vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2023-3-129-138vtio-1664Research ArticleСмежные дисциплиныRelated DisciplinesРепротезирование аортального клапана после ранее выполненного TAVIAortic valve replacement after previous TAVIТитовД. А.TitovD. A.

Москва

Moscow

СоркомовМ. Н.SorkomovM. N.

Соркомов Максим Нюргустанович,

121552, Москва, Рублевское шоссе, д. 135

Maxim Sorcomov,

135, Rublevskoye Shosse str., 121552, Moscow

sorcommn@gmail.comПурсановаД. М.PursanovaD. M.

Москва

Moscow

ФедосейкинаМ. И.FedoseykinaM. I.

Москва

Moscow

БабенкоС. И.BabenkoS. I.

Москва

Moscow

МуратовР. М.MuratovR. M.

Москва

Moscow

ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии имени А.Н. Бакулева» Минздрава РоссииРоссияBakulev Research Center for Cardiovascular SurgeryRussian Federation202307072023253129138Copyright © Титов Д.А., Соркомов М.Н., Пурсанова Д.М., Федосейкина М.И., Бабенко С.И., Муратов Р.М., 20232023Титов Д.А., Соркомов М.Н., Пурсанова Д.М., Федосейкина М.И., Бабенко С.И., Муратов Р.М.Titov D.A., Sorkomov M.N., Pursanova D.M., Fedoseykina M.I., Babenko S.I., Muratov R.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1664

Эндоваскулярные операции при пороках аортального клапана хорошо зарекомендовали себя у пациентов пожилого возраста и с тяжелой сопутствующей патологией, конкурирующей с основным заболеванием. Однако риск развития дисфункции по причине структурной дегенерации биологического протеза и протезного эндокардита остается высоким. Выполнение повторных операций сопряжено с риском развития осложнений, но открытая операция в данной группе больных является единственным методом лечения.

Цель

Цель: описание серии повторных операций при дисфункции имплантированных протезов после TAVI.

Материал и методы

Материал и методы. В отделении неотложной хирургии приобретенных пороков сердца НМИЦ ССХ им. А.Н. Бакулева МЗ РФ (заведующий профессор Р.М. Муратов) с 2015-го по 2022 г. выполнено 6 повторных операций у больных, ранее перенесших транскатетерное протезирование аортального клапана (TAVI). Средний возраст больных на момент TAVI составлял 70,6 года (62–83), на момент повторной операции – 74,3 года (70–84). Прогнозируемый риск смертности по EuroSCORE II на момент повторного вмешательства – 42,2% (21,7–87,6). Среднее время до выполнения повторной операции составило 42 месяца. Показаниями для реоперации в 4 случаях явился ранний активный протезный эндокардит, в 2 случаях – структурная дегенерация протеза.

Результаты

Результаты. На госпитальном этапе умер 1 пациент от острой сердечной недостаточности, операция выполнялась по жизненным показаниям в условиях крайней исходной тяжести. У трех пациентов ранний п/о период протекал без осложнений. У одной больной потребовалась ВАБК по причине ОСН, также 1 больной выполнена имплантация постоянного ЭКС. Среднее время нахождения в стационаре составило 14 дней. У пациентов с активной формой протезного эндокардита проводился 6-недельный курс антибиотикотерапии. Функция имплантированных протезов была удовлетворительной.

Выводы

Выводы. Репротезирование аортального клапана после ранее выполненного TAVI является вынужденной операцией и единственным способом лечения дисфункции протеза. В условиях активного протезного эндокардита своевременная операция обеспечивает спасение данной категории пациентов.

Endovascular surgery for aortic valve defects has proven itself well in elderly patients with severe comorbidities competing with the underlying disease. However, the risk of dysfunction resulting from structural degeneration of bioprosthetic heart valve and prosthetic valve endocarditis remains high. Repeated surgeries are associated with complications, but open surgery is the only method of treatment in this group of patients.

Objective

Objective: to describe a series of reinterventions for prosthetic valve dysfunction occurring after TAVI.

Material and methods

Material and methods. From 2015 to 2022, at the Department of Emergency Surgery for Acquired Heart Diseases (Head, Professor R.M. Muratov), Bakulev Research Center for Cardiovascular Surgery, 6 reoperations were performed in patients who had previously undergone transcatheter aortic valve implantation (TAVI). The average age of patients at the time of TAVI and at the time of reoperation was 70.6 years (62–83) and 74.3 years (70–84), respectively. The EuroSCORE II predicted risk of mortality at the time of reintervention was 42.2% (21.7–87.6). The mean time to reoperation was 42 months. Indications for reoperation were early active prosthetic endocarditis (4 cases) and structural valve degeneration (2 cases).

Results

Results. At the hospital stage, 1 patient died of acute heart failure; the operation was performed for vital indications in conditions of extreme initial severity. In three patients, the early postoperative period was uneventful. One patient required intra-aortic balloon counterpulsation (IABP) due to heart failure, and 1 patient was implanted with permanent pacemaker. The average time of hospitalization was 14 days. Patients with active prosthetic endocarditis received a 6-week course of antibiotic therapy. The function of the implanted valves was satisfactory.

Conclusions

Conclusions. Aortic valve replacement after previous TAVI is an emergency operation and represents the only way to treat valve dysfunction. Under active prosthetic endocarditis, timely surgery can save this patient cohort.

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The authors declare that there are no conflicts of interest present.