CC BY
30
I. SURGERY
https://doi.org/10.35805/BSK2021IV022
SOME INNOVATIVE TECHNOLOGIES FOR THE CORRECTION OF VALVULAR HEART DISEASES. REVIEW
Sagatov I.Y.
orcid.org/0000-0002-4668-1513
Kudaibergen A.B.
orcid.org/0000-0002-2725-7530
Momynov B.M.
orcid.org/0000-0002-6008-0298
Corresponding author: Momynov B.M. - Resident of Cardiac Surgery Department, JSC "A.N. Syzganov National Scientific Center for Surgery".
E-mail:
bakhytzhan.momynov@gmail.com
Conflict of interest
The authors declare that they have no conflicts of interest
Keywords
mitral valve, correction
Хат алысатын автор: Момынов Б.М. - кардиохирургия бвлiмiнiндэр'1гер-резидент'1, «А.Н. Сызранов атындары Уяттык, еылыми хирургия орталыры» АК.
E-mail:
bakhytzhan.momynov@gmail.com
Мудделер кактыгысы
Авторлар мудделер кактырысынын жоктырын мэлiмдейдi
Туйш сездер
митральды какпакша, тузету
Sagatov I.Y., Kudaibergen A.B., Momynov B.M.
JSC «A.N. Syzganov National Scientific Center for Surgery», Almaty, Kazakhstan
Abstract
Valve defects or congenital/acquired heart defects are damage to the valve and/or subvalvular structures, which leads to impaired hemodynamics and the development of heart failure. Asymptomatic valvular heart disease is present in 2.5% of the population; with age, this figure rises to 13%. In the absence of permanent treatment, lesions of the heart valves significantly reduce the quality and duration of life. The European Society of Cardiology (ESC) and the American Heart Association (AHA) regularly review the effectiveness of new surgical treatments and reflect their findings in international guidelines. Today, minimally invasive surgery is the most effective and safe way to treat patients with valvular heart disease. The article presents two new methods for the treatment of valvular heart disease. Transapical mitral valve repair on a beating heart with neochord implantation (TOP-MINI) is a new MVP option that has been approved for patients with severe mitral regurgitation due to prolapse of the leaflet (s) or chord (grades 2-4). The new procedure with the NeoChord DS1000 device results in a significant reduction in mitral regurgitation and in reverse remodeling of the left ventricle and left atrium after 6 months of follow-up. Also reviewed is Minimally Invasive Aortic Valve Replacement (MA VR), which has been shown to be beneficial in improving patient satisfaction by minimizing pain and earlier recovery. Sutureless valves are preferred over traditional aortic valve replacement (AVR) due to the reduced operation time and the need for blood transfusion. The Perceval valve (Sorin, Sallugia, Italy) is a self-expanding bovine pericardial prosthesis placed in a nitinol stent designed to facilitate aortic valve implantation. A systematic review and meta-analysis demonstrated that the early clinical and hemodynamic characteristics of the Perceval valve are satisfactory and comparable to those of conventional A VRs.
This literature review was carried out in accordance with the PRISM statement. The databases searched in this review included Pubmed, Web of Science, Scopus and Cochrane databases for systematic reviews.
Журектщ какпакшалы ауруын тузетудщ инновацияльщ кейб1р технологиялары. Эдебиет шолуы
Саратов I.E., Кудайберген А.Б., Момынов Б.М.
«А.Н. Cbi3FaHOB атында?ы Улттык, ?ылыми хирургия орталь™» АК,, Алматы к,., Казахстан Ацдатпа
Какпакшалардын журе пайда болган немесе туа бткен акаулары - бул гемодинамиканын бузылуына жэне журек жеткiлiксiздiпнiн дамуына экелетн какпакшалардын жэне/немесе какпакша асты куурылымдардын закымдануы. Асимптоматикалык журек акаулары халыктын 2,5% - ында кездеседi, жасына карай бул кврсеткш 13% - €а дейн артады. Журек клапандарынын закымдануын туракты емдеу болмаЕан жаедайда, вмiр суру сапасы мен узактыгын айтарлыктай твмендете^. Еуропалык кардиология котамы (Еуропалык Кардиология котамы, ESC) жэне Американдык журек кауымдастыЕы (American Heart Association, AHA) емдеудiн жана хирургиялык эдiстерiнiн ттмдШш yнемi зерттеп отырады жэне халыкаралык усыныстарда вз зерттеулершщ нэтижелерн кврсетедi. Бупнп танда минимал-ды инвазивт хирургия журек какпакшасы бар наукастарды емдеудн ен ™мд1 жэне кдутаз эдiсi болып табылады. Макалада журек клапанынын патологиясын емдеудн ею жана эдiсi келлршген. Неохордты (TOP-MINI) имплантаци-ялау аркылы жумыс iстейтiн журектеп митральды какпакшаны трансапикальды калпына келлру - бул PMK-нщ жана нускасы, ол жапырактын немесе аккордтын (2-4 градус) пролапсына байланысты ауыр митральды жеткiлiксiздiп бар наукастар ушн макулдантан. NeoChord ds1000 курылгысы бар жана процедура 6 айлык бакылаудан кейн митральды жеткiлiксiздiкгiн жэне сол жак карыншанын жэне сол жак атриумнын кайта калпына келу дэрежеанщ айтарлыктай твменде^не экеледi. Сондай-ак, аорта какпакшасын (MA VR) минималды инвазивт ауыстыру эдiсi карастырышн, ол ауырсынуды азайту жэне ертерек калпына кел^ру аркылы пациенпердщ канагаттануын арттырудын артыкшылыгын кврсет. Жказ клапандар операция уакытын кыскарту жэне кан кую кажетшп есебнен дэсгyрлi аорта какпаЕын (AVR) ауыстыртан жвн. Perceval клапаны (Сорин, Саллуджия, Италия) - бул аорта какпакшасын имплантациялауды женлдету ушн жасалеан нитинол стентне орнатылган взiн-взi кенейтетн бука перикардты протез. Жyйелi шолу жэне мета-анализ Perceval клапанынын ерте клиникалык жэне гемодинамикалык сипаттамалары канаЕаттанарлык жэне карапайым AVR-мен салыстырылатындырын кврсет.
Бул эдебиетт шолу PRISM мэлiмдемесiне сэйкес журпзШщ. Осы шолуда iзделrен дереккорларра жYЙелi шо-лулар Yшiн Pubmed, Web of Science, Scopus жэне Cochrane дереккорлары кiрдi.
Некоторые инновационные технологии коррекции клапанных пороков сердца. Обзор литературы
Сагатов И.Е., Кудайберген А.Б., Момынов Б.М.
АО «Национальный научный центр хирургии им. А.Н. Сызганова», г. Алматы, Казахстан Аннотация
Пороки клапанов или врожденные/приобретенные пороки сердца - это поражение клапана и/или подкла-панных структур, которое приводит к нарушению гемодинамики и развитию сердечной недостаточности. Бессимптомные клапанные пороки сердца присутствуют у 2,5% населения, с возрастом эта цифра возрастает до 13%. При отсутствии постоянного лечения поражения клапанов сердца существенно снижает качество и продолжительность жизни. Европейское общество кардиологов (European Society of Cardiology, ESC) и Американская кардиологическая ассоциация (American Heart Association, AHA) регулярно изучают эффективность новых хирургических методов лечения и отражают результаты своих исследований в международных рекомендациях. На сегодняшний день минимально инвазивная хирургия является наиболее результативным и безопасным способом лечения пациентов с клапанными пороками сердца. В статье представлены два новых методы по лечению клапанной патологии сердца. Трансапикальное восстановление митрального клапана на работающем сердце с имплантацией неохорды (TOP-MINI) - это новый вариант ПМК, который был одобрен для пациентов с тяжелой митральной недостаточностью из-за пролапса створки (листов) или хорды (2-4 степени). Новая процедура с устройством NeoChord DS1000 приводит к значительному снижению степени митральной недостаточности и обратного ремоделирования левого желудочка и левого предсердия через 6 месяцев наблюдения. Также рассмотрен метод минимально инвазивной замены аортального клапана (MAVR), которая продемонстрировала преимущество в отношении повышения удовлетворенности пациентов за счет минимизации боли и более раннего выздоровления. Бесшовные клапаны предпочтительнее традиционной замене аортального клапана (AVR) за счет сокращения времени операции и необходимости переливания крови. Клапан Perceval (Sorin, Саллуджия, Италия) - это саморасширяющийся протез из бычьего перикарда, установленный в нитиноловый стент, разработанный для упрощения имплантации аортального клапана. Систематический обзор и метаанализ продемонстрировали, что ранние клинические и гемодинамические характеристики клапана Perceval являются удовлетворительными и сопоставимы с таковыми у обычных AVR.
