Epidemiological aspects of the aortic valve pathology

Abstract

The dynamics of the structure of aortic valve pathology over the thirty-year (1991–2020) period of operation of the cardiac surgery hospital of the first department and the clinic of surgery for advanced training of doctors of the Military Medical Academy named after S.M. Kirov is evaluated. 849 cases of aortic valve replacement were retrospectively studied (626 (74%) men, 223 (26%) women). The average age of the patients was 51.8 ± 9.7 years. It was established that the main causes of aortic valve damage were rheumocarditis, calcified aortic stenosis, infectious endocarditis and congenital heart disease in the form of a bicuspid aortic valve. A significant decrease in the incidence of rheumatism as a cause of aortic malformation was revealed from 36% in the period from 1991 to 2000 to 13% in the period from 2011 to 2020. The frequency of calcified aortic stenosis during this period, on the contrary, increased from 30% to 70%, respectively. At the same time, the relationship between the increase in life expectancy of the population of the Russian Federation and the frequency of occurrence of calcified aortic stenosis is traced. This is due to a long asymptomatic period that characterizes the natural course of this pathology, as a result of which the clinical manifestations of this pathology manifest, as a rule, only in old age. During the study period, an increase in the average age of patients who needed aortic valve replacement was also noted. If in the last decade of the twentieth century. it was 41.5 years, then in the period from 2011 to 2020, the average age of patients who needed aortic valve replacement increased to 61.5 years. Thus, over the past thirty years, there has been a significant change in the structure of the pathology of the aortic valve. Calcified aortic stenosis has become the most common cause of prosthetics of aortic malformation, against the background of a significant decrease in the frequency of rheumatic genesis of aortic valve damage.

Keywords

acquired heart defects / calcified aortic stenosis / rheumocarditis / aortic valve replacement / infectious endocarditis / bicuspid aortic valve / senile asthenia

References

[1] Olivetti G, Melissari M, Capasso JM, et al. Cardiomyopathy of the aging human heart. Myocyte loss and reactive cellular hypertrophy. Circ Res. 1991;68(6):1560–1568. DOI: 10.1161/01.res.68.6.1560

[2] Olivetti G., Melissari M., Capasso J.M., et al. Cardiomyopathy of the aging human heart. Myocyte loss and reactive cellular hypertrophy // Circ Res. 1991. Vol. 68, No. 6. P. 1560–1568. DOI: 10.1161/01.res.68.6.1560

[3] Skopin II, Otarov AM. Preoperative risk factors for aortic valve prosthetics in elderly and senile patients. Byulleten’ NCSSKH im. A.N. Bakuleva RAMN. 2017;18(3):243–245. (In Russ.). DOI: 10.24022/1810-0694-2017-18-3-243-255

[4] Скопин И.И., Отаров А.М. Предоперационные факторы риска при протезировании аортального клапана у больных пожилого и старческого возраста // Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2017. Т. 18, № 3. С. 243–245. DOI: 10.24022/1810-0694-2017-18-3-243-255

[5] Rossiiskii statisticheskii ezhegodnik. 2020: Stat. sb. Moscow: Rosstat; 2020. 700 p. (In Russ.).

[6] Российский статистический ежегодник. 2020. Стат. сб. М.: Росстат, 2020. 700 с.

[7] Gulyaev NI, Varavin NA, Korovin AE, et al. Modern aspects of the pathogenesis of calcification of aortic half-moons (literature review). Vestnik of Saint Petersburg University. Medicine. 2016;(3):20–34. (In Russ.). DOI: 10.21638/11701/spbu11.2016.302

[8] Гуляев Н.И., Варавин Н.А., Коровин А.Е., и др. Современные аспекты патогенеза кальциноза аортальных полулуний (обзор литературы) // Вестник Санкт-Петербургского университета. 2016. № 3. С. 20–34. DOI: 10.21638/11701/spbu11.2016.302

[9] Thaden JJ, Nkomo VT, Enriquez-Sarano M. The global burden of aortic stenosis. Prog Cardiovasc Dis. 2014;56(6):565–571. DOI: 10.1016/j.pcad.2014.02.006

[10] Thaden J.J., Nkomo V.T., Enriquez-Sarano M. The global burden of aortic stenosis // Prog Cardiovasc Dis. 2014. Vol. 56, No. 6. P. 565–571. DOI: 10.1016/j.pcad.2014.02.006

[11] Shostak NA, Karpova NY, Rashid MA, et al. Calcified aortic stenosis of degenerative genesis-clinical and instrumental indicators. Russian Journal of Cardiology. 2006;11(5):40–44. (In Russ.).

[12] Шостак Н.А., Карпова Н.Ю., Рашид М.А., и др. Кальцинированный аортальный стеноз дегенеративного генеза – клиникоинструментальные показатели // Российский кардиологический журнал. 2006. Т. 11, № 5. С. 40–44.

