CHOICE OF THE IMPLANTABLE SUPPORT RINGS IN CONNECTIVE TISSUE DYSPLASIA AND SEVERE MITRAL REGURGITATION
https://doi.org/10.15829/1560-4071-2016-11-16-21
Abstract
Aim. To analyze the results of valve-securing surgery on mitral valve in connective tissue dysplasia.
Material and methods. From 2011 to 2014 y., totally 171 patient included, with isolated mitral regurgitation. Patients were randomized to 2 groups. Mean age in the Group D — ring, and Group C — flex, was 57 [42;65] and 54 [41;63] year old, respectively (p=0,092). Part of males was 69 and 67% in the groups, respectively.
Results. There were no cases of 30-day mortality. During 24 months of follow-up, in D ring and C flex groups, survival was 96,0±2,3% (95% CI 88,6-98,7%) and 94,3±2,8% (95% CI 85,5- 97,9%), resp. (р=0,899); no re-operation — 97,0±2,1% (95% CI 88,4-99,3%) and 100%, resp. (р=0,044); no return of significant mitral regurgitation 80,8±6,5% (95% CI 64,0-90,3%) and 92,8±3,1% (95% CI 83,4-97,0%), resp. (р=0,002).
Conclusion. Application of flexible C flex rings in valve-securing operations makes it to achieve better results in middle-long-term post-operation period comparing to the usage of semi-hard support rings in patients with connective tissue dysplasia and severe mitral regurgitation.
About the Authors
A. V. Afanasiev
E. N. Meshalkin Novosibirsk Scientific-Research Institute of Circulation Pathology, Novosibirsk, Russia
Russian Federation
Russian Federation
S. I. Zheleznev
E. N. Meshalkin Novosibirsk Scientific-Research Institute of Circulation Pathology, Novosibirsk, Russia
Russian Federation
Russian Federation
A. V. Bogachev-Prokofiev
E. N. Meshalkin Novosibirsk Scientific-Research Institute of Circulation Pathology, Novosibirsk, Russia
Russian Federation
Russian Federation
V. M. Nazarov
E. N. Meshalkin Novosibirsk Scientific-Research Institute of Circulation Pathology, Novosibirsk, Russia
Russian Federation
Russian Federation
I. I. Demin
E. N. Meshalkin Novosibirsk Scientific-Research Institute of Circulation Pathology, Novosibirsk, Russia
Russian Federation
Russian Federation
D. A. Astapov
E. N. Meshalkin Novosibirsk Scientific-Research Institute of Circulation Pathology, Novosibirsk, Russia
Russian Federation
Russian Federation
A. M. Karaskov
E. N. Meshalkin Novosibirsk Scientific-Research Institute of Circulation Pathology, Novosibirsk, Russia
Russian Federation
Russian Federation
References
1. Filsoufi F, Carpentier A. Principles of reconstructive surgery in degenerative mitral valve disease. Sem in thorac and cardiovasc surg. 2007; 19(2), 103-10. doi:10.1053/j.semtcvs.2007.04.003.
2. Brown ML, Schaff HV, Li Z, et al. Results of mitral valve annuloplasty with a standardsized posterior band: Is measuring important? J Thorac Cardiovasc Surg 2009; 138: 886-91.
3. Cosgrove DM, Arcidi JM, Rodriguez L, et al. Initial experience with the Cosgrove-Edwards annuloplasty system. Ann Thorac Surg. 1995; 60: 499-503.
4. Lange R, Guenther T, Kiefer B, et al. Mitral valve repair with the new semirigid partial Colvin–Galloway Future annuloplasty band. J Thorac Cardiovasc Surg 2008; 135: 1087-93.
5. Nazarov VM, Zheleznev SI, Zheltovsky YuV, et al. Correction of mitral regurgitation using annuloplasty rings in patients with degenerative mitral valve disease. Siberian medical journal (Irkutsk) 2013; 8: 31-8. Russian (Назаров В. М., Железнев С. И., Желтовский Ю. В. и др. Коррекция митральной недостаточности с помощью опорных колец при дисплазии соединительной ткани. Сибирский медициинский журнал (Иркутск) 2013; 8: 31-8).
6. Zheleznev SI, Bogachev-Prokophiev AV, Tuleutaev RM, et al. Results of surgical treatment posterior mitral leaflet prolapse due to degenerative mitral valve disease. Siberian medical journal (Irkutsk) 2014; 7: 29-32. Russian (Железнев С. И., Богачев-Прокофьев А.В., Тулеутаев Р. М. и др. Пролапс задней створки митрального клапана: результаты хирургического лечения при мезенхимальной дисплазии. Сибирский медицинский журнал (Иркутск) 2014; 7: 29-32).
7. Nazarov VM, Afanasyev AV, Demin II. Correction f mitral insufficiency in Barlow disease. Circulation pathology and cardiac surgery 2014; 1: 70-3. Russian (Назаров В. М., Афанасьев А. В., Демин И. И. Коррекция митральной недостаточности при болезни Барлоу. Патология кровообращения и кардиохирургия 2014; 1: 70-3).
8. Nazarov VM, Afanasyev AV, Zheleznev SI, et al. Intermediate results of mitral valve surgery in asymptomatic patients with severe mitral regurgitation due to degenerative mitral valve disease. Cardiology 2015; 11: 53-60. Russian (Назаров В. М., Афанасьев А. В., Железнев С. И. и др. Непосредственные результаты хирургического лечения выраженной асимптомной митральной недостаточности дегенеративного генеза. Кардиология 2015; 11: 53-60).
9. David TE, Komeda M, Pollick C, et al. Mitral valve annuloplasty: the effect of the type on left ventricular function. AnnThoracSurg 1989; 47: 524–7.
10. Jensen MO, Jensen H, Smerup M, et al. Saddle-shaped mitral valve annuloplasty rings experience lower forces compared with flat rings. Circulation. 2008; 118: s250-s255.
11. Jimenez JH, Liou SW, Padala M, et al. A saddle-shaped annulus reduces systolic strain on the central region of the mitral anterior leaflet. J. Thorac. Cardiovasc. Surg. 2007; 134: 1562-8.
12. Ryan LP, Jackson BM, Hamamoto H, et al. The influence of a annuloplasty geometry on mitral leaflet curvature. Ann Thorac Surg. 2008; 86: 749-60; discussion 749-60.
13. Salgo IS, Gorman JHIII, Gorman RC, et all. Effect of annular shape on leaflet curvature in reducing mitral leaflet stress. Circulation. 2002; 107: 711-7.
14. Chang BC, Youn YN, Ha JW, et al. Long-term clinical results of mitral valvuloplasty using flexible and rigid rings: a prospective and randomized study. J Thorac Cardiovasc Surg 2007; 133: 995-1003.
Review
For citations:
Afanasiev A.V., Zheleznev S.I., Bogachev-Prokofiev A.V., Nazarov V.M., Demin I.I., Astapov D.A., Karaskov A.M. CHOICE OF THE IMPLANTABLE SUPPORT RINGS IN CONNECTIVE TISSUE DYSPLASIA AND SEVERE MITRAL REGURGITATION. Russian Journal of Cardiology. 2016;(11):16-21. (In Russ.) https://doi.org/10.15829/1560-4071-2016-11-16-21
Views:
633
Email this article 