| Abstract | UVOD: Aortalna regurgitacija (AR) je stanje u kojem dolazi do prekomjernoga povrata krvi iz aorte u lijevi ventrikul (LV) za vrijeme dijastole. Kirurška terapija AR može uključivati operativni zahvat s očuvanjem zalistaka (AVRep) s ili bez zamjene korijena i uzlazne aorte ili zamjenu zaliska (AVR). ----- METODE I ISPITANICI: U istraživanje je uključeno 158 bolesnika (30 žena i 128 muškaraca, prosječne dobi 53,7 ± 14,1 godina) operiranih zbog AR u Kliničkoj bolnici Dubrava u razdoblju od 2014. – 2020. godine. AVRep metodom operirano je 107, a AVR 58 bolesnika. Značajno je više bolesnika s NYHA statusom I (30 vs 10, p = 0,002) i II (68 vs 28, p < 0,001) operirano AVRep metodom. Bolesnicima je učinjena transtorakalna ehokardiografija predoperativno, postoperativno i u praćenju. ----- REZULTATI: Postoperativno, zabilježeno je značajno više bolesnika s neznatnom (27 vs 2, p < 0,001) i blagom AR (14 vs 0, p < 0,001) operiranih AVRep nego AVR metodom. Postoperativno, nije bilo značajne razlike u istisnoj frakciji (LVEF) niti promjerima LV među skupinama. Zabilježen je prvotni postoperativni pad LVEF pa značajno veći porast u praćenju operiranih AVRep nego AVR metodom (58,6 ± 9,00 % vs 54,4 ± 10,10 %, p = 0,005). Multiplom regresijskom analizom uočen je blago negativan utjecaj AVR metode na LVEF u praćenju u odnosu na AVRep, izraženiji u starijih muškaraca (β = - 4,21, R2 = 0,0431, p = 0,009). ----- ZAKLJUČAK: AVRep se pokazala kao metoda izbora kod bolesnika s dilatacijom korijena aorte i neznačajno promijenjenim zaliscima. U odnosu na AVR, AVRep rezultira manjim mortalitetom i manjom incidencijom tromboembolijskih događaja. Također, nakon AVRep metode uočen je značajno bolji oporavak funkcije LV, pogotovo u žena i mlađih. |
| Abstract (english) | INTRODUCTION: Aortic regurgitation (AR) is a state of excessive blood return from aorta to the left ventricle (LV) during diastole. Surgical therapy of AR includes valve-sparing surgery (AVRep) with or without root and ascending aorta replacement or valve replacement (AVR). ----- METHODS: The research included a total of 158 patients (30 women and 128 men, the average age 53.7 ± 14.1 years) who underwent a surgical treatment for AR in Clinical hospital Dubrava between the 2014 and 2020. AVRep was used in 107, and AVR in 58 patients. Significantly more patients with NYHA grade I (30 vs 10, p = 0.002) and II (68 vs 28, p < 0.001) underwent AVRep. Patients had done the preoperative, postoperative and follow-up transthoracal echocardiography. ----- RESULTS: Significantly more patients were noted to undergo AVRep than AVR with postoperative trivial (27 vs 2, p < 0.001) and mild (14 vs 0, p < 0.001) AR. There was no significant difference between the groups in ejectic fraction (LVEF) and LV diameters postoperatively. An initial postoperative decrease of LVEF, and later increase in LVEF was noted, but significantly more after AVRep than AVR (58.6 ± 9.00 % vs 54.4 ± 10.10 %, p = 0.005). A multiple regression analysis enhanced a slight negative effect of AVR method on LVEF in follow-up in comparison to AVRep, more pronounced in older men (β = - 4,21, R2 = 0,0431, p = 0,009). ----- CONCLUSION: AVRep has shown to be a method of choice for patients with the dilatation of the aortic root and slightly deformed valves. In comparison to AVR, AVRep results in lower mortality and lower incidence of thromboembolic events. The AVRep showed a significant LV function recovery as well, especially in women and younger. |
