ВАРИАНТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПОРОКОВ АОРТАЛЬНОГО КЛАПАНА У ПАЦИЕНТОВ С УЗКИМ ФИБРОЗНЫМ КОЛЬЦОМ



DOI: http://dx.doi.org/10.25298/2221-8785-2019-17-6-630-636


С. С. Лазута (S. S. Lazuta), С. В. Спиридонов (S. V. Spiridonov)

Аннотация


Введение. В обзоре прослежены основные успехи и проблемы в реконструктивной хирургии пороков аортального клапана при узком фиброзном кольце аортального клапана.
Цель. Исследование проблемы феномена «протез-пациент несоответствия» при хирургическом лечении пороков аортального клапана с узким фиброзным кольцом и путей преодоления данной проблемы.
Материал и методы. Проанализированы литературные источники по данной тематике отечественных и зарубежных авторов.
Результаты. Феномен «протез-пациент несоответствия» является фактором риска у пациентов, перенесших замену аортального клапана, и связан с плохим гемодинамическим и симптоматическим статусом.
Выводы. Хирургам следует приложить все усилия, чтобы не допустить возникновения ППН. Можно предотвратить ППН, используя протезы нового поколения, бескаркасные биопротезы (например «протез быстрого развертывания» Perceval) или аллотрансплантаты, выполняя операцию Озаки либо ее модификацию, или выполнить расширение кольца аортального клапана с целью имплантации протеза большего размера.

Ключевые слова


аортальный клапан, узкое фиброзное кольцо, «протез-пациент несоответствия»

Полный текст:

Литература


Kwasny, L. B. History of heart valve repair / L. B. Kwasny, R. W. Bianco, L. H. Toledo-Pereyra // Heart valves. From Design to Clinical Implantation / eds: P. A. Iaizzo [et al.]. – Boston : Springer US, 2013. – P. 85-120.

Kwasny LB, Bianco RW, Toledo-Pereyra LH. History of heart valve repair. In: Iaizzo PA, Bianco RW, Hill AJ, Louis JDS, editors. Heart valves. From Design to Clinical Implantation. Boston, MA: Springer US; 2013. pp. 85-120.

Comparison of early hemodynamics of 19-mm aortic valve bioprostheses in patients with a small aortic annulus / S. Domoto [et al.] // Interactive Cardio Vascular and Thoracic Surgery. – 2016. – Vol. 22 (1). – Р. 19-25. – doi: 10.1093/icvts/ivv284.

Domoto S, Niinami H, Uwabe K, Koike H, Tabata M, Morita K, Kambe M, Iguchi A. Comparison of early hemodynamics of 19-mm aortic valve bioprostheses in patients with a small aortic annulus. Interactive Cardio Vascular and Thoracic Surgery. 2016;22(1):19-25. doi: 10.1093/icvts/ivv284.

Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery and the European Society of Cardiology, in collaboration with the European Association of Percutaneous Cardiovascular Interventions / A. Vahanian [et al.] // European Heart Journal. – 2008. – Vol. 29 (11). – P. 1463-1470. – doi: 10.1093/eurheartj/ehn183.

Vahanian A, Alfieri O, Al-Attar N, Antunes M, Bax J, Cormier B, Cribier A, De Jaegere P, Fournial G, Kappetein AP, Kovac J, Ludgate S, Maisano F, Moat N, Mohr F, Nataf P, Pie´rard L, Pomar JL, Schofer J, Tornos P, Tuzcu M, van Hout B, Von Segesser LK, Walther T. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery and the European Society of Cardiology, in collaboration with the European Association of Percutaneous Cardiovascular Interventions. European Heart Journal. 2008;29(11):1463-1470. doi: 10.1093/eurheartj/ehn183.

Сердечно-сосудистые заболевания в Республике Беларусь: анализ ситуации и стратегии контроля / А. Г. Мрочек [и др.] ; Национальная Академия Беларуси, Республиканский научно-практический центр “Кардиология”. – Минск : Беларуская навука, 2011. – 342 с.

