First Experience of Sutureless Redo on Mitral Valve Using Valve-in-Valve Technique: Two-Stage Implantation on a Large Animal.

Sutureless implantation of the mitral valve bioprosthesis using the valve-in-valve method was performed on a large animal (sheep). According to the results of a two-stage implantation (primary implantation of a xenopericardial 26-mm framed bioprosthesis and reimplantation of the developed 23-mm bioprosthesis), minor changes in quantitative indicators were revealed: an increase in the transprosthetic gradient by 1.3 mm Hg and a decrease in the area of the mitral orifice by 21.6%. Considerable reduction in the intervention time by 18 min was achieved (by 40% in comparison with the primary prosthesis). The absence of adverse events in the animal and complications in the post-operative period, as well as physiological hemodynamic indicators indicate the safety of the developed medical device.

[10 years' experience of heart valve bioprostheses. Present status and future development]. / 10-letnii opyt bioprotezirovaniia klapanov serdtsa. Sovremennoe sostoianie i perespektivy razvitiia.

Long-term results of mitral valve replacement with bioprostheses of three original designs are overviewed. Refinement of the supporting framework design, and of modelling and conservation methodologies has made it possible to improve the survival rates and provided for the absence of specific complications in two groups of patients. Experimental evidence allows for anticipating an increase in the terms of bioprostheses performance.

[Experience in the perfecting of direct myocardial revascularization inpatients with ischemic heart disease]. / Opyt osvoeniia operatsii priamoi revaskuliarizatsii miokarda u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The first 100 operations for aortocoronary and mammary-coronary shunting in patients with ischemic heart disease are analysed. The operations were carried out on patients aged from 36 to 59 years who had no severe concomitant diseases. Angina pectoris of effort was encountered in 47%, angina of effort and of rest in 33%, and unstable angina in 20% of patients. The operations were performed under conditions of extracorporeal circulation. In 100 patients 184 arteries were shunted (1.8 shunt per one patient). A mammary-coronary shunt was established in 13 patients; the left internal thoracic artery was used in all of them for shunting the anterior interventricular branch. Improvement was recorded in 88.5% of patients after the operation. Thirteen (13.0%) patients died. It is concluded that patients should be chosen with great care for aortocoronary shunting with due regard for the risk factors.

[Evaluation of the function of mitral valve prosthesis by non-invasive methods]. / Otsenka funktsii protezov mitral'nogo klapana serdtsa neinvazivnymi metodami.

The study was undertaken to examine the correlation between the parameters of central hemodynamics and mitral valve prosthesis functions which were obtained by invasive techniques, as well as these of physical working capacity, hemodynamics, and blood by noninvasive methods at rest and during bicycle ergometry in the graded exercise test. An examination was made of 24 patients every 0.5-8 years (mean 3.2 years) after replacement of mitral valves by xenobioprostheses. "Oxygen pulse" and cardiac index defined during exercise highly correlated with prosthetic mid-diastolic pressure gradients. A moderate correlation was found between dry erythrocytic mass and total pulmonary blood flow resistance. The findings may be useful for the early diagnosis of prosthetic dysfunctions.