Patients In Long-term Period Research Articles

LONG-TERM RESULTS OF AORTIC VALVE REPLACEMENT

Valvular heart disease makes up about 25% of all heart diseases. Of all the valvular heart diseases, aortic valvular disease is reported as more common. According to data from surgical hospitals, isolated aortic stenosis occurs in 44-68% of cases of aortic defects. Among patients with aortic valvular disease of non-rheumatic genesis, mesenchymal dysplasia causes the defect in 20% of cases, and in Europe and the United States, up to 10% of the population suffers from this disease. Aortic defects lead to the occurrence and progression of heart failure, cardiac arrhythmias and, as a consequence, a decrease in the life quality and life expectancy. Heart valve replacement is the most effective method for correcting heart defects that enables to eliminate the substrate of pathological changes, improve intracardiac hemodynamics and the life quality of patients. The evolution of various models of artificial valves creates conditions for the choice of surgical approaches to the treatment of aortic defects and a decrease in postoperative mortality rates in patients in the remote. At the same time, there are no large-scale studies in the scientific space of our country devoted to investigating the long-term consequences of aortic valve replacement by modern valve prostheses. There are questions whether it is appropriate to perform on the Ross operation in adults that entails the necessity of constant reoperations on the pulmonary artery valve and progressive dysfunction of the transplanted pulmonary valve in the high pressure areas of the arterial circle.
 The aim of this study is to investigate the characteristics of aortic valve replacement and the quality of life of the operated patients in long-term period.
 The study group included 634 patients with isolated aortic failure, who were operated on at N.N. Amosov National Institute of Cardiovascular Surgery from January 1, 2005 to January 1, 2007. The average follow-up period was 11.3 ± 0.9 years. The main indicators studied for the 15-year period were as follows: survival rate, stability of good and satisfactory results, incidence of thromboembolic complications, and reoperations.
 The study has demonstrated the following results for 15 year period: survival rate is 57.4%, stability of good results is 35.3%, incidence rate of thromboembolic events is 79.7%, and reoperations were required in 95.4% of all cases. The maze procedure was performed on in 21 (6,9%) patients. Concomitant CABG was observed in 93 (5.0%) patients. Reoperations were performed in cases of risks for thrombosis (panus, paraprost. fistula) of aortic prostheses (n=5), endocardytis (n=3); A-V blockade (pacemaker) was performed in 11 (1.6%) patients
 Best results of aortic valve replacement were observed in remote period in patients with II-III NYHA class with presence of sinus rhythm. The patients, who are at high risk of cardiovascular events, must be under close followed-up. The level of thromboembolic complications did not differ in terms of the type of implanted prosthesis. Labyrinth surgery should be performed on to restore sinus rhythm, as well as to reduce the progress of heart failure and prevent thromboembolic complications.
 Aortic valve replacement with the maze operation enables to renew sinus rhythm at the hospital stage quite successfully.

Analysis of the causes of recurrent postoperative ventral hernias

To study the causes of recurrent postoperative ventral hernias and methods for their prevention. There were 58 patients with recurrent postoperative ventral hernias after various methods of abdominal wall repair for the period 2005-2017. The main causes of recurrent postoperative ventral hernias were identified. Local tissue rearrangement resulted recurrent hernia in 21 (36.2%) patients, that was observed even in patients with small hernia. Size discrepancy between endoprosthesis and hernial orifice caused a recurrence in 20 (34.5%) patients. In 11 (19%) patients, implant detachment followed by recurrent hernia occurred. Postoperative wound complications followed by recurrent hernia were diagnosed in 6 (10.3%) patients. Non-compliance with recommendations for wearing a bandage and restricting physical exertion also contributed to the development of recurrent hernia. Moreover, recurrent hernia occurred mainly in obese patients. Mean body mass index was 34.27±2.2 kg/m2. Recurrent hernia was again detected in 12 out of 35 patients in long-term period after surgical treatment. It is necessary to abandon local tissue rearrangement and to select a correct size of synthetic material for prevention of recurrent postoperative hernia. Preoperative body weight control is essential in patients with obesity. Wearing a bandage and restricting physical exertion are obligatory in postoperative period. Annual examination during 3-5 years after surgery is essential for timely diagnosis of recurrent hernia.

Tracheolaryngeal resection for cicatricle stenosis

To determine the safest and the most effective surgical treatment of patients with cicatricle stenosis of tracheolaryngeal segment via analysis of different approaches. For the period 1963-2015 at Petrovsky Russian Research Center for Surgery and Sechenov First Moscow State Medical University 1128 patients with cicatricle tracheal stenosis have been treated. There were 683 men and 445 women. 684 (60.6%) patients were young and the most employable (21-50 years). All patients were divided into 2 groups depending on time of treatment: the first one included 297 patients between 1963 and 2000, the second group - 831 patients between 2001 and 2015. In group 1 tracheolaryngeal anastomosis was made in 10 (16.9%) out of 59 patients who underwent tracheal resection. Previously indication for this surgery was cicatricle stenosis of cervical trachea and larynx with upper borderline of cicatricle changes at least 2 cm from vocal folds. In group 2 these procedures were more frequent. 94 (28.5%) out of 330 patients underwent tracheolaryngeal resection. Cranial borderline of lesion was within 0.5 cm from the vocal folds (only if posterior laryngeal wall at the level of cricoid cartilage was intact). Difficult patients are those who need for double-level or redo repair and procedures with tracheostomy. In the second group overall morbidity after tracheal resections followed by anastomosis was 5.6%. These complications were more common after tracheolaryngeal anastomosis (17%). There were no lethal outcomes after 94 tracheolaryngeal resections. Good long-term results were observed in 89.8% of patients after circular resection. Their quality of life was similar to that of healthy people. Preserved cicatricle tracheal segments during tracheal repair with T-shaped airway tube adversely affects quality of life in these patients in long-term period.

