Long-term analysis of differentiated approach in surgical treatment of patients with isolated aortic stenosis: retrospective study

Background: in modern surgical practice, aortic valve replacement can be performed using: standard replacement by median sternotomy, various minimally invasive approaches and transcatheter methods. However, while each technique has of advantages, it also has a potential concern, that leading to the dilemma of choosing one technique for a particular patient. The aim of our study was to retrospectively analyze the immediate and long-term outcomes of three types of surgical treatment for isolated aortic valve diseases.
Materials and methods: from October 2012 to September 2025, 950 operations - isolated aortic valve replacements were performed in our Center. For each type of operation, was developed indications. According these criteria, all patients were divided for groups: Group I - median sternotomy, Group II - mini-J sternotomy and Group III - TAVI. The mean age in the groups was: 68.1±11.4, 67.8±12.4 and 77.9±10.5 years, respectively (p < 0.001). Female gender predominance: 63.7%, 63.3% and 62.3%, respectively (p = 0.168). The peak gradient in aortic valve was 73.9±19.4, 74.2±19.8 and 76.2±16.6 mmHg (p < 0.001). Overall EuroScore II 2.6±0.5%.
Results: hospital mortality was 1.7%, 1.1% and 3.4%, respectively (p < 0.001). Complications: complete atrioventricular block, ventricular septal defect - didn't differ significantly (p = 1.0). Duration of surgery was: 206.6 ± 22.7, 209.9 ± 20.9 and 65.5 ± 12.5 min. The average follow-up period for group I was 87.7 months, for group II - 85.8 months. and group III - 86.5 months. The 7-year survival rate was 81.2%, 85.1% and 77.2% (Logrank test = 0.014). Freedom from thromboembolic complications at 7 years was 87.5%, 92.5%, and 97.7% (Log-rank test = 0.192).
Conclusion: Applagin differentiated approach for surgical treatment of aortic valve disease, how based on comorbidity and severe aortic valve disease of patients, allows effective and safe surgical treatment of this group of patients and shows good immediate and long-term results.

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