Results of the valve-preserving operations in the patients, suffering aortal dissection Type A

Objective. To investigate resuspension of aortal valve in the patients, suffering aortal dissection of Type A. Materials and methods. In 1994 - 2018 yrs period in Amosov National Institute of Cardio-Vascular Surgery 385 patients, suffering an acute aortal dissection Type A, were treated. In 169 patients aortal dissection have led to occurrence of an acute aortal insufficiency. Among these patients resuspension of the aortal valve was performed in 43, who have got aortal insufficiency from moderate one to severe. Results. In 43 patients with initial aortal insufficiency, from moderate one to severe, to whom resuspension of aortal valve was performed, postoperatively, in accordance to data of echocardiography, its function have appeared competent. During the year after primary intervention in 2 patients the aortal valve prosthesis was performed for severe aortal insufficiency developed. Conclusion. Resuspension of aortal valve constitutes an effective method of its function restoration in patients, suffering aortal dissection Type A and aortal insufficiency from moderate to severe. Preservation of own aortal valve improves patient’s quality of life, lowers the risks of thromboembolic and hemorrhagic complications and prevents delay for thrombing of a false channel due to long-lasting anticoagulant therapy.

Procedure of complex braided wrapping of ascending aorta in her poststenotic dilation while doing correction of aortal stenosis

Objective. To study clinical possibilities of original procedure of the ascending aorta braid-like bandage for her poststenotic dilation while performance of the aortal stenosis surgical correction. Materials and methods. To the main Group 196 patients were included those, who were operated on for prevailing aortal stenosis, conjoined with poststenotic dilation of ascending aorta. In accordance to the echocardiographic investigation data the ascending aorta diameter preoperatively have constituted (47.7 ± 1.7) mm. In all the patients the aortal valve prosthesis was performed together with complex braided wrapping of ascending aorta. Into the control group 121 patients were included, in whom Bentall intervention was accomplished with vascular prosthesis of ascending aorta. Results. Hospital lethality in the main group have constituted 0.5%. Diameter of ascending aorta in the moment of hospital discharge have constituted (39.1 ± 1.5) mm, and in late follow-up period - (40.3 ± 1.1) mm. Conclusion. Basing on clinical experience gained, it is expedient to recommend the original procedure of braided wrapping of ascending aorta in presence of her poststenotic dilation while performing surgical correction of prevailing aortal stenosis.

The anemia correction in chronic diseases in perioperative period while performing prosthesis of aortal valve

Objective. To determine the impact of preoperative correction, using hydroxide of iron (III) erythropoietin, in patients, having the heart aortal failures, complicated by the chronic diseases anemia, on the postoperative anemia after doing the aortal valve prosthesis in accordance to the blood-preserving technology in the artificial blood circulation conditions. Materials and metods. The investigation was conducted in 83 patients, to whom the aortal valve prosthesis was performed with a blood-preserving technology in conditions of artificial blood circulation without application of hemo-concentrating columns and a cell-saver apparatus. All the patients were divided into three Groups in accordance to levels of hemoglobin, iron and the blood-preserving technologies applied. To the Group A 31 patients were included, in whom the initial concentration of hemoglobin, hematocrit and iron was normal. The patients were operated, using the donor’s blood components. To the Group B 37 patients were included, who were operated on without application of the donor’s blood components, using a blood-preserving technology in conditions of artificial blood circulation without application of hemo-concentrating columns and a cell-saver apparatus. In the Group C 15 patients were present, who have had initial preoperative anemia of chronic diseases with low values of hemoglobin, hematocrit and iron. Before the preoperative week a preoperative correction of anemia was conducted to them, using hydroxide of iron (III) and erythropoietin. Comparative characteristics of intraoperative application of the aortal valve prosthesis in the donor’s Group A, preoperative combined correction of anemia due to chronic illnesses - in the Group C, and of the blood-preserving technologies - in the Groups B and C are adduced. The impact of intraoperative application while performing the aortal valve prosthesis of the donor’s blood components, preoperative combined correction of the chronic diseases anemia with a blood-preserving technology in conditions of artificial blood circulation without application of hemo-concentrating columns and a cell-saver apparatus on the postoperative anemia level were investigated. Results. The data obtained witness, that in Group A with the objective to stabilize the levels of hemoglobin and hematocrit intraoperatively the donor’s blood components - (568.0 ± 93.0) ml of erythrocytic mass and (596.0 ± 48.0) ml of a fresh frozen plasm were needed, what constitutes 25% of the circulating blood volume. In Group B postoperatively after the aortal valve prosthesis in accordance to the blood-preserving technology without transfusion of the donor’s blood preparations a hemoglobin level have lowered down by 19.9% (p ˂ 0.05), hematocrit - by 17.5% (p ˂ 0.05), and a thrombocytes quantity - by 24.0% (p ˂ 0.05). Correction, performed for preoperative anemia, using hydroxide of iron (III) and erythropoietin to patients, suffering anemia due to chronic diseases in Group C, have had raised a serum iron level in 6.2 times (p ˂ 0.05), ferritin - in 5.4 times (p ˂ 0.05), and hemoglobin - by 6.7%. Performance of the aortal valve prosthesis in accordance to the blood-preserving technologies in conditions of artificial blood circulation without application of the donor’s blood components in patients of Group C have stabilized a postoperative level of the serum iron, hemoglobin and the thrombocytes quantity. Conclusion. In 18% of the patients, owing the heart aortal failures, the chronic diseases anemia is observed, caused by predominantly rheumatic inflammatory illnesses with moderate anemia and hypoferritinemia. Correction of anemia of chronic diseases, using hydroxide of iron (III) and stimulation of hematopoiesis with erythropoietin in preoperative period have raised the serum iron level in 6.2 times (p ˂ 0.05), coefficient of transferrin saturation by iron - by 41.9% (p ˂ 0.05), a ferritin level - in 5.5 times (p ˂ 0.05). For the levels of hemoglobin and hematocrit stabilization while doing the aortal valve prosthesis operation in patients of Group A the donor’s blood components - (568.0 ± 93.0) ml of erythrocytic mass and (596.0 ± 48.0) ml of the fresh frozen plasm, constituting 25% of the circulating blood volume, - were applied. In the patients of Group В after performance of the aortal valve prosthesis in accordance to the blood-preserving technology the level of hemoglobin by 17.4%, the serum iron - by 15.2% and the thrombocytes quantity - by 24.0% have lowered. Preoperative correction of anemia, using hydroxide of iron (III) and stimulation of hematopoiesis, applying erythropoietin in patients of Group C, to whom the aortal valve prosthesis was done with a blood-preserving technology in conditions of artificial blood circulation without application of hemo-concentrating columns and a cell-saver apparatus, have had lowered the postoperative anemia level by 11.7% (p ˂ 0.05).

