TREATMENT OF PATIENTS WITH DIFFERENT SURGICAL RISKS (LITERATURE REVIEW)

Calcific aortic stenosis is one of the most common valvular heart diseases, which may require surgery. Regardless of the etiology, the consequence of this disease is concentric hypertrophy of the left ventricle and progressive myocardial fibrosis, independently affecting the long-term survival of patients after aortic valve replacement. “Open” surgical or transcatheter aortic valve replacement is the only effective way to treat aortic stenosis. “Open” surgical procedure remains the “gold standard”, however, transcatheter aortic valve replacement is characterized by rapid development and expansion to the population of moderate and low-risk patients. For a comparative assessment of the effectiveness and safety of transcatheter and “open” surgical procedures in patients of different risk categories, OBSERVANT, NOTION, PARTNER, PARTNER 2, PARTNER 3 studies were conducted, but on their basis, it is impossible to draw an unambiguous conclusion about the advantage of one or another method. An “intermediate” option for surgical correction of aortic stenosis in conditions of extracorporeal circulation and cardioplegia, possibly combining the advantages of classical surgical and transcatheter methods, is the replacement of the aortic valve with mini-invasive access and, in some cases, using seamless aortic valve prostheses. Thus, the question of the optimal method of correction of severe aortic stenosis in patients with moderate and high surgical risk remains open. In the process of managing such patients, it is important to take into account the individual characteristics of patients and strive to personalize treatment.

1. Coffey S, Roberts-Thomson R, Brown A, Carapetis J, Chen M, Enriquez-Sarano M, et al. Global epidemiology of valvular heart disease. Nature Reviews Cardiology. 2021.

2. Kanwar A, Thaden JJ, Nkomo VT. Management of patients with aortic valve stenosis. Mayo Clinic proceedings. 2018;93(4):488–508.

3. Lindman BR, Clavel MA, Mathieu P, Iung B, Lancellotti P, Otto CM, et al. Calcific aortic stenosis. Nat Rev Dis Primers. 2016;2:16006.

4. Thaden JJ, Nkomo VT, Enriquez-Sarano M. The global burden of aortic stenosis. Progress in cardiovascular diseases. 2014;56(6):565–71.

5. Eveborn GW, Schirmer H, Heggelund G, Lunde P, Rasmussen K. The evolving epidemiology of valvular aortic stenosis. the Tromsø study. Heart (British Cardiac Society). 2013;99(6):396–400.

6. Bing R, Cavalcante JL, Everett RJ, Clavel MA, Newby DE, Dweck MR. Imaging and impact of myocardial fibrosis in aortic stenosis. JACC Cardiovascular imaging. 2019;12(2):283–96.

7. Badhwar V, Rankin JS, Ad N, Grau-Sepulveda M, Damiano RJ, Gillinov AM, et al. Surgical ablation of atrial fibrillation in the United States: trends and propensitymatched outcomes. The Annals of thoracic surgery. 2017;104(2):493–500.

8. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. European heart journal. 2017;38(36):2739–91.

9. Hiratzka LF, Creager MA, Isselbacher EM, Svensson LG, Nishimura RA, Bonow RO, et al. Surgery for aortic dilatation in patients with bicuspid aortic valves: A statement of clarification from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. The Journal of thoracic and cardiovascular surgery. 2016;151(4):959–66.

10. Harris AW, Pibarot P, Otto CM. Aortic stenosis: guidelines and evidence gaps. Cardiology clinics. 2020;38(1):55–63.

11. Katbeh A, Ondrus T, Barbato E, Galderisi M, Trimarco B, Van Camp G, et al. Imaging of myocardial fibrosis and Its functional correlates in aortic stenosis: a review and clinical potential. Cardiology. 2018;141(3):141–9.

12. Calin A, Mateescu AD, Popescu AC, Bing R, Dweck MR, Popescu BA. Role of advanced left ventricular imaging in adults with aortic stenosis. Heart (British Cardiac Society). 2020;106(13):962–9.

13. Herrmann S, Fries B, Salinger T, Liu D, Hu K, Gensler D, et al. Myocardial fibrosis predicts 10-year survival in patients undergoing aortic valve replacement. Circulation Cardiovascular imaging. 2018;11(8):e007131.

14. Aboyans V, Ricco JB, Bartelink MEL, Bjorck M, Brodmann M, Cohnert T, et al. 2017 ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the diagnosis and treatment of peripheral arterial diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). European heart journal. 2018;39(9):763–816.

15. Gallo G, Presta V, Volpe M, Rubattu S. Molecular and clinical implications of natriuretic peptides in aortic valve stenosis. Journal of molecular and cellular cardiology. 2019;129:266–71.

16. Villar AV, García R, Merino D, Llano M, Cobo M, Montalvo C, et al. Myocardial and circulating levels of microRNA-21 reflect left ventricular fibrosis in aortic stenosis patients. International journal of cardiology. 2013;167(6):2875–81.

17. Wojciechowska A, Braniewska A, KozarKamińska K. MicroRNA in cardiovascular biology and disease. Adv Clin Exp Med. 2017;26(5):865–74.

