<p><strong>Background.</strong> The obvious expansion of mini-invasive technologies is looming large in surgical treatment of heart diseases. Hundreds of thousands of transcatheter aortic valve replacement procedures have been performed in the world today. The improvement in quality and the increase in life expectancy in cohorts of patients who until recently have been considered inoperable are now routinely achievable. A significant limitation of this method for Russian clinics is the absence of domestic transcatheter implantable prosthetic heart valves on the market. During the last five years, such devices have been developed at “MedEng” (Penza, Russia) scientific and production enterprise. We present the first Russian transcatheter aortic valve prosthesis, its leaflets made of polytetrafluoroethylene, components of the delivery system and implantation, as well as the hospital outcomes of clinical trials. <br /><strong>Aim.</strong> To evaluate the clinical and hemodynamic results of transcatheter aortic valve implantation using a “MedLab-KT” prosthesis during hospital stay.<br />Methods. A prospective study included 54 patients who underwent transcatheter repair of the aortic valve using a “MedLab-KT” prosthesis. To evaluate the frequency of complications, myocardial infarction, strokes, bleeding, deaths during hospital stay and gradient indices on the prosthesis, postoperative ultrasound examination data were obtained and analyzed. <br /><strong>Results.</strong> The results are comparable with those achieved by using the foreign models known from literature. <br /><strong>Conclusion.</strong> The clinical and hemodynamic results of using the “MedLab-KT” aortic valve prosthesis can be considered as satisfactory.<br /><strong>Keywords:</strong> polytetrafluoroethylene; transcatheter aortic valve implantation<br /><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.<br /><strong>Authors’ contribution</strong><br />Conception and study design: V.V. Bazylev, E.V. Rosseykin, A.B. Voevodin<br />Data collection and analysis: A.B. Voevodin, A.S. Zakharova<br />Statistical analysis: A.B. Voevodin<br />Drafting the article: A.B. Voevodin<br />Critical revision of the article: A.B. Voevodin<br />Final approval of the version to be published: V.V. Bazylev, A.B. Voevodin, A.S. Zakharova, E.V. Rosseykin<br /><strong>ORCID ID</strong><br />V.V. Bazylev, https://orcid.org/0000-0001-6089-9722<br />A.B. Voevodin, https://orcid.org/0000-0002-7078-1274<br />A.S. Zakharova, https://orcid.org/0000-0001-7239-2945<br />E.V. Rosseykin, https://orcid.org/0000-0003-0784-2246</p>
<p><strong>Aim.</strong> The study was designed to compare the immediate echocardiographic characteristics of aortic valve reconstruction by using autologous pericardium and the method proposed in 2007 by Shigeyuki Ozaki, as well as aortic valve replacement by means of frame-mounted biological prostheses Medtronic HANCOCK®II T505 CINCH® II and the Carpentier-Edwards PERIMOUNT.<br /><strong>Methods.</strong> Over a period from January 2014 to February 2016, 76 patients underwent aortic valve replacement by means of frame-mounted biological prostheses Medtronic HANCOCK®II T505 CINCH® II (n=41) and Carpentier-Edwards PERIMOUNT (n=35) at our hospital. 20 patients underwent the Ozaki procedure. These three groups of patients were assigned to the study. Demographic and preoperative indicators of patients from all three groups were homogeneous (р>0.05). The evaluation of the aortic valves replaced was carried out by echocardiography.<br /><strong>Results.</strong> Echocardiography was performed before the procedure and in the early postoperative period. Statistical analysis using ANOVA showed significantly lower values of the aortic valve pressure gradient (p<0.001) and larger effective orifice area and indexed effective orifice area of the valve (p<0.001) in the group of the Ozaki procedure.<br /><strong>Conclusion</strong>. According to echocardiography data, in the immediate postoperative period the Ozaki procedure is associated with lower mean and peak gradients of pressure on the aortic valve and larger effective orifice area and indexed effective orifice area of the valve, as compared with the frame-mounted biological aortic prostheses Medtronic HANCOCK®II T505 CINCH® II and the Carpentier-Edwards PERIMOUNT.<br /><br />Received 27 May 2016. Accepted 24 June 2016.</p><p><strong>Funding:</strong> The study had no sponsorship. <br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p>
We compared the immediate outcomes of hybrid procedure and step-by-step internal carotid artery (CA) stenting and coronary artery bypass grafting (CABG) in high-risk surgical patients with combined lesions of coronary and carotid vasculature. The indications for hybrid surgery were identified. 50 patients with combined lesions of the coronary bed and the carotid vasculature were divided into two groups. The 1st group had 30 patients (60%), who first underwent CA stenting followed by CABG. The 2nd group included 20 patients (40%), who underwent hybrid procedures (simultaneous CA stenting and CABG). Patients with atherosclerosis of aortoiliac and femoropopliteal segments (p <0.0001) were by far more frequent in the hybrid procedures group. The 1st group was found to have no fatal outcomes. 3 patients (10%) experienced cerebral stroke. The hybrid procedures group had no deaths and cerebral stroke patients. 2 patients developed a myocardial infarction. None of the above indices was found to have statistically significant differences between the groups (р >0.05). On average, the patients of the 1st group were in the Intensive Care Unit (ICU) for 2.91.9 days; the patients of the 2nd group stayed in the ICU for 3.96.4 days (р = 0.42). The average postoperative hospital stay for the 1 st group patients amounted to 10.84.5 days, while that for the 2nd group patients was equal to 10.85.8 days (р = 1). The groups were found to have no statistically relevant differences of complication risks, the length of ICU stay, and the total number of days spent in hospital. If patients with combined lesions of the coronary artery and the carotid artery also suffer from critical lower-extremity stenosis, a hybrid procedure allows surgeons to perform CA stenting.
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