EVALUATION OF HEMODYNAMIC AND BIOMARKER CHANGES IN PATIENTS UNDERGOING SURGICAL AORTIC VALVE REPLACEMENT

Dimce  Slaveski; Dragana Lončar-Stojiljković; Aleksandra Gavrilovska Brzanov; Marija  Bozhinovska; Haris Sulejmani; Marija Jovanovski Srceva

doi:10.5937/sanamed0-61650

Dimce Slaveski University of Banja Luka, Faculty of Medicine, Banja Luka, Bosnia and Herzegovina
Dragana Lončar-Stojiljković ¹ University of Banja Luka, Faculty of Medicine, Banja Luka, Bosnia and Herzegovina; ² Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
Aleksandra Gavrilovska Brzanov 1. University Clinic for Traumatology, Orthopedic Diseases, Anesthesiology, Reanimation and Intensive Care, and Emergency Medicine, Skopje, North Macedonia; 2. Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, North Macedonia
Marija Bozhinovska University Medical Centre Ljubljana, Clinical Department of Anaesthesiology and Perioperative Intensive Therapy, Ljubljana, Slovenia
Haris Sulejmani Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, Skopje, North Macedonia
Marija Jovanovski Srceva 1. University Clinic for Traumatology, Orthopedic Diseases, Anesthesiology, Reanimation and Intensive Care, and Emergency Medicine, Skopje, North Macedonia; 2. Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, Skopje, North Macedonia

DOI: https://doi.org/10.5937/sanamed0-61650

Keywords: Aortic stenosis, aortic valve replacement, lactate, creatine kinase–MB isoenzyme, biomarkers

Abstract

Background: Aortic stenosis (AS) is a systemic disease characterized by valvular obstruction, ventricular remodeling, and perioperative vulnerability to oxygen supply–demand imbalance. This study evaluated perioperative metabolic and biomarker dynamics and early postoperative outcomes in patients undergoing surgical aortic valve replacement (AVR).

Patients and Methods: A prospective observational study was conducted on 60 consecutive adults with severe AS who underwent surgical AVR at a single center. Demographics, anthropometric data, intraoperative variables, complications, and pre- and postoperative hemodynamic and laboratory parameters were evaluated. Postoperatively, the following were assessed at 6 and 24 hours: mean arterial pressure (MAP), arterial oxygen saturation (SaO₂), partial pressure of oxygen (PaO₂), pH, partial pressure of carbon dioxide (PaCO₂), hemoglobin (Hb), lactate, and creatine kinase–MB isoenzyme (CK-MB). Continuous data are presented as mean ± standard deviation (SD) or median (interquartile range, IQR). Paired t-tests were used to compare values between 6 and 24 hours.

Results: The mean age was 69.9 ± 7.3 years; 58.3% were male. Mean anesthesia and operation times were 151.5 ± 21.8 and 126.8 ± 20.6 minutes, respectively; mean cardiopulmonary bypass (CPB) and cross-clamp times were 78.3 ± 17.6 and 58.5 ± 16.7 minutes. Nearly half of the patients (46.7%) had no postoperative complications; others experienced bleeding (16.7%), arrhythmias requiring therapy (6.7%), permanent pacemaker implantation (8.3%), re-exploration (6.7%), infection (8.3%), respiratory failure (3.3%), or renal failure (3.3%). From 6 to 24 hours postoperatively, lactate decreased (2.34 ± 0.96 →1.87 ± 0.98 mmol/L; p = 0.006) and CK-MB declined (52.5 ± 34.2 →39.0 ± 30.8 U/L; p = 0.001), while Hb increased (103.5 ± 10.1 →120.1 ± 22.9 g/L; p < 0.001). pH decreased modestly (7.396 ± 0.057 →7.365 ± 0.065; p = 0.015). MAP, SaO₂, PaO₂, and PaCO₂ showed no significant changes. The median hospital stay was 7 days (IQR 6–8).

Conclusions: In patients undergoing surgical AVR for AS, early postoperative trends demonstrated an improving metabolic profile (lower lactate) and biomarker normalization (CK-MB) with stable oxygenation, alongside low-to-moderate complication rates and a consistent 7-day median stay. Integrating perioperative oxygen-balance markers and cardiac biomarkers with imaging and left ventricular hypertrophy (LVH) assessment may refine timing and risk stratification for intervention. Prospective studies with standardized imaging and longer follow-up are warranted to link early metabolic recovery with ventricular remodeling and clinical outcomes.