18. Fabiani I, Scatena C, Mazzanti CM, Conte L, Pugliese NR, Franceschi S, et al. Micro-RNA-21 (biomarker) and global longitudinal strain (functional marker) in detection of myocardial fibrotic burden in severe aortic valve stenosis: a pilot study. J Transl Med. 2016;14(1):248.

19. Fabiani I, Pugliese NR, Calogero E, Conte L, Mazzanti MC, Scatena C, et al. MicroRNAs distribution in different phenotypes of Aortic Stenosis. Scientific reports. 2018;8(1):9953.

20. Bakaeen FG, Rosengart TK, Carabello BA. Aortic stenosis. Annals of internal medicine. 2017;166(1):Itc1-itc16.

21. Koh LY, Hwang NC. Frailty in cardiac surgery. Journal of cardiothoracic and vascular anesthesia. 2019;33(2):521–31.

22. Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al. Frailty assessment in the cardiovascular care of older adults. Journal of the American College of Cardiology. 2014;63(8):747–62.

23. Clark MA, Duhay FG, Thompson AK, Keyes MJ, Svensson LG, Bonow RO, et al. Clinical and economic outcomes after surgical aortic valve replacement in Medicare patients. Risk Manag Healthc Policy. 2012;5:117–26.

24. Bokeria LA (editor). Cardiovascular surgery. 2019. М.: Bakoulev NMRCCVS; 2020. 294 p. (In Russ.)

25. Skopin II, Otarov AM, Kakhktsyan PV, Asatryan TV, Kurbanov ShM, Paronyan KhV. Aortic valve replacement in elderly and senile patients: analysis of preoperative risk factors. Complex problems of cardiovascular diseases. 2018;7(4S):24–35. (In Russ.)

26. Arora S, Misenheimer JA, Ramaraj R. Transcatheter aortic valve replacement: comprehensive review and present status. Texas Heart Institute journal / from the Texas Heart Institute of St Luke‘s Episcopal Hospital, Texas Children‘s Hospital. 2017;44(1):29–38.

27. Jones BM, Krishnaswamy A, Tuzcu EM, Mick S, Jaber WA, Svensson LG, et al. Matching patients with the ever-expanding range of TAVI devices. Nature reviews Cardiology. 2017;14(10):615–26.

28. Osnabrugge RL, Mylotte D, Head SJ, Van Mieghem NM, Nkomo VT, LeReun CM, et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. Journal of the American College of Cardiology. 2013;62(11):1002–12.

29. Dasi LP, Hatoum H, Kheradvar A, Zareian R, Alavi SH, Sun W, et al. On the mechanics of transcatheter aortic valve replacement. Annals of biomedical engineering. 2017;45(2):310–31.

30. Abramowitz Y, Jilaihawi H, Chakravarty T, Mack MJ, Makkar RR. Porcelain aorta: a comprehensive review. Circulation. 2015;131(9):827–36.

31. Barbanti M, Tamburino C, D‘Errigo P, Biancari F, Ranucci M, Rosato S, et al. Five-year outcomes of transfemoral transcatheter aortic valve replacement or surgical aortic valve replacement in a real world population. Circ Cardiovasc Interv. 2019;12(7):e007825.

32. Thyregod HG, Steinbrüchel DA, Ihlemann N, Nissen H, Kjeldsen BJ, Petursson P, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the allcomers NOTION randomized clinical trial. Journal of the American College of Cardiology. 2015;65(20):2184–94.

33. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. The New England journal of medicine. 2016;374(17):1609–20.

34. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in lowrisk patients. The New England journal of medicine. 2019;380(18):1695–705.

35. Cao C, Liou KP, Pathan FK, Virk S, McMonnies R, Wolfenden H, et al. Transcatheter aortic valve implantation versus surgical aortic valve replacement: meta-analysis of clinical outcomes and costeffectiveness. Curr Pharm Des. 2016;22(13):1965–77.

36. Magovern GJ, Cromie HW. Sutureless prosthetic heart valves. The Journal of thoracic and cardiovascular surgery. 1963;46:726–36.

37. Pfeiffer S, Fischlein T, Santarpino G. Sutureless Sorin Perceval aortic valve implantation. Seminars in thoracic and cardiovascular surgery. 2017;29(1):1–7.

38. Gotzmann M, Wilbring M, Charitos E, Treede H, Silaschi M. Hemodynamic comparison of sutureless and rapid-deployment valves with conventional bioprostheses. The Thoracic and cardiovascular surgeon. 2020;68(7):584–94.

39. Vola M, Fuzellier JF, Anselmi A, Campisi S, Haber B, Isaaz K, et al. Sutureless 3F Enable valve replacement for pure aortic regurgitation. J Card Surg. 2015;30(11):796–800.

40. Ng ACT, Prihadi EA, Antoni ML, Bertini M, Ewe SH, Ajmone Marsan N, et al. Left ventricular global longitudinal strain is predictive of all-cause mortality independent of aortic stenosis severity and ejection fraction. European heart journal cardiovascular Imaging. 2018;19(8):859–67.