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Prosthetic heart valves are widely used biomedical devices. The need for these prostheses is increasing due to the increasing life expectancy of the general population and the consequent incidence of age-related degenerative valvular defects. However, even though mechanical prosthetic valves have been significantly modernized over the last decades, they are still associated with several life-threatening complications, the main one being thrombosis. Addressing this problem is challenging and requires collaboration between bioengineering and cardiothoracic surgery. Thus, the problem of creating the most adapted model of prosthetic heart valve (PHV) turns out to be at the confluence of sciences – medicine, biology, applied mechanics, mathematical modeling, etc. Today, it seems clear that the engineering ideas for hemodynamic adaptation of PHV models have been fully developed. However, research in the field of materials science, as well as a search for surface modification methods, remain a pressing bioengineering challenge.
Prosthetic heart valves are widely used biomedical devices. The need for these prostheses is increasing due to the increasing life expectancy of the general population and the consequent incidence of age-related degenerative valvular defects. However, even though mechanical prosthetic valves have been significantly modernized over the last decades, they are still associated with several life-threatening complications, the main one being thrombosis. Addressing this problem is challenging and requires collaboration between bioengineering and cardiothoracic surgery. Thus, the problem of creating the most adapted model of prosthetic heart valve (PHV) turns out to be at the confluence of sciences – medicine, biology, applied mechanics, mathematical modeling, etc. Today, it seems clear that the engineering ideas for hemodynamic adaptation of PHV models have been fully developed. However, research in the field of materials science, as well as a search for surface modification methods, remain a pressing bioengineering challenge.
Highlights. In the present study, we conducted a retrospective analysis redo mitral valve replacement due to prosthesis failure. Predictors of adverse events and death have been analyzed. The quality of obtained predictors was verified using ROC analysis.Aim. To analyze predictors of adverse events and death in redo mitral procedure for treating mitral bioprostheses failure.Methods. The retrospective registry study of catamnesis of patients undergoing treatment for mitral valve prosthesis dysfunction was carried out. The age and gender of patients, medical history, underlying and comorbid diseases, features of primary replacement and reoperation, durability of the primary prosthesis, adverse events and death after redo mitral valve replacement and others (more than 30 factors) were taken into account. Stepwise logistic regression was used for statistical processing. The quality of obtained predictors was verified using ROC analysis.Results. The results of the study have revealed that there are modifiable risk factors such as cardiopulmonary bypass time, ischemia time, and nonmodifiable risk factors like reoperation, baseline severity of the patient's condition, complications of median resternotomy, concomitant interventions on aortic valve during reoperation. Moreover, treating atrial fibrillation during primary replacement proved to have an overall protective effect.Conclusion. Тhe only modifiable factors that can be influenced during redo mitral valve replacement due to biological prosthesis failure are cardiopulmonary bypass duration and aortic cross-clamping time.
Aim. To compare the results of mitral valve replacement with the full-flow mechanical valve MedInzh-ST and the classical prosthesis MedInzh-2, to learn the structural and functional parameters of the heart depending from the prosthesis in the long-tern period. Material and methods. From 2015 to February 2020 years an the basis of the cardio-surgical department of the Regional clinical Hospital 116 patients, in order to correct defects, were underwent mitral prosthetics with MedInzh valves. Of these 55 patients received a new full-flow valve MedInzh-ST. 61 patients a classical MedInzh-2. Before surgery and in the long-term period all patients were underwent transthoracic echocardiography with using expert-class devices. In the long-tern postoperative period 34 patients were underwent echocardiographic research after implantation full-flow valves and 40 patients after prosthetics of classical prosthesis. Results. The choice of the prosthesis model did not affect the incidence of postoperative complications and the rate of hospital mortality. In all cause of death is not associated with impaired function of the prosthesis. All patients before the discharge from hospital were fixed the positive effect from surgical treatment. In the long-term postoperative period between patients after implantation of full-flow valves, the cases of prosthetic platelets were not registered. One patient was diagnosed with prosthetic thrombosis after implantation of a classical prosthesis, which required further reprosthetics. There were no signs of prosthetic endocarditis and paraprosthetic fistula in both groups. There were no significant differences in the structural and geometric parameters of the heart in all patients. Conclusion. Analysis of the functional characteristics of the new full-flow valve MedInzh-ST in the long-term period allows us to conclude that the new valve model meets modern requirements for efficiency and safety.
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