Open transaortic implantation of 'Medlab-KT' prosthesis. / Otkrytaia transaortal'naia implantatsiia proteza 'Medlab-KT'.

AIM: The study was aimed at comparing the immediate clinical and haemodynamic results of open implantation of the balloon-expandable aortic prosthesis 'MedLab-KT' with the respective parameters of standard replacement of the aortic valve by a mechanical prosthesis in high-risk surgical patients. PATIENTS AND METHODS: We analysed a total of 209 cases of prosthetic repair of the aortic valve. The Study Group comprised 28 patients subjected to open implantation of the 'MedLab-KT' prosthesis in conditions of extracorporeal circulation and myocardial ischaemia and belonging to a high-surgical risk cohort. The Comparison Group included 181 patients who endured standard open prosthetic repair of the aortic valve with a mechanical prosthesis. Using the ppropensity score matching method, we selected 28 patients from the Comparison Group, followed by assessing the incidence of adverse clinical events and haemodynamic parameters of the aortic valve prosthesis at the in-hospital stage. RESULTS: There were no lethal outcomes in the study group, with one in the group of standard aortic valve repair - 3.6%. The mean operative time in the Study and Comparison Group patients amounted to 121.5±51.2 and 274.2±55.3 min (p=0.04), the duration of extracorporeal circulation to 56.1±19.5 and 119.9±23.4 min (p=0.04), that of myocardial ischaemia to 38.4±17.1 and 96.7±20.8 (p=0.03), respectively. The mean gradient on the aortic valve in the 'MedLab-KT' group was less (7.5±3.2 mm Hg) than in those of the second group (9±3.5 mm Hg), with no statistically significant differences in the parameters revealed (p=0.096). All patients of the study group were discharged from hospital in a satisfactory condition, with the haemodynamic result of the operation regarded as satisfactory. CONCLUSION: Comparing the main clinical characteristics and haemodynamic parameters in the groups of 'MedLab-KT' and aortic valve prosthetic repair at the hospital stage revealed no statistically significant differences. Open implantation of the 'MedLab-KT' prosthesis proved safe and effective.

[Transcatheter aortic valve replacement after Ozaki procedure]. / Transkateternoe protezirovanie aortal'nogo klapana posle protsedury Ozaki.

The Ozaki operation is currently considered to be a sufficiently known surgical procedure performed in aortic valve defects. Despite satisfactory results in the mid-term period after neocuspidalization, there have been reported cases of pronounced aortic insufficiency due to rupture of neocusps or their endocarditis. Transcatheter aortic valve replacement is a rapidly developing trend at the junction of modern cardiac surgery and interventional cardiology, expansively covering groups of patients at high, moderate and recently also low surgical risk. Repeat open cardiosurgical interventions remain a zone of especially increased risk of complications. This clinical case report describes technical aspects and immediate outcomes of successful transcatheter implantation of aortic valve prosthesis in a patient with aortic insufficiency revealed 2 years after the Ozaki procedure.

[Transcatheter replacement of pulmonary artery valve with a graft containing polytetrafluoroethylene leaflets]. / Transkateternaia zamena klapana legochnoi arterii protezom so stvorkami iz politetraftorétilena.

Annually, many operations for repeat prosthetic reconstruction of the pulmonary artery valve are performed due to dysfunction after primary correction of both congenital and acquired heart defects. Open operations with artificial circulation are associated with a high surgical risk. Transcatheter implantation is a new and progressive technique of heart valve replacement. Until recently, implantation of only a biological graft in the position of a pulmonary artery valve was possible, but a limited service life and high risk of the development of infective endocarditis stimulate search for new solutions of this problem. In the he present work we describe cases concerning placement of the first Russian-made valve-containing stent in the position of the pulmonary artery, with the stent's closing mechanism made of polytetrafluoroethylene thus giving ground to count on more favourable results.