OBJECTIVES: This study aimed to assess mitral valve function after repair of ventricular septal defect (VSD) combined with mitral regurgitation (MR) in the mid-term follow-up period, to evaluate the clinical utility of simultaneous mitral valve repair (MVR). METHODS: From June 2005 to March 2014, 60 patients with VSD and MR underwent surgical treatment. After performing propensity score analysis (1:1) for the entire sample, 46 patients were selected and divided into 2 groups: those with VSD closure and MVR - 23 patients and those with VSD closure without mitral valve intervention - 23 patients. The follow-up period - 32 (28;40) months. RESULTS: There was no postoperative mortality in either group. There was no significant difference in the duration of the postoperative period between groups. Mean cardiopulmonary bypass time and aortic cross-clamping time were significantly longer in the 'VSD + MVR' group (cardiopulmonary bypass, P=0.023; aortic cross-clamp, P< 0.001). There was no significant difference in regurgitation area (P=0.30) and MR grade (P= 0.76) between groups postoperatively. There was no significant difference in freedom from MR ≥ 2+ between groups (log-rank test, P= 0.28). The only significant risk factor for recurrent MR ≥ 2+ during the follow-up period was mild residual MR in the early postoperative period ( P=0.037). CONCLUSIONS: In infants with VSD combined with MR, simultaneous MVR has no benefits simultaneous MVR provided no advantage over that of isolated VSD closure. We found that the presence of mild residual MR in the early postoperative period predisposes the development of MR ≥ 2+ in follow-up period.
We analysed results of different types of monopolar and bipolar radiofrequency (RF) ablation in the surgical correction of valvular heart disease. From 2007 to 2011, RF ablation procedure performed 283 patients with atrial fibrillation and heart valve disease. Depending on the type of ablation electrode, all patients were divided into three groups: 64 (22.6%) cases monopolar ablation (MA), irrigated bipolar electrode (IBE) was used in 83 (29.3%) cases and dry bipolar ablation (DBA) formed 136 (48.1%). Time of ablation schemes using a monopolar electrode was significantly more, what increased time of aortic cross-clamping and cardiopulmonary bypass. No significant differences in the time parameters for groups of IBE and DBA has been received. Mortality in the hospital stay was not significantly different between the groups, reaching for the MA, IBE and DBA groups 1.5, 1.2 and 2.2% (p = 0.957; p = 0.784; p = 0.139). In neither case death was not directly related to the ablation procedure and type of electrode. Freedom from AF and AT in groups using bipolar ablative devices was significantly higher at all stages of the assessment results, amounting to MA, IBE and DBA groups, 68.1%, 84.0% and 85,7% respectively (log-rank test, p = 0.012 to DBA group and p = 0.021 for Group IBE). No significant differences between the use of irrigated electrodes and execution of the dry ablation were found (log-rank test, p = 0.249).
The “ideal” graft for forming outflow ways is a big issue in reconstructive heart valve surgery. For today, this question is a field of interest especially in pediatric cardiac surgery, because the existing prosthesis are exposed to aggressive degenerative processes due to metabolic features, and also do not have the growth potential. Therefore, repetitive graft reimplantation gradually increases risk of surgery and greatly reduce the quality of patient’s life. Tissue engineering is a new perspective approach in surgery of congenital and heart valve diseases, which may help overcome limitations of existing and provide the new opportunities for surgical correction. This review highlights current trends in development of tissue-engineered heart valves and grafts, and existing limitations and potential solutions are discussed.
The Ross procedure has emerged as an attractive option for aortic valve replacement in children and young adults. This work represents immediate postoperative period results and long term outcome after Ross procedure among the pediatric population in the single center experience. The main part of a material is submitted by the statistical analysis of risk factors in the early postoperative period within more than 5 years postoperative analysis of long term condition.
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