Abstract
Aim: To assess clinical and functional efficacy of implanted biological prosthesis “ASPIRE” (manufactured by Vascutek) for correction of mitral valve disease. Materials and methods: From October 2008 to December 2013, biological prostheses “ASPIRE” (Vascutek) were implanted to 34 patients with mitral valve disease (mean age 63.59 ± 4.96 years, 79.4% female). From these, 24 patients had mitral stenosis and 10 patients had mitral insufficiency. 73.5% of all patients had heart failure Strazhesko-Vasilenko IIA grade and 85.3% of patients had chronic heart failure NYHA III. Isolated mitral valve replacement was performed only in 8 (23.5%) of patients. In 22 (64.7%) of cases mitral valve replacement was combined with tricuspid valvuloplasty in various modifications. Duration of cardiopulmonary bypass and of aortic clamping was 88.09 ± 25.95 and 65.68 ± 25.51 minutes, respectively. Before and after surgery all patients underwent echocardiographic assessment and clinical assessment of their general status. Results: In-hospital mortality was 5.88% (n = 2) and was related to multiorgan failure in the early postoperative period. All 32 (94.12%) surviving patients improved with decrease or complete disappearance of heart failure. Postoperative complications were typical for cardiac surgery. There were no episodes of embolism, structural dysfunction, thrombosis of the prosthesis and endocarditis of the prosthesis in the early postoperative period. Pressure gradients across prosthetic valves were not high and corresponded to good clinical and hemodynamic results in the early postoperative period. Conclusion: Taking into account good immediate results of mitral valve replacement, as well as no need in lifelong anticoagulation in patients with multiple concomitant disorders, implantation of the biological prosthesis “ASPIRE” (Vascutek) could become a procedure of choice for correction of valve abnormalities in patients above 65 years. For more comprehensive assessment of the implanted prosthesis, it is necessary to further assess long-term results of valve replacement.
Highlights
Цель – оценить клиническую и функциональную эффективность имплантации биологического протеза “ASPIRE” фирмы Vascutek при коррекции митральных клапанных пороков
surviving patients improved with decrease
Postoperative complications were typical for cardiac surgery
Summary
Цель – оценить клиническую и функциональную эффективность имплантации биологического протеза “ASPIRE” фирмы Vascutek при коррекции митральных клапанных пороков. 34 пациентам (средний возраст 63,59 ± 4,96 года, женщин – 79,4%) с митральным пороком сердца выполнена имплантация биологического протеза “ASPIRE” фирмы Vascutek. Из них митральный стеноз был у 24 пациентов, недостаточность митрального клапана – у 10. Изолированное протезирование митрального клапана выполнялось только у 8 (23,5%) пациентов. Госпитальная летальность составила 5,88% (n = 2) и была связана с развитием полиорганной недостаточности в раннем послеоперационном периоде. Тромбоэмболий, структурной дисфункции, тромбоза протеза и протезного эндокардита в раннем послеоперационном периоде выявлено не было. Учитывая хорошие непосредственные результаты протезирования митрального клапана, а также отсутствие необходимости в пожизненной антикоагулянтной терапии у пациентов с большим количеством сопутствующих заболеваний, имплантация биологического протеза “ASPIRE” фирмы Vascutek может стать операцией выбора при коррекции клапанной патологии у пациентов старше 65 лет. К безусловным преимуществам биологических протезов относятся: отличные гемодинамические параметры, устойчивость к инфекции, отсутствие тромбогенности и низкий риск геморрагического инсульта
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