Aim: to assess cardiac conduction disturbances after transcatheter aortic valve replacement (TAVR) with the “MedLab-KT” device in early postoperative period.Methods. The study comprised 80 patients (mean age 72,4±5,1 years; 42,5% males) undergoing successful TAVR with the “MedLab-KT”. Before operation, all patients were evaluated with 12-lead ECG and 24-hour Holter monitoring, transthoracic and transesophageal echocardiography, computed tomography, coronarography. In 29 (36,3%) patients cardiac conduction abnormalities were detected before operation: 1st degree atrioventricular (AV) block was found in 17 patients, including concomitant left anterior hemiblock (LAH) in 7 patients, and right bundle branch block (RBBB) in 3 (LAH+RBBB). Second degree AV-block type 1 was found in 1 patient. LAH – in 2, RBBB – in 5, and left bundle branch block (LBBB) – in 4. Post-operative follow-up was limited to hospital stay (13,4±7,4 days).Results. De-novo conduction abnormalities (reversible and irreversible) were detected in 41 patients (51,3%). Post-TAVR complete AV-block was found in 6 (7,5%) patients, and required temporal pacing. In 4 of those patients AV-block was transient and resolved within 1 day. In 2 (2,5%) patients permanent pacing was required due to irreversible distal AV-block. In one case AV-block developed 2 days after TAVR in a patient with pre-existent 1st degree AV-block in combination with LAH+RBBB. Another patient developed complete AV-block at 3d day after TAVR; in this case there was pre-existent 1st degree AV-block plus LAH. Persistent interventricular block was found in 35 patients: complete LBBB - in 17 patients and complete RBBB – in 1 patient. There were no statistically significant predictors of conduction disturbance development following TAVR.
; Дурманов Сергей Семенович, канд. мед. наук, заведующий отделением; Базылев Владлен Владленович, доктор мед. наук, профессор, главный врач Введение. Проблемы лечения фибрилляции предсердий по-прежнему не решены окончательно. В течение нескольких десятилетий активно развивались хирургические и интервенционные методы ее коррекции. В случаях, когда исчерпаны возможности консервативного и/или оперативного лечения, прибегают к радиочастотной аблации (РЧА) атриовентрикулярного (АВ) узла с имплантацией электрокардиостимулятора (ЭКС). В ряде исследований отмечалось достоверное улучшение качества жизни и уменьшение симптомов фибрилляции предсердий после РЧА АВ-узла и имплантации ЭКС. Но мы не нашли работ, в которых изучалось бы качество жизни пациентов с помощью опросника SF-36 после РЧА АВ-узла в зависимости от типа имплантированного ЭКС. Цель. Изучение показателей качества жизни пациентов с помощью опросника SF-36 после РЧА АВузла в зависимости от типа имплантированного ЭКС. Материал и методы. В исследование были включены 148 больных после имплантации ЭКС и РЧА АВ-узла. Исследуемая группа представлена пожилыми пациентами (возраст 72,2 ± 7,4 года) с сохраненной фракцией выброса левого желудочка 58,5 ± 10,7%, индексом массы тела 30,7 ± 5,5 кг/м 2 , преимущественно женского пола (76,4%), страдающими артериальной гипертензией (92,5%). В зависимости от типа имплантированного ЭКС (одно-или двухкамерный) пациенты были разделены на две группы. Анкетирование проводилось по опроснику SF-36. Тридцать шесть пунктов опросника сгруппированы в восемь шкал: физическое функционирование (PF), ролевая деятельность (RP), телесная боль (BP), общее здоровье (GH), жизнеспособность (VT), социальное функционирование (SF), эмоциональное состояние (RE) и психическое здоровье (MH). Все шкалы формируют два показателя: психологический и физический компоненты здоровья. Если итоговое значение находилось в интервале 40-60% от идеального уровня здоровья, это соответствовало среднему, или «нормальному» состоянию здоровья. Результаты. Показатели качества жизни пациентов после РЧА АВ-узла не различаются в группах ни в зависимости от типа ЭКС, ни в зависимости от формы ФП. В группе больных после РЧА АВ-узла показатели, отражающие социальное (SBS SF) и физическое (SBS PF) функционирование, оказались ниже 40% от идеального уровня здоровья.
Aim. To evaluate intraoperative doses of administered heparin to achieve the target value of activated clotting time (ACT) in patients receiving preoperative anticoagulant therapy with warfarin or one of the non-vitamin K antagonists oral anticoagulants (NOAC).Materials and methods. The study was of a retrospective. Inclusion criteria: patients with atrial fibrillation (AF) who have indications for catheter ablation in accordance with national clinical guidelines; age 18-75 years; absence of thrombus and the effect of echocontrasting 3-4 stage in the left atrium cavity according to transesophageal echocardiography or computed tomography with contrast enhancement; regular intake of anticoagulants prescribed at least 3 weeks before hospitalization. Exclusion criteria: additional intake of antiplatelet drugs; contraindications to the anticoagulant therapy, including intolerance to the components of drugs; weight more than 100 kg. According to the criteria for inclusion in the study 279 patients were included (211 of them received warfarin and 68 received one of the NOAC). The mean age of the patients was 59.2±8.9 years, the body mass index was 59.2±8.9 kg/m2. Among them, men accounted for 155 (55,6%), diabetes mellitus was diagnosed in 28 (10%), arterial hypertension - in 224 (80.3%), coronary heart disease - in 103 (36.9%). Paroxysmal AF was observed in 185 (66.3%) of patients, persistent AF - in 77 (27.6%), and long-standing persistent AF - in 17 (6.1%). To ensure maximum comparability of the groups pseudorandomization was performed with the formation of 67 pairs of patients.Results. A group of patients taking warfarin for preoperative preparation required lower doses of heparin to achieve the target AСT and amounted to 14.8±5.1 thousand ME compared to 17.9±4.4 thousand ME in the NOAC group (p=0.0001). Despite the lower dose of heparin the ACT level in the warfarin group was significantly higher than in patients taking NOAC (441.5±203.4 sec. and 345.4±148.8 sec. accordingly, p=0.0001).Conclusions. A significantly lower dose of heparin was required in the warfarin group to achieve the target ACT (>300) than in the group of NOAC, while the maximum ACT value was higher. Thus, with the standard starting dose of heparin, the target anticoagulation was achieved faster in patients receiving warfarin.
Aim. To study the incidence and possible risk factors for atrial fibrillation (AF) in the early postoperative period after transapical implantation of the first domestic aortic valve (TAVI) “MedLab-CT”.Material and methods. The study included 118 patients after successful TAVI. The study did not include patients with open aortic valve replacement due to dislocation of the prosthesis, with severe intraoperative complications leading to the death of the patient, and patients with permanent AF. The mean age of the patients was 71.1 ± 4.9 years, body mass index was 31.1 ± 5.9 kg/m2, men were 39.8%, hypertension was in 93.2%, diabetes mellitus (DM) was in 27.9%, paroxysmal AF was in 12.7%, coronary heart disease (CHD) was in 56.7%, smoking was noted in 8.4% cases. The median follow-up time corresponded to the hospital stay - 9.5 days. To identify cardiac arrhythmias, daily regular ECG recordings in 12 leads were assessed from the first day after TAVI. In the presence of palpitations, 24-hour ECG monitoring was performed. Indicators such as age, male gender, DM, history of AF, interatrial block before surgery, CHD, and echocardiographic parameters were studied as possible predictors of AF development in the early postoperative period after TAVI. There were no significant differences in the studied parameters in patients with AF paroxysms and sinus rhythm.Results. In the early postoperative period, AF episodess occurred in 46 (39%) patients. New-onset AF occurred in 38 (32.2%) patients. The only statistically significant risk factor for AF in the postoperative period in our series of observations was CHD (OR 5.756; 95% CI 1.009-8.132; p = 0.048).Conclusion. Patients with paroxysmal AF in the early postoperative period were not detected cerebrovascular events. In the early postoperative period, the only significant predictor of AF was the presence of proven CHD in patients.
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