CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 98 AFRICA (p < 0.001). The EF value was statistically significantly increased in the postoperative period (p = 0.008) (Table 3). The amount of variation between postoperative and pre-operative values was analysed and the direction of change, percentage change and standard deviation values are given in Table 4. The pre- and postoperative echocardiographic findings were separately investigated in the four valve groups. Mean values for LVEDD, LVESD, maximum gradient, mean gradient, LVM and LVMI showed statistically significant reductions in the postoperative period in all groups. For EF, in spite of the increase in all groups, this increase was found to be significant only in the sutureless valve group (p = 0.006) (Table 5). The difference between pre- and postoperative echocardiographic findings were analysed according to the PPM classification of patients (IEOA severe, moderate, normal). The distribution of severe, moderate and normal PPM in the four valve groups was 20, 73.4 and 6.6% in the bovine pericardial valve group (n = 15); 9, 73 and 18% in the porcine valve group (n = 33); 5.4, 36.4 and 58.2% in the mechanical valve group (n = 74); and 0, 29.7 and 70.3% in the sutureless valve group (n = 54). In all groups, a decrease was observed for LVEDD, LVESD, maximum gradient, mean gradient, LVM and LVMI. Only LVEDD did not show a significant change in the severe PPM group (p = 0.23), while statistically significant decreases were observed in the other groups. PAP did not show significant decrease in the severe PPM group (p = 0.20), while there were significant decreases in the moderate PPM (p = 0.02) and normal PPM groups (p = 0.001). EF revealed a significant increase only in the normal PPM group (p = 0,001), while a decrease was seen in the severe PPM group (p = 0.19) (Table 6). One-year postoperative echocardiographic aortic valve assessment revealed minimum valvular aortic regurgitation (AR) in 95.4% of patients (n = 168), with first-degree valvular AR in 2.8% of patients (n = 5) and second-degree paravalvular AR in 1.7% of patients (n = 3). Postoperative assessment identified newly developing AF in 21.6% of patients (n = 43), cerebrovascular events in 6% of patients (n = 12), full atrioventricular block in 3.5% of patients (n = 7) and end-stage renal failure in 1.5% of patients (n = 3). At the end of the first year, 11.5% of patients had died (n = 23) and 88.5% of patients survived (n = 176). Table 3. General comparison of pre-operative and first year postoperative echocardiographic findings of the patients Parameters Pre-operative echocardiography Postoperative echocardiography p-value Ascending aortic diameter, cm 4.04 ± 0.30 4.22 ± 0.30 0.27 EF, % 54.87 ± 7.84 55.98 ± 6.20 0.008 LVEDD, cm 4.77 ± 0.74 4.54 ± 0.51 < 0.001 LVESD, cm 3.00 ± 0.70 2.76 ± 0.55 < 0.001 Maximum gradient, mmHg 84.64 ± 19.41 24.63 ± 11.17 < 0.001 Mean gradient, mmHg 52.46 ± 13.83 13.50 ± 6.85 < 0.001 PAP, mmHg 36.16 ± 10.46 32.82 ± 7.57 < 0.001 LVM, g 228.76 ± 66.61 185.29 ± 44.42 < 0.001 LVMI, g/m2 124.15 ± 34.46 100.35 ± 22.31 < 0.001 EF: ejection fraction; LVEDD: left ventricular end-diastolic diameter; LVESD: left ventricular end-systolic diameter; PAP: pulmonary artery pressure; LVM: left ventricular mass; LVMI: left ventricular mass index. Table 4. Analysis of the amount of postoperative change, percentage of change and direction of change in echocardiographic parameters compared to pre-operative data Parameters Range of change Direction of change Percentage change (%) Amount of change (mean ± SD) Δ EF, % Pre-operative ↑ 2.93 ± 11.46 1.01 ± 4.79 Postoperative Δ LVEDD, cm Pre-operative ↓ 24.03 ± 383.83 0.23 ± 0.65 Postoperative Δ LVESD, cm Pre-operative ↓ 6.05 ± 18.01 0.24 ± 0.55 Postoperative Δ LVM, g Pre-operative ↓ 16.21 ± 18.64 44.56 ± 52.47 Postoperative Δ LVMI, g/m2 Pre-operative ↓ 16.25 ± 18.64 24.17 ± 27.96 Postoperative Δ Maximum gradıent, mmHg Pre-operative ↓ 69.40 ± 15.66 60.01 ± 27.96 Postoperative Δ Mean gradient, mmHg Pre-operative ↓ 72.99 ± 15.34 39.62 ± 15.55 Postoperative Δ Ascending aorta diameter, cm Pre-operative ↑ 2.85 ± 7.02 0.10 ± 0.27 Postoperative Δ PAP, mmHg Pre-operative ↓ 3.69 ± 23.75 2.58 ± 9.07 Postoperative Δ: difference between postoperative and pre-operative values; ↑: increase; ↓: decrease; EF: ejection fraction; LVEDD: left ventricular end-diastolic diameter; LVESD: left ventricular end-systolic diameter; PAP: pulmonary artery pressure; LVM: left ventricular mass; LVMI: left ventricular mass index. Summary of valve brands used Sorin SJM Edwards Medtronic Liva Nova Frequency 60 45 30 15 0 39 53 24 33 50 Fig. 1. Subgroups and statistical distribution of valve brands used. Table 2. Statistical analysis of first year postoperative echocardiographic data by valve type Echocardiographic data Porcine valve (mean ± SD) Bovine pericardial valve (mean ± SD) Sutureless valve (mean ± SD) Mechanical valve (mean ± SD) p-value EF, % 54.85 ± 6.79 55.67 ± 4.95 56.20 ± 6.51 56.40 ± 5.95 0.39 LVEDD, cm 4.53 ± 0.43 4.57 ± 0.57 4.46 ± 0.45 4.59 ± 0.57 0.89 LVESD, cm 2.73 ± 0.42 2.84 ± 0.67 2.66 ± 0.54 2.82 ± 0.59 0.29 Maximum gradient, mmHg 27.79 ± 11.60 23.73 ± 8.77 19.87 ± 7.67 26.85 ±12.47 0.001 Mean gradient, mmHg 15.67 ± 7.89 13.07 ± 5.12 11.04 ± 4.79 14.40 ± 7.48 0.007 PAP, mmHg 34.45 ± 7.55 35.20 ± 7.99 34.20 ± 9.166 30.63 ± 5.54 0.013 LVM, g 180.27 ± 31.70 200.60 ± 50.92 178.42 ± 33.88 189.38 ± 53.24 0.54 LVMI, g/m2 97.12 ± 20.01 104.40 ± 26.44 101.14 ± 17.81 100.38 ± 25.36 0.51 EF: ejection fraction; LVEDD: left ventricular end-diastolic diameter; LVESD: left ventricular end-systolic diameter; PAP: pulmonary artery pressure; LVM: left ventricular mass; LVMI: left ventricular mass index.
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