Mrochek AG, Grakovich AA, Kozlov ID, Gorbachev VV; National Academy of Sciences, Republican Scientific and Practical Centre “Cardiology”. Serdechno-sosudistye zabolevanija v Respublike Belarus: analiz situacii i strategii kontrolja. Minsk: Belaruskaja navuka, 2011; 342 p. (Russian).

Aortic valve replacement: determinants of operative mortality / G.-W. He [et al.] // Annals of Thoracic Surgery. – 1994. – Vol. 57 (5). – P. 1140-1146. – doi: 10.1016/0003-4975(94)91344-7.

He GW, Acuff TE, Ryan WH, Douthit MB, Bowman RT, He YH, Mack MJ. Aortic valve replacement: determinants of operative mortality. Annals of Thoracic Surgery. 1994;57(5):1140-1146. doi: 10.1016/0003-4975(94)91344-7.

Intensive glycemic control and the prevention of cardiovascular events : Implications of the ACCORD, ADVANCE, and VA Diabetes Trials / J. S. Skyler [et al.] // Journal of the American College of Cardiology. – 2009. – Vol. 53 (3). – Р. 298-304. – doi: 10.1016/j.jacc.2008.10.008.

Skyler JS, Bergenstal R, Bonow RO, Buse J, Deedwania P, Gale EA, Howard BV, Kirkman MS, Kosiborod M, Reaven P, Sherwin RS. Intensive glycemic control and the prevention of cardiovascular events: Implications of the ACCORD, ADVANCE, and VA Diabetes Trials. Journal of the American College of Cardiology. 2009;53(3):298-304. doi: 10.1016/j.jacc.2008.10.008.

Czarny, M. J. Diagnosis and management of valvular aortic stenosis / M. J. Czarny, J. R. Resar // Clinical Medicine Insights: Cardiology. – 2014. – Vol. 8, suppl. 1. – Р. 815-824. – doi: 10.4137/CMC.S15716.

Czarny MJ, Resar JR. Diagnosis and management of valvular aortic stenosis. Clinical Medicine Insights: Cardiology. 2014;8(Suppl 1):815-824. doi: 10.4137/CMC.S15716.

Barner, H. B. Prosthetic valves for the small aortic root / H. B. Barner, A. J. Labovitz, A. C. Fiore // Journal of Cardiac Surgery. – 1994. – Vol. 9 (№ 2, suppl.). – Р. 154-157.

Barner HB, Labovitz AJ, Fiore AC. Prosthetic valves for the small aortic root. Journal of Cardiac Surgery. 1994;9(2 Suppl):154-157.

Factors affecting left ventricular mass regression after aortic valve replacement with stentless valves / D. F. Del Rizzo [et al.] // Seminars in Thoracic and Cardiovascular Surgery. – 1999. – Vol. 11 (№ 4, suppl. 1). – P. 114-120.

Del Rizzo DF, Abdoh A, Cartier P, Doty D, Westaby S. Factors affecting left ventricular mass regression after aortic valve replacement with stentless valves. Seminars in Thoracic and Cardiovascular Surgery. 1999;11(4 Suppl 1):114-120.

Meta-analysis of valve hemodynamics and left ventricular mass regression for stentless versus stented aortic valves / B. Kunadian [et al.] // Annals of Thoracic Surgery. – 2007. – Vol. 84 (1). – P. 73-78. – doi: 10.1016/j.athoracsur.2007.02.057.

Kunadian B, Vijayalakshmi K, Thornley AR, de Belder MA, Hunter S, Kendall S, Graham R, Stewart M, Thambyrajah J, Dunning J. Meta-analysis of valve hemodynamics and left ventricular mass regression for stentless versus stented aortic valves. Annals of Thoracic Surgery. 2007;84(1):73-78. doi: 10.1016/j.athoracsur. 2007.02.057.

Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevant / N. Hanayama [et al.] // Annals of Thoracic Surgery. – 2002. – Vol. 73 (6). – P. 1822-1829. – doi: 10.1016/s0003-4975(02)03582-8.

Hanayama N, Christakis GT, Mallidi HR, Joyner CD, Fremes SE, Morgan CD, Mitoff PR, Goldman BS. Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevant. Annals of Thoracic Surgery. 2002;73(6):1822-1829. doi: 10.1016/s0003-4975(02)03582-8.

Early in vivo experience with the Hemodynamic Plus St. Jude Medical heart valves in patients with narrowed aortic annulus / T. Carrel [et al.] // Annals of Thoracic Surgery. – 1996. – Vol. 61 (5). – P. 1418-1422. – doi: 10.1016/0003-4975(96)00112-9.

Carrel T, Zingg U, Jenni R, Aeschbacher B, Turina MI. Early in vivo experience with the Hemodynamic Plus St. Jude Medical heart valves in patients with narrowed aortic annulus. Annals of Thoracic Surgery. 1996;61(5):1418-1422. doi: 10.1016/0003-4975(96)00112-9.

Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiography / J. G. Dumesnil [et al.] // Journal of the American College of Cardiology. – 1990. – Vol. 16, № 3. – P. 637-643. – doi: 10.1016/0735-1097(90)90355-s.

Dumesnil JG, Honos GN, Lemieux M, Beauchemin J. Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiography. Journal of the American College of Cardiology. 1990;16(3):637-643. doi: 10.1016/0735-1097(90)90355-s.

Anatomic validation of the ventricular mass estimates from clinical two-dimensional echocardiography: initial results / N. Reichek [et al.] // Circulation. – 1983. – Vol. 67 (1). – Р. 348-352.

Reichek N, Helak J, Plappert T, Sutton MS, Weber KT. Anatomic validation of the ventricular mass estimates from clinical two-dimensional echocardiography: initial results. Circulation. 1983;67(1):348-352.

Flow-dependent changes in Doppler-derived aortic valve effective orifice area are real and not due to artifact / L. Kadem [et al.] // Journal of the American College of Cardiology. – 2006. – Vol. 47 (1). – Р. 131-137. – doi: 10.1016/j.jacc.2005.05.100.

Kadem L, Rieu R, Dumesnil JG, Durand LG, Pibarot P. Flow-dependent changes in Doppler-derived aortic valve effective orifice area are real and not due to artifact. Journal of the American College of Cardiology. 2006;47(1):131-137. doi: 10.1016/j.jacc.2005.05.100.

Prediction of valve prosthesis-patient mismatchprior to aortic valve replacement: which is the best method / S. Bleiziffer [et al.] // Heart. – 2007. – Vol. 93 (5). – Р. 615-620. – doi: 10.1136/hrt.2006.102764.

Bleiziffer S, Eichinger WB, Hettich I, Guenzinger R, Ruzicka D. Prediction of valve prosthesis-patient mismatch prior to aortic valve replacement: which is the best method. Heart. 2007;93(5):615-620. doi: 10.1136/hrt.2006.102764.

Prosthesis-patient mismatch affects long-term survival after mechanical valve replacement / S. Kohsaka [et al.] // Journal of Thoracic and Cardiovascular Surgery. – 2008. – Vol. 135, № 5. – P. 1076-1080. – doi: 10.1016/j.jtcvs.2007.11.032.

Kohsaka S, Mohan S, Virani S, Lee VV, Contreras A, Reul GJ, Coulter SA. Prosthesis-patient mismatch affects long-term survival after mechanical valve replacement. Journal of Thoracic and Cardiovascular Surgery. 2008;135(5):1076-1080. doi: 10.1016/j.jtcvs.2007.11.032.

Impact of valve prosthesis-patient mismatch on shorttermmortality after aortic valve replacement / C. Blais [et al.] // Circulation. – 2003. – Vol. 108 (8). – Р. 983-988. – doi: 10.1161/01.CIR.0000085167.67105.32.

Blais C, Dumesnil JG, Baillot R, Simard S, Doyle D, Pibarot P. Impact of valve prosthesis-patient mismatch on shorttermmortality after aortic valve replacement. Circulation. 2003;108(8):983-988. doi: 10.1161/01.CIR.0000085167. 67105.32.