[13] Woldu B, Bloomfield GS. Rheumatic heart disease in the twenty-first century. Curr Cardiol Rep. 2016;18(10):96. DOI:10.1007/s11886-016-0773-2

[14] Woldu B., Bloomfield G.S. Rheumatic heart disease in the twenty-first century // Curr Cardiol Rep. 2016. Vol. 18, No. 10. P. 96. DOI:10.1007/s11886-016-0773-2

[15] Leal MTBC, Passos LSA, Guarçoni FV, et al. Rheumatic heart disease in the modern era: recent developments and current challenges. Rev Soc Bras Med Trop. 2019;52:e20180041. DOI: 10.1590/0037-8682-0041-2019

[16] Leal M.T.B.C., Passos L.S.A., Guarçoni F.V., et al. Rheumatic heart disease in the modern era: recent developments and current challenges // Rev Soc Bras Med Trop. 2019. Vol. 52. P. e20180041. DOI: 10.1590/0037-8682-0041-2019

[17] Clavel MA, Pibarot P. A decade of revolutions in calcific aortic stenosis. Cardiol Clin. 2020;38(1):13–14. DOI: 10.1016/j.ccl.2019.10.001

[18] Clavel M.A., Pibarot P. A decade of revolutions in calcific aortic stenosis // Cardiol Clin. 2020. Vol. 38, No. 1. P. 13–14. DOI: 10.1016/j.ccl.2019.10.001

[19] Harris AW, Pibarot P, Otto CM. Aortic stenosis: guidelines and evidence gaps. Cardiol Clin. 2020;38(1):55–63. DOI: 10.1016/j.ccl.2019.09.003

[20] Harris A.W., Pibarot P., Otto C.M. Aortic stenosis: guidelines and evidence gaps // Cardiol Clin. 2020. Vol. 38, No. 1. P. 55–63. DOI: 10.1016/j.ccl.2019.09.003

[21] Lindman BR, Clavel MA, Mathieu P, et al. Calcific aortic stenosis. Nat Rev Dis Primers. 2016;2:16006. DOI: 10.1038/nrdp.2016.6

[22] Lindman B.R., Clavel M.A., Mathieu P., et al. Calcific aortic stenosis // Nat Rev Dis Primers. 2016. Vol. 2. P. 16006. DOI: 10.1038/nrdp.2016.6

[23] Roth GA, Huffman MD, Moran AE, et al. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation. 2015;(132):1667–1678. DOI: 10.1016/j.jacc.2017.04.052

[24] Roth G.A., Huffman M.D., Moran A.E., et al. Global and regional patterns in cardiovascular mortality from 1990 to 2013 // Circulation. 2015. Vol. 132, No. 17. P. 1667–1678. DOI: 10.1016/j.jacc.2017.04.052

[25] Frieden TR, Cobb LK, Leidig RC, et al. Reducing premature mortality from cardiovascular and other non-communicable diseases by one third: achieving sustainable development goal indicator 3.4.1. Glob Heart. 2020;15(1):50. DOI: 10.5334/gh.531

[26] Frieden T.R., Cobb L.K., Leidig R.C., et al. Reducing premature mortality from cardiovascular and other non-communicable diseases by one third: achieving sustainable development goal indicator 3.4.1 // Glob Heart. 2020. Vol. 15, No. 1. P. 50. DOI: 10.5334/gh.531

[27] Rajput FA, Zeltser R. Aortic valve replacement. In: StatPearls [Internet] Treasure Island (FL): StatPearls Publishing. 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537136/

[28] Rajput F.A., Zeltser R. Aortic valve replacement. In: StatPearls [Internet] Treasure Island (FL): StatPearls Publishing. 2020. Режим доступа: https://www.ncbi.nlm.nih.gov/books/NBK537136/ Дата обращения: 07.10.2021

[29] Bashir M, Harky A, Bleetman D, et al. Aortic valve replacement: are we spoiled for choice? Semin Thorac Cardiovasc Surg. 2017;29(3):265–272. DOI: 10.1053/j.semtcvs.2017.08.003

[30] Bashir M., Harky A., Bleetman D., et al. Aortic valve replacement: are we spoiled for choice? // Semin Thorac Cardiovasc Surg. 2017. Vol. 29, No. 3. P. 265–272. DOI: 10.1053/j.semtcvs.2017.08.003

[31] Liu M, Lu L, Sun R. Rheumatic heart disease: causes, symptoms, and treatments. Cell Biochem Biophys. 2015;72(3):861–863. DOI: 10.1007/s12013-015-0552-5

[32] Liu M., Lu L., Sun R. Rheumatic heart disease: causes, symptoms, and treatments // Cell Biochem Biophys. 2015. Vol. 72, No. 3. P. 861–863. DOI: 10.1007/s12013-015-0552-5

[33] Shikhverdiev NN, Ushakov DI, Peleshok AS, et al. Biological age and its role in the stratification of cardiac surgical risk. Grekov’s Bulletin of Surgery. 2019;178(1):17–20. (In Russ.). DOI: 10.24884/0042-4625-2019-178-1-17-20

[34] Шихвердиев Н.Н., Ушаков Д.И., Пелешок А.С., и др. Биологический возраст и его роль в стратификации кардиохирургического риска // Вестник хирургии им. И.И. Грекова. 2019. Т. 178, № 1. С. 17–20. DOI: 10.24884/0042-4625-2019-178-1-17-20

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Gordienko A.V., Shikhverdiev N.N.