References

Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632. doi: 10.1093/eurheartj/ehab395.

Bakaeen FG, Rosengart TK, Carabello BA. Aortic stenosis. Ann Intern Med. 2017;166(1):ITC1-16. doi: 10.7326/AITC201701030.

Bäck M, Marie PY. Valve, ventricle, and vessel: the triumvirate of aortic stenosis assessment. Circ Cardiovasc Imaging. 2016;9(3):e004590. doi: 10.1161/CIRCIMAGING.116.004590.

Bennett J, Thornton GD, Nitsche C, Gama FF, Aziminia N, Gul U, et al. Left ventricular hypertrophy in aortic stenosis: early cell and matrix regression 2 months post-aortic valve replacement. Circ Cardiovasc Imaging. 2024;17(12):e017425. doi: 10.1161/CIRCIMAGING.124.017425.

Mahmod M, Chan K, Fernandes JF, Ariga R, Raman B, Zacur E, et al. Differentiating left ventricular remodeling in aortic stenosis from systemic hypertension. Circ Cardiovasc Imaging. 2024;17(8):e016489. doi: 10.1161/CIRCIMAGING.123.016489

Barletta G, Del Bene MR, Venditti F, Pilato G, Stefàno P. Surgical aortic valve replacement and left ventricular remodeling: survival and sex-related differences. Echocardiography. 2021;38(7):1095-103. doi:10.1111/echo.15122.

Baumgartner H, Hung J, Bermejo J, Chambers JB, Edvardsen T, Goldstein S, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography.. J Am Soc Echocardiogr. 2017;30(4):372-92. doi: 10.1016/j.echo.2017.02.009.

Mahon C, Mohiaddin RH. The emerging applications of cardiovascular magnetic resonance imaging in transcatheter aortic valve implantation. Clin Radiol. 2021;76(1):73.e21-73.e37. doi: 10.1016/j.crad.2019.11.011.

Charitakis K, Nguyen TC. Severe symptomatic aortic stenosis? Check troponin, too. J Am Heart Assoc. 2019;8(6):e012156. doi: 10.1161/JAHA.119.012156.

Khuong JN, Liu Z, Campbell R, Jackson SM, Borg Caruana C, Ramson DM, et al Troponin as a predictor of outcomes in transcatheter aortic valve implantation: systematic review and meta-analysis. Gen Thorac Cardiovasc Surg. 2023;71(1):12-19. doi: 10.1007/s11748-022-01888-2.

Jakobsson J, Vadman S, Hagel E, Kalman S, Bartha E. The effects of general anaesthesia on oxygen consumption: A meta-analysis guiding future studies on perioperative oxygen transport. Acta Anaesthesiol Scand. 2019;63(2):144-153. doi: 10.1111/aas.13265.

Lugo G, Arizpe D, Domínguez G, Ramírez M, Tamariz O. Relationship between oxygen consumption and oxygen delivery during anesthesia in high-risk surgical patients. Crit Care Med. 1993;21(1):64-9. doi: 10.1097/00003246-199301000-00014.

Généreux P, Pibarot P, Redfors B, Mack MJ, Makkar RR, Jaber WA, et al. Staging classification of aortic stenosis based on cardiac damage. Eur Heart J. 2017;38(45):3351-8. doi: 10.1093/eurheartj/ehx381.

Généreux P, Pibarot P, Redfors B, Bax JJ, Zhao Y, Makkar RR, et al. Evolution and prognostic impact of cardiac damage after aortic valve replacement. J Am Coll Cardiol. 2022;80(8):783-800. doi: 10.1016/j.jacc.2022.05.006.

Jørgensen TH, Thyregod HGH, Savontaus M, Willemen Y, Bleie Ø, Tang M, et al. Transcatheter aortic valve implantation in low-risk tricuspid or bicuspid aortic stenosis: the NOTION-2 trial. Eur Heart J. 2024;45(37):3804-14. doi: 10.1093/eurheartj/ehae331.

Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597-607. doi: 10.1056/NEJMoa1008232.