The first experience of implantation of the transcatheter aortal valve prosthesis “MedLab-KT”

Aim.Transcatheter aortic valve replacement in patients with high and extremely high risk has become a routine procedure in many cardiac surgery clinics. Until recently, there were no transcatheter prostheses produced within Russia. This article analyzes the results of applying the first domestic transcatheter aortic valve prosthesis MedLab­KT.Material and methods.In the period from June 2018 to October 2018, 7 operations of transcatheter aortic valve replacement were made using the MedLabKT prosthesis. In all cases, implantation was performed by transapical access.Results.We noted one death. In all cases, paraprosthetic regurgitation was not registrated or was not significant. There are no cases of dislocation of the prosthesis. There were no complications associated with access. In one case, implantation was complicated by myocardial infarction.Conclusion.The first experience of implantation demonstrated the efficacy and safety of using the MedLab­LT prosthesis for transcatheter aortic valve replacement. The analysis of long­term results is required.

The first experience of implantation of the transcatheter aortal valve prosthesis “MedLab-KT”

Aim. Transcatheter aortic valve replacement in patients with high and extremely high risk has become a routine procedure in many cardiac surgery clinics. Until recently, there were no transcatheter prostheses produced within Russia. This article analyzes the results of applying the first domestic transcatheter aortic valve prosthesis MedLab­KT. Material and methods. In the period from June 2018 to October 2018, 7 operations of transcatheter aortic valve replacement were made using the MedLabKT prosthesis. In all cases, implantation was performed by transapical access.Results. We noted one death. In all cases, paraprosthetic regurgitation was not registrated or was not significant. There are no cases of dislocation of the prosthesis. There were no complications associated with access. In one case, implantation was complicated by myocardial infarction.Conclusion. The first experience of implantation demonstrated the efficacy and safety of using the MedLab­LT prosthesis for transcatheter aortic valve replacement. The analysis of long­term results is required.

INFECTIOUS ENDOCARDITITIC AORTAL VALVE AND THE ATRIAL SEPTAL DEFECT AT THE PATIENT WITH TOTAL INVERSION OF THE INTERNAL ORGANS

Situs viscerus inversus totalis – a complete reverse arrangement of the internal organs – is a rarely occurring congenital anomaly of development. Situs inversus with dextrocardia is more common. Congenital heart disease is observed with situs inversus with dextrocardia in 3–5% of cases, usually with transposition of large vessels. Сlinical сase of the patient P., 28 years old, with infective endocarditis of the aortic valve and atrial septal defect and situs viscerus inversus totalis also are presented. This case demonstrates the high importance of radiation methods in the diagnosis of complete transposition of organs as a congenital anomaly of development, as well as concomitant pathological conditions at the stages of surgical correction of these conditions.