Этот обзор литературы был проведен в соответствии с заявлением PRISM. Базы данных, в которых проводился поиск в этом обзоре, включали Pubmed, Web of Science, Scopus и Cochrane для систематических обзоров.
Автор для корреспонденции: Момынов Б.М. - врач-резидент отделения кардиохирургии, АО «Национальный научный центр хирургии им. А.Н. Сызганова». E-mail:
bakhytzhan.momynov@gmail.com
Конфликт интересов
Авторы заявляют об отсутствии конфликта интересов
Ключевые слова
митральный клапан, коррекция
Relevance
Valvular disease or congenital/acquired heart disease are lesions of the valve and/or subval-vular structures that leads to impaired hemodynamics and the development of heart failure. Asymptomatic valvular heart disease are present in 2.5% of the population with age this figure increases to 13%. In the absence of permanent treatment of heart valve lesions significantly reduces the quality and duration of life. The European Society of Cardiology (ESC) and the American Heart Association (AHA) regularly study the effectiveness of new surgical methods of treatment and reflect the results of their research in international recommendations. For today minimally invasive surgery is the most effective and safe way to treat patients with valvular heart disease. New methods of correction that can be developed in Kazakhstan for the general development of cardiac surgical care to the population of the country. This literature review was carried out in accordance with the PRISM statement. The databases searched in this review included Pubmed, Web of Science, Scopus and Cochrane databases for systematic reviews.
The first method
The method is a transapical restoration of the mitral valve on a working heart with implantation of a neochord (TOP-MINI) - this is a new version of the MVR that has been approved for patients with severe mitral insufficiency due to prolapse of the leaf or chord (2-4 degrees). The procedure is performed using the NeoChord DS1000 system (NeoChord, Inn., Eden Prairie, MN) under the control of direct 2D and 3D transesophageal echocardiography (TEE) both for implantation and for adjusting the tension of the neochord. According to research at a hospital in Padua, Italy, from November 2013 to December 2014. During this period 111 patients were examined. The mechanism of MR development was primary or degenerative in 96 patients (86%) and secondary or functional in 12 patients (11%). Among 96 patients with primary MR, isolated posterior leaf prolapse (PML) was evident in 72 patients (75%), anterior leaf prolapse (AML) - in 13 cases (14%) and disease of both leaflets - in 11 (11%). Of the patients with primary MR Neochord implantation was performed in 49 cases (51%), while traditional surgical replacement of MVR or MV was performed in 6 (6%). Currently 16 patients (17%) are listed for traditional open heart
A, Insertion of the NeoChord DS1000 device (NeoChord, Inc, Eden Prairie, Minn) through a left minithora-cotomy and a posterolateral ventriculotomy to sequentially release 3 expanded polytetra-fluoroethylene chords to the free edge of the prolapsing A2. B, The loop and the end of each single expanded polytetrafluoroethylene chord are secured with colored mosquito surgical hemostat forceps. C, The loop and the end of each neochord are then secured to one of the long sides of a properly shaped rectangular pericardial patch. D, The chords attached to the anterior leaflet are now looped, and 3 more chords are then sutured to the other long side of the patch, which becomes the new free edge of the anterior mitral leaflet. E, The patch is then hoisted, driven with the help of forceps, inside the left ventricle by gently pulling on the 3 neochords, until it is positioned against the ventricular side of the anterior leaflet. F, The final result with the new augmented anterior leaflet. (Figure designed by Fabrizio Lavezzi.) https://doi.org/10.1016/j. jtcvs.2019.02.027
surgery, while 19 (20%) are scheduled for Neochord implantation. Six patients (6%) were treated with medication because MR was not serious enough to require intervention.
