научные стать ВАК, РИНЦ, Scopus, Web of Science

Valvular heart disease (VHD) is an underestimated cause of disability, morbidity, reduced quality of life, and premature mortality [1]. In the general population, the age-adjusted prevalence of moderate or severe VHD comprised 2.5% [2], with the further prevalence increase from 0.7% in 18–44-year-olds to 13.3% in the 75 years and older group [3]. The marked undertreatment of patients with VHD is clearly apparent in the steady increase in the number of surgical and transcatheter interventions [4]. Currently, the most common treatment for VHD is surgical heart valve replacement with either mechanical or tissue valve prosthesis, with approximately 250,000–300,000 replacements globally per year [5]. Mechanical heart valves (MHV) are commonly implanted in 55% of cases, whereas tissue heart valves (THV) are chosen in 45% of cases [6]. The decision-making process on optimal heart valve substitutes is driven mainly by patients’ own choice, age, contraindications to anticoagulation therapy, and place of residence [7]. Despite the superior durability of MHV, high shear stresses may cause the activation of blood elements and initiation of platelet aggregation, causing thrombus formation. Therefore, MHV recipients need to take life-long anticoagulation therapy to prevent thromboembolic events. THV that mimic native valves do not require such therapy but have a rather limited lifespan due to structural valve degradation, including calcification (Figure 1) [8]. THV recipients will require reoperation in 13.4–36.6% of cases within five years after the index surgery [9]. Each reoperation is associated with a higher rate of perioperative complications and mortality due to the present comorbidities, advanced age, and surgical complexity itself [9]. Recently emerged minimally invasive percutaneous procedures, such as transcatheter aortic valve replacement (TAVR), have indicated a tendency towards a wider application of THV [10]. Transcatheter approaches are used either for the first heart valve replacement or for a redo «valve-in-valve» implantation [11]. All recent commercially available transcatheter systems have proved promising results, especially in the elderly group with contraindications to surgical aortic valve replacement [7,12]. However, the use of thinner pericardium and biomaterial micro-damages during crimping questions the long-term TAVR durability and freedom from SVD, taking into account the expansion of indications to lower- and moderate-risk patient groups [13,14].