Митральная недостаточность является самой распространенной клапанной патологией. Почти у половины пациентов стандартное протезирование митрального клапана с использованием искусственного кровообращения не может быть выполнено в связи с высоким риском развития осложнений, обусловленным тяжестью порока либо наличием сопутствующих заболеваний. В последние годы для данной категории пациентов предложена методика транс катетерного протезирования митрального клапана. К настоящему вре мени известно о ряде транскатетерных протезов для имплантации в нативный митральный клапан, находящихся на стадии доклинических либо клинических испытаний. В данной статье проанализированы результаты клинического при менения протезов для транскатетерного протезирования митрального клапана.Российский кардиологический журнал. 2018;23(11):137-144 http://dx.
We present a case report of successful transcatheter implantation of a Russian-made cardiac valve prosthesis in a patient with dysfunction of biological mitral valve prosthesis (valve-in-valve). A patient aged 78 years with a high surgical risk and severe heart failure due to mitral valve bioprosthesis dysfunction is described. Fluoroscopyand transesophageal echocardiography-guided transapical implantation of a MedLab-CT prosthesis (23 mm) was made. When a heart rate of 180 beats per minute, a stent prosthesis was implanted. Transcatheter implant valve functioned properly after surgery. The patient was discharged in satisfactory condition.
We conducted a retrospective comparative analysis of 75 patients undergoing video-assisted mitral valve repair with right minithoracotomy over a period from November 2011 to August 2013. The control group comprised 71 patients operated on mitral valve by using median sternotomy during the same period. Median (25th; 75th) times of cardiopulmonary bypass and aortic cross-clamping were significantly longer in the minimally invasive group (180 [139; 224] and 111 [87; 145] min, respectively) as compared to the controls (84 [69; 117] and 62 [49; 81 ] min, respectively), p<0.01. Fatal outcome occurred in 2 (2.7%) cases in the minimally invasive group versus none in the controls. In both cases death resulted from intraoperative aortic dissection. While ventilation time and intensive care unit stay were comparable across the groups, postoperative respiratory failure occurred in 6 (8%) cases in the minimally invasive group versus none in the controls (p<0.05). No other significant differences in the postoperative course were observed between the groups. The results of the present study are generally consistent with the world's tendencies. On the other hand, complication rates observed in the minimally invasive group present a considerable economic burden and require substantial human resources in the postoperative period.
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