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 Federation10.15825/1995-1191-2024-3-134-140vtio-1808Research ArticleТрансплантация сердца и вспомогательное кровообращениеHeart Transplantation and Assisted CirculationПредоперационная механическая поддержка кровообращения у пациентов с острой митральной регургитацией после некроза папиллярных мышцPreoperative extracorporeal mechanical circulatory support for patients with acute severe mitral valve regurgitation due to papillary muscle necrosishttps://orcid.org/0000-0002-0192-1931ЯблонскийП. П.IablonskiiP. P.

Яблонский Павел Петрович

30625, Ганновер, ул. Карл-Нойберг, 1

Pavel P. Iablonskii

1, Carl-Neuberg-Str., Hannover, 30625

pavel.yablonski@gmail.comНатановР.NatanovR.

Ганновер

Hannover

КюнК.KuehnC.

Ганновер

Hannover

РупарварА.RuhparwarA.

Ганновер

Hannover

ИсмаилИ.IsmailI.

Ганновер

Hannover

Медицинского университета ГанновераГерманияDepartment of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical SchoolGermany202414062024263134140Copyright © Яблонский П.П., Натанов Р., Кюн К., Рупарвар А., Исмаил И., 20242024Яблонский П.П., Натанов Р., Кюн К., Рупарвар А., Исмаил И.Iablonskii P.P., Natanov R., Kuehn C., Ruhparwar A., Ismail I.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/1808  Цель

  Цель: проанализировать 12-летний опыт лечения острой постинфарктной недостаточности митрального клапана в одном центре.

Материалы и методы

Материалы и методы. В ретроспективное исследование включены 12 взрослых пациентов с инфарктом миокарда с подъемом сегмента ST (STEMI) и соответствующей острой митральной регургитацией, которые были прооперированы с 2009-го по 2017 год. Мы проанализировали внутрибольничный период всех пациентов и отдаленный период. Все пациенты прошли предоперационную коронарную ангиографию и эхокардиографию. Все пациенты были оперированы в условиях искусственного кровообращения и холодовой кровяной кардиоплегии. При необходимости проведения веноартериальной экстракорпоральной мембранной оксигенации (ВА-ЭКМО) предпочтение отдавалось бедренному доступу.

  Результаты

  Результаты. Семь пациентов нуждались в ВА-ЭКМО-поддержке, шесть из них – до операции; четверо из них получали механическую циркуляторную поддержку вне нашего стационара и были транспортированы на ЭКМО. Всем пациентам было выполнено чрескожное коронарное вмешательство (ЧКВ) с успешной реваскуляризацией инфаркт-связанной артерии. Все пациенты, кроме одного, были прооперированы в течение первых 24 часов от отрыва папиллярной мышцы. В раннем послеоперационном периоде погиб один пациент. Пациенты, получавшие ВА-ЭКМО, имели большую продолжительность инотропной поддержки, времени вентиляции и пребывания в отделении интенсивной терапии (p < 0,01).

Выводы

Выводы. Острая недостаточность митрального клапана вследствие STEMI остается тяжелым осложнением, но периоперационное использование ВА-ЭКМО позволяет существенно снизить 30-дневную смертность и улучшить результаты лечения этой группы пациентов.

Background

Background. Acute mitral valve insufficiency has a high mortality rate (up to 100%). Mechanical circulatory support and emergency surgery can improve the survival of this patient cohort.

Objectives

Objectives: to analyze a 12-year single-center experience of treating acute post-infarction mitral valve insufficiency.

Materials and methods

Materials and methods. This retrospective study included 12 adult patients with ST elevated myocardial infarction (STEMI) and corresponding acute mitral valve insufficiency who underwent surgery between 2009 and 2017. We analyzed the in-hospital period of all patients and long-term follow-ups whenever possible. All patients underwent preoperative coronary angiography and echocardiography. All patients underwent cardiopulmonary bypass and cold-blood cardio- plegia. If venoarterial extracorporeal membrane oxygenation (VA-ECMO) was required, the femoral approach was preferred.

Results

Results. Seven patients needed VA-ECMO support, six of them preoperatively; four received mechanical circulatory support outside the hospital. All patients underwent percutaneous coronary intervention (PCI) with successful revascularization of the culprit artery. All but one patient underwent surgery within the first 24 hours. One patient underwent repeat surgery once the mitral valve could be repaired, and the other patient did not require any coronary bypass. In-hospital mortality occurred in one patient in the VA-ECMO group. Patients receiving VA-ECMO had longer duration of inotropic support, ventilation time, and intensive care unit stay (p < 0.01).

Conclusions

Conclusions. Acute mitral valve insufficiency due to STEMI remains a dramatic complication, but the perioperative use of VA-ECMO helps reduce 30-day mortality and improve outcomes in this group of patients.

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