Effect of gene therapy for quality of life and change of objective indexes blood supply of the lower limbs in patients with peripheral atherosclerosis

Цель исследования Оценить результаты генной терапии у больных с ХОЗАНК II и III стадии в сроки до 3х лет.Материалы и методы Располагаем опытом использования первого зарегистрированного отечественного гентерапевтического препарата на основе гена vegf 165 в комплексном лечении больных с хроническими облитерирующими заболеваниями артерий нижних конечностей (ХОЗАНК) при II и III стадиях по А.В. Покровскому – Фонтейну в количестве 65 наблюдений. Из них прослежены отдаленные результаты лечения в сроки свыше 3-х лет у 45 человек (II ст. – 27 пациентов, III ст. n=18). Средний возраст больных составил 63,3±5,8. Оценка результатов проведена в зависимости от исходной стадии заболевания. Эффективность лечения оценивалась следующими методами: 1. Определение качества жизни (физического и психологического компонентов здоровья) производилось в помощью русифицированной версии стандартного опросника SF 36; 2. Дистанция безболевой ходьбы (ДБХ) определялась при проведении тредмил-теста (скорость ходьбы 1 км/час, угол наклона 0°); 3. Сохранность конечностей; 4. Выживаемость больных. Результаты и их обсуждение Значительно улучшились показатели качества жизни через 1 год наблюдения с последующим сохранением положительного результата в течение 3-х лет у всех пациентов с II стадией ХОЗАНК. Среднее значение физического компонента здоровья (ФКЗ) при включении в клиническое исследование (КИ) составило 29,0±6 баллов. В течение первого года показатель возрос до 42,2±8. В дальнейшем отмечен дальнейший рост до уровня 47,6±9 к концу срока наблюдения. Психологический компонент здоровья (ПКЗ): исходно 34,2±4,0 балла, за первый год наблюдения увеличился до 52,9±5, а за 2 и 3 годы стабилизировался и достиг отметки 54,8±6. Среднее значение ДБХ - 159±123 м, через 1 год - 676 ±542, через 2 года 704 ±475, через 3 года - 654±415м. Сохранность конечностей на протяжении всего срока наблюдения составила 100%, выживаемость – 88,9%.У пациентов с III стадией ХОЗАНК исходное значение ФКЗ составило 22,3±1,3 баллов. В течение первого года показатель возрос до 31,4±9,3 и в дальнейшем отмечено его постепенное увеличение до 37,5 ±9,0 к концу 3 года. Изменения ПКЗ были более значимы. При включении в КИ - 25,2±4,3 балла, за первый год наблюдения увеличение до 36,2±11. За 2 и 3 годы данный показатель продолжил свой рост и достиг отметки 51,1±8,3 балла. Исходно среднее значение ДБХ - 31,5±25м, через 1 год - 200 ±107, через 2 года - 274 ±72, через 3 года - 271±63м. Сохранность конечностей за весь период наблюдения - 78%. В трех наблюдениях в течение первого года и в одном в течение второго года выполнены ампутации нижних конечностей на уровне бедра по поводу прогрессирования хронической ишемии. Выживаемость в этой группе составила 100%.Выводы Применение одного курса лечения препаратом на основе гена vegf 165 у больных с II и III стадиями ХОЗАНК по А.В. Покровскому-Фонтейну приводит к стойкому положительному эффекту у значительного большинства пациентов в отдаленном периоде до трех лет и не требует повторных курсов генной терапии. У 82% пациентов отмечено улучшение как физического, так и, в большей степени, психологического компонентов качества жизни; отмечено значительное увеличение ДБХ, повысилась их повседневная активность. У всех пациентов отмечена хорошая переносимость препарата и отсутствие побочных действий; зафиксирована стабилизация полученных результатов. Выживаемость составила 93,3%.

THE LIS STUDY (LYUBERTSY STUDY ON MORTALITY RATE IN PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION). EVALUATION OF DRUG THERAPY. PART 2. INFLUENCE OF PREVIOUS DRUG TREATMENT ON LONG-TERM LIFE PROGNOSIS

Aim. To evaluate drug therapy received by patients who had survived acute myocardial infarction (AMI) in the framework of the AMI register (the “LIS” study) and estimate this therapy influence on long-term outcomes of the disease. Material and methods. The total of 961 patients of 1133 enrolled in the “LIS” study , were discharged from hospital. 191 patients had died during follow-up. 632 patients (who had survived and consented to visit out-patient clinic) underwent repeated examination (median of follow-up 1.6 [1.0; 2.4] years). Data about treatment before and during AMI were received from patient’s charts; data about treatment after AMI were obtained from out-patient medical records. Results. Before reference AMI only a small number of the patients received the main drug groups (antiplatelet agents, β-blockers, ACE inhibitors, statins), at that ACE inhibitors were prescribed more often than the others. Use of β-blockers and ACE inhibitors before reference AMI significantly improved long-term life prognosis [relative risk (RR) 0.70 and 0.66, respectively]. Rate of the main drug groups prescribed in hospital was rather high with the exception of thrombolytics (less than 10%). Thrombolytics, β-blockers and antiplatelet agents prescribed in hospital significantly improved long-term life prognosis of patients (RR 0.42, 0.65 and 0.58 respectively). At the second visit (according to data of out-patient medical records) rate of antiplatelet agents, ACE inhibitors, β-blockers and statins prescription exceeded 60%. Conclusion. Very low prevalence of adequate drug therapy preceding AMI determines high mortality rate among survived acute stage of myocardial infarction patients in long-term period.