According to the Department of Cardiac Surgery, Medicover Hospital, Warsaw, Poland. Twenty-one patients with severe mitral insufficiency due to posterior valve prolapse (81% male; average age: 60.7 years ± 12.7 years) underwent surgery on the NeoChord DS1000 system. There were 12 (57.1%) patients with type A (isolated central prolapse/flail), 8 (38.1%) patients with type B (multi-segment disease) and 1 (4.8%) patient with type C (posterior/ paracommisural region) prolapse MV. A pathological leaflet was available in 12 (57.1%) patients. The average number of neochords was 3 (2-6). Echocardiography was used to evaluate the morphology
of the left heart and the degree of MR before and 6 months after chord implantation. Early success of the procedure was achieved in 100% of patients. At 6-month follow-up, minor mitral insufficiency (traces and mild) was detected in 17 (81.0%) patients, moderate MR - in 4 (19.0%) patients; the average values of the left sections of the size and volume, mitral E and E' velocity of the lateral annular space MV significantly decreased.
The second method
Minimally invasive aortic valve replacement (MAVR) has taken advantage of satisfaction by minimizing pain and earlier recovery. Sutureless valves are preferred over traditional aortic valve replacement (AVR) due to the reduction in surgery time and the need for transfusion.
The Perceval valve (Sorin, Sallugia, Italy) is a self-expanding bovine pericardial prosthesis placed in a nitinol stent designed to facilitate aortic valve implantation. This meta-analysis assesses the clinical, hemodynamic outcomes and survival of the sutureless Perceval.
After applying the inclusion and exclusion criteria, 14 out of 66 relevant articles were selected for evaluation. Of these 14 studies, 2505 patients were enrolled. Current data on the Perceval valve in aortic valve disease are limited to observational studies only. Minimally invasive surgery was performed in 976 patients, of which 336 - through the right anterior thoracotomy. The most commonly used Perceval M and L seamless valves, 782 and 770, respectively. Serious adverse event rates included 30-day mortality (0 to 4.9%), cerebrovascular accident (0 to 3%), permanent pacemaker insertion (0 to 17%), moderate to severe paravalvular leakage (0 up to 8.6%) and reoperation (from 0 to 4.8%). The postoperative mean aortic valve gradient ranged
from 9 to 15.9 mm Hg, and the postoperative NYHA class I or II ranged from 82 to 96%. Annual survival rates ranged from 86% to 100%; and 5-year survival rates ranged from 71.3% to 85.5% in two studies.
Conclusions
The new procedure with the NeoChord DS1000 device is possible in properly selected patients and results in a significant reduction in mitral regurgitation and in reverse remodeling of the left ventricle and left atrium after 6 months of follow-up.
A systematic review and meta-analysis demonstrated that the early clinical and hemodynamic characteristics of the Perceval valve are satisfactory and comparable to those of conventional AVRs. However, long-term data on the longevity and he-modynamics of the Perseval valve are somewhat limited. Large-scale randomized trials are recommended to accurately assess the long-term stability and complications associated with the Perseval valve.
Source: Aortic Valve Replacement Using a Perceval Sutureless Aortic Bioprosthesis David Heimansohn, MD, and Sina Moainie, MD; https:// doi.org/10.1053/j.optechst-cvs.2017.09.004
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