Second natural history study of congenital heart defects. Aortic stenosis: echocardiography / R. A. Nishimura [et al.] // Circulation. – 1993. – Vol. 87, suppl. 2. – P. 166-172.

Nishimura RA, Pieroni DR, Bierman FZ, Colan SD, Kaufman S, Sanders SP, Seward JB, Tajik AJ, Wiggins JW, Zahka KG. Second natural history study of congenital heart defects. Aortic stenosis: echocardiography. Circulation. 1993;87(2 Suppl):166-172.

Pibarot, P. The relevance of prosthesis-patient mismatch after aortic valve replacement / P. Pibarot, J. G. Dumesnil // Nature Clinical Practice Cardiovascular Medicine. – 2008. – Vol. 5, № 12. – P. 764-765. – doi: 10.1038/ncpcardio1366.

Pibarot P, Dumesnil JG. The relevance of prosthesis-patient mismatch after aortic valve replacement. Nature Clinical Practice Cardiovascular Medicine. 2008;5(12):764-765. doi: 10.1038/ncpcardio1366.

Prosthesis-patient mismatch affects survival after aortic valve replacement / V. Rao [et al.] // Circulation. – 2000. – Vol. 102 (№ 19, suppl. 3). – P. III5-9. – doi: 10.1161/01.cir.102.suppl_3.iii-5.

Rao V, Jamieson WR, Ivanov J, Armstrong S, David TE. Prosthesis-patient mismatch affects survival after aortic valve replacement. Circulation. 2000;102(19 Suppl 3):III5-9. doi: 10.1161/01.cir.102.suppl_3.iii-5.

Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic position / D. Mohty [et al.] // Circulation. – 2006. – Vol. 113, № 3. – P. 420-426. – doi: 10.1161/CIRCULATIONAHA.105.546754.

Mohty D, Malouf JF, Girard SE, Schaff HV, Grill DE, Enriquez-Sarano ME, Miller FAJr. Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic position. Circulation. 2006;113(3):420-426. doi: 10.1161/CIRCULATIONAHA.105. 546754.

Hemodynamic features of the freestyle aortic bioprosthesis compared with stented bioprosthesis / J. G. Dumesnil [et al.] // Annals of Thoracic Surgery. – 1998. – Vol. 66, suppl. 6. – P. S130-S133. – doi: 10.1016/s0003-4975(98)01119-9.

Dumesnil JG, LeBlanc MH, Cartier PC, Métras J, Desaulniers D, Doyle DP, Lemieux MD, Raymond G. Hemodynamic features of the freestyle aortic bioprosthesis compared with stented bioprosthesis. Annals of Thoracic Surgery. 1998;66(Suppl 6):S130-133. doi: 10.1016/s0003-4975(98)01119-9.

The Freedom SOLO valve for aortic valve replacement: clinical and hemodynamic results from a prospective multicenter trial / S. Beholz [et al.] // Journal of Heart Valve Disease. – 2010. – Vol. 19 (1). – P. 115-123.

Beholz S, Repossini A, Livi U, Schepens M, El Gabry M, Matschke K Trivedi U, Eckel L, Dapunt O, Zamorano JL. The Freedom SOLO valve for aortic valve replacement: clinical and hemodynamic results from a prospective multicenter trial. Journal of Heart Valve Disease. 2010;19(1):115-123.

A new method prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic ring / S. Konno [et al.] // Journal of Thoracic and Cardiovascular Surgery. – 1975. – Vol. 70 (5). – P. 909-917.

Konno S, Imai Y, Iida Y, Nakajima M, Tatsumo K. A new method prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic ring. Journal of Thoracic and Cardiovascular Surgery. 1975;70(5):909-917.

Manouguian, S. Aortic and aortic-mitral enlargement / S. Manouguian, P. G. Kirchoff // Journal of Thoracic and Cardiovascular Surgery. – 1996. – Vol. l12 (1). – P. 207.

Manouguian S, Kirchoff PG. Aortic and aortic-mitral enlargement. Journal of Thoracic and Cardiovascular Surgery. 1996;112(1):207.

Nicks, R. Hypoplasia of the aortic root: the problem of aortic valve replacement / R. Nicks, Т. Cartmill, L. Bernstein // Thorax. – 1970. – Vol. 25 (3). – P. 339-349.

Nicks R, Cartmill Т, Bernstein L. Hypoplasia of the aortic root: the problem of aortic valve replacement. Thorax. 1970;25(3):339-346.

Procedural, 30 day and one year outcome following CoreValve or Edwards transcatheter aortic valve implantation: results of the Belgian national registry / J. M. Bosmans [et al.] // Interactive CardioVascular and Thoracic Surgery. – 2011. – Vol. 12 (5). – P. 762-767. – doi: 10.1510/icvts.2010.253773.

Bosmans JM, Kefer J, De Bruyne B, Herijgers P, Dubois C, Legrand V, Verheye S, Rodrigus I. Procedural, 30 day and one year outcome following CoreValve or Edwards transcatheter aortic valve implantation: results of the Belgian national registry. Interactive Cardio Vascular and Thoracic Surgery. 2011;12(5):762-767. doi: 10.1510/icvts.2010.253773.

Stent valve implantation in conventional redo aortic valve surgery to prevent patient-prosthesis mismatch / E. Ferraria [et al.] // Interactive CardioVascular and Thoracic Surgery. – 2017. – Vol. 24 (3). – P. 319-323. – doi: 10.1093/icvts/ivw397.

Ferraria E, Franciosia G, Clivio S, Faletra F, Moccetti M, Moccetti T, Pedrazzini G, Demertzis S. Stent valve implantation in conventional redo aortic valve surgery to prevent patient-prosthesis mismatch. Interactive CardioVascular and Thoracic Surgery. 2017;24(3):319-323. doi: 10.1093/icvts/ivw397.

Ремоделирование левого желудочка у пациентов после имплантации аортального аллографта : тезисы докладов VII съезда кардиологов, кардиохирургов, рентгенэндоваскулярных и сосудистых хирургов Республики Беларусь, Минск, 15-16 дек. 2016 г. / С. В. Спиридонов [и др.] // Кардиология в Беларуси. – 2016. – № 6. – С. 928.

Spiridonov SV, Shhetinko NN, Odincov VO, Shket AP, Ostrovskij JuP. Remodelirovanie levogo zheludochka u pacientov posle implantacii aortal'nogo allografta. In: VII sezd kardiologov, kardiohirurgov, rentgenjendovaskuljarnyh i sosudistyh hirurgov Respubliki Belarus. Tezisy dokladov; 2016 Dec 15-16; Minsk. 2016. p. 928. (Kardiologija v Belarusi [Cardiology in Belarus]; no. 6). (Russian).

Спиридонов, С. В. Криосохраненные аллографты в лечении пациентов с патологией аортального клапана : диссертация на соискание учёной степени доктора медицинских наук : 14.01.26 / С. В. Спиридонов ; Республиканский научно-практический центр “Кардиология”. – Минск, 2017. – 250 л.

Spiridonov SV. Kriosohranennye allografty v lechenii pacientov s patologiej aortalnogo klapana [Cryopreserved allografts in the treatment of patients with aortic valve diseases] [dissertation]. Minsk (Belarus): Republican Scientific and Practical Centre “Cardiology”; 2017. 250 l. (Russian).

Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease / S. Ozaki [et al.] // Interactive Cardio Vascular and Thoracic Surgery. – 2011. – Vol. 12 (4). – P. 550-553. – doi: 10.1510/icvts.2010.253682.

Ozaki S, Kawase I, Yamashita H, Uchida S, Nozawa Y, Matsuyama T, Takatoh M, Hagiwara S. Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease. Interactive Cardio Vascular and Thoracic Surgery. 2011;12(4):550-553. doi: 10.1510/icvts.2010.253682.


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