Abstract
The objective of the study was to assess late results of the mitral valve replacement with
biologic prostheses «BioLAB», determine range and rate of their degeneration in the mitral
position.
Material and methods. Between January 1993 and December 2008 we implanted 83 prostheses
«BioLAB» into the mitral position at the department of urgent surgery for acquired heart
defects of A.N. Bakulev SCCVS RAMS. Age of the patients was between 51 and 73 years,
mean age was 64.2 ± 6.1 years. Long-term follow-up period was between 1.5 and 14.5 years,
mean follow-up period was 6.3 ± 3.1 years. The main etiological reason of the heart defect
development was rheumatism - 63 (78%) cases. Twenty two (27%) patients underwent close
mitral commissurotomy (5 of them twice), 5 patients had reoperations for dysfunction of
mechanical prosthesis.
Results. 9 (11%) patients were reoperated for bioprosthesis degeneration. The period from the
first operation to repeated replacement was between 6 and 10 years, mean 7.8 ± 1.5 years.
Patients' age at the moment of repeated intervention was between 57 and 80 years, mean age
was 71.4 ± 4.0 years. Six patients belonged to the IV functional class, 2 - to the III FC.
6 patients had circulatory insufficiency of 2B stage, 2 had 2A stage. Thirty day mortality rate
was 33.3% (3 patients).
Conclusion. Prosthesis «BioLAB» produces adequate hemodynamic correction with implantation
into the mitral position. It can be recommended for the patients over 70 years. However
their estimated age should be considered at the moment of potential repeated intervention and
availability of concomitant pathology.
References
Барбараш Л. С., Караськов А. М., Семеновский М. Л. и др. Биопротезы клапанов сердца в России: опыт трех клиник // Патол. кровообр. и кардиохир. 2011. № 2. С. 21-26.
Барбараш Л. С., Новикова С. П., Нехорошев Б. К. и др. 10-летний опыт биопротезирования клапанов сердца. Современное состояние и перспективы развