BackgroundAs life expectancy and quality of health improve, more and more people reach old age, and so does the number of heart diseases. One of the most urgent problems among elderly patients is degenerative stenosis of the aortic valve (AV). The conservative treatment of symptoms of chronic heart failure with AV stenosis improves the patient’s condition only for a while, whereas surgical treatment such as replacement of AV is recognized as the main effective method of treating a defect. Recently, alternative technologies for prosthetic AV have been developed, aimed at reducing adverse effects of artificial circulation (AC) in high-risk patients and minimizing the scope of surgical intervention.Aim of studyThe aim of the study was to evaluate the immediate results of surgical treatment of aortic stenosis using different methods in patients over 70.Material and methodsThe article presents the results of treatment of 64 patients over 70 with isolated AV stenosis, operated with different surgical techniques from July, 2016 to January, 2018. All patients were divided into three groups, differing in the severity of the initial condition and the method treatment. Group 1 (transcatheter implantation of the prosthetic AV, EuroSCORE II — 21.81%) consisted of 19 patients, Group 2 (non-suture implantation of a Perceval prosthetic valce under the AC, EuroSCORE II — 13.81%) consisted of 13 patients and Group 3 (“standard” prosthetics, EuroSCORE II — 9.89%) consisted of 32 patients.ResultsIn Group 1, two patients died, the hospital mortality was 10.5%. In Group 2 and Group 3, one patient died, the hospital mortality was 7.6 and 3.1%, respectively. Implantation of a permanent pacemaker was required in three patients (15.7%) from the TAVI group after installation of Medtronic Core Valve and two patients (15.3%) from the Perceval group.ConclusionThe obtained results of AV replacement by various methods allowed to expand indications for the management of AV stenosis in patients of the older age group with a high surgical risk of operation under AC conditions who had not previously been considered candidates for surgical treatment of aortic malformation due to the age and severity of the concomitant pathology.
BACKGROUND In 12–47% of patients, there is a need to repeat the aortic valve replacement due to various valve-related complications in the immediate and late postoperative period. The standard operation of repeated aortic valve replacement is a complex procedure and it is associated with an increased risk due to adhesions in the pericardial cavity, previously performed coronary bybass surgery, diffculties of excision of the previously implanted prosthesis, narrow fbrous aortic valve ring and aorta. In 2007, the sutureless Perceval S aortic valve bioprosthesis (Sorin Group, Italy) was introduced into clinical practice. One of the advantages of such a prosthesis is the convenience of its anatomical positioning during repeated operations and the absence of the need to fx the prosthesis with sutures. The aim of study was to summarize the experience of sutureless implantation of the aortic valve prosthesis during repeated replacement.MATERIAL AND METHODS We report the results of treatment in 3 patients with valve-associated complications, who underwent aortic valve repeated replacement with the Perceval S sutureless prosthesis.RESULTS There were no hospital mortality and paraprosthetic regurgitation in the repeated replacement of the aortic valve with the Perceval S sutureless prosthesis. Two patients required implantation of a permanent pacemaker due to the development of a complete atrioventricular block, which was not related to the model of the prosthesis used.CONCLUSION The use of aortic valve prosthesis in cardiac surgery, which does not require fxation with sutures, allows non-standard decisions to be made in the surgical treatment of patients with various complications of previously performed aortic valve replacement and provides good immediate results if repeated replacement is necessary.
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