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Background. Among cardiovascular diseases, valve pathology of various aetiology comprises a primary factor of chronic heart failure. Mitral valve diseases afflict over half of all patients with acquired heart defects. Today’s long-term outcomes of mitral valve replacement are not quite satisfactory, which urges the invention of novel vales. Such a modern artificial valve is the nationally developed bivalve full-flow MedInzh-ST prothesis.Objectives. Assessment of advantages of the novel MedInzh-ST full-flow mechanical valve vs. MedInzh-2 model in analyses of short-term postoperative outcomes.Methods. Over a five-year period, 116 patients underwent indicated mitral replacement with MedInzh valves. The full-flow MedInzh-ST was implanted in 55 patients, and MedInzh-2 — in 61. All patients had transthoracic echocardiography for structural and functional heart and implant control prior to surgery and discharge from hospital. Clinical and echocardiographic analyses were performed in the early postoperative period.Results. The choice of valve model had no effect on the rates of postoperative complications and hospital mortality. All lethal cases were not associated with the valve malfunction. All patients with predominant mitral stenosis revealed the reliably lower peak and mean transmitral pressure gradient and pulmonary artery systolic pressure, irrespective of the valve model. The novel full-flow valve implantation significantly more often associated with a reduced right ventricle size. All patients with predominant insufficiency were observed to reduce mitral regurgitation and the left ventricular size upon defect correction. Patients with full-flow protheses significantly more often had a reduced end-systolic dimension.Conclusion. The MedInzh-ST full-flow mechanical valve satisfies the modern requirements for efficacy and safety. Mitral stenosis correction with full-flow valves is shown to exert a greater effect on reverse right ventricular remodelling compared to the classical model.
Background. Among cardiovascular diseases, valve pathology of various aetiology comprises a primary factor of chronic heart failure. Mitral valve diseases afflict over half of all patients with acquired heart defects. Today’s long-term outcomes of mitral valve replacement are not quite satisfactory, which urges the invention of novel vales. Such a modern artificial valve is the nationally developed bivalve full-flow MedInzh-ST prothesis.Objectives. Assessment of advantages of the novel MedInzh-ST full-flow mechanical valve vs. MedInzh-2 model in analyses of short-term postoperative outcomes.Methods. Over a five-year period, 116 patients underwent indicated mitral replacement with MedInzh valves. The full-flow MedInzh-ST was implanted in 55 patients, and MedInzh-2 — in 61. All patients had transthoracic echocardiography for structural and functional heart and implant control prior to surgery and discharge from hospital. Clinical and echocardiographic analyses were performed in the early postoperative period.Results. The choice of valve model had no effect on the rates of postoperative complications and hospital mortality. All lethal cases were not associated with the valve malfunction. All patients with predominant mitral stenosis revealed the reliably lower peak and mean transmitral pressure gradient and pulmonary artery systolic pressure, irrespective of the valve model. The novel full-flow valve implantation significantly more often associated with a reduced right ventricle size. All patients with predominant insufficiency were observed to reduce mitral regurgitation and the left ventricular size upon defect correction. Patients with full-flow protheses significantly more often had a reduced end-systolic dimension.Conclusion. The MedInzh-ST full-flow mechanical valve satisfies the modern requirements for efficacy and safety. Mitral stenosis correction with full-flow valves is shown to exert a greater effect on reverse right ventricular remodelling compared to the classical model.
The aim of the study. To study the structure of lethal and non-lethal complications with an analysis of survival and the likelihood of non-lethal complications after mitral valve (MV) replacement with bicuspid mechanical prostheses over a five-year period. Materials and methods. The data of 260 patients who were treated in the period of 2012–2014 were analyzed a surgical intervention was performed – isolated MV prosthetics with mechanical bivalve prostheses. Among the patients, there were 84 (32.3 %) men and 176 (67.7 %) women. The median age was 51.0 [44.0–55.5] years. Statistical analysis was carried out using IBM SPSS Statistics 26.0 (USA). Results of the study and conclusions. According to the results of the five-year survival after MV prosthetics with mechanical prostheses, it was 86.6 %. At the same time, acute cardiovascular diseases (myocardial infarction, cardiac arrhythmias) were the leading cause of death. Among non-lethal thromboembolic complications, acute cerebrovascular accident prevailed, it developed in 65.3 %. Among nonlethal hypocoagulation complications, nosebleeds were most often recorded – in 40.5 % of patients. The probability of developing non-lethal thromboembolic complications by the fifth year is 20.0 % vs 18.5 % in the first six months after prosthetics with mechanical prostheses. And the probability of developing non-lethal hypocoagulation complications by the fifth year is 26.8 % vs 6.1 % in the first six months after prosthetics with mechanical prostheses.
The aim of the study. To develop a mathematical model for predicting the development of thromboembolic complications and bleeding in patients after mitral valve replacement with mechanical prostheses based on an analysis of a number of risk factors – age, compliance, heart rate at the postoperative stage, prosthesis manufacturer, hemostasis indicators.Materials and methods. There were examined 260 patients. The following risk factors were analyzed: patient compliance (Morisky-Green test), heart rate at the postoperative stage, prosthesis manufacturer (MedInzh, Carbomedics, ATS, On-X), hemostasis indices (international normalized ratio, activated partial thromboplastin time, D-dimer, fibrinogen, soluble fibrin-monomeric complexes).Results of the study and conclusion. The frequency of thromboembolic complications was 5.2 cases, bleeding 4.7 cases per 1000 patient-months. With an increase in the level of soluble fibrin-monomeric complexes by 1 g/L, the risk of thromboembolic complications increases by 1.63 times, the presence of a MedInzh’s prosthesis increases the risk of thromboembolic complications by 2.04 times compared to prostheses of other companies, with paroxysmal or permanent forms of atrial fibrillation the risk thromboembolic complications increase 16.29 times compared with patients with sinus rhythm. In compliant patients, the risk of bleeding is 52.5 (1/0.08) times lower than in non-compliant patients; with an increase in the activated partial thromboplastin time by 1 sec, the risk of bleeding increases by 1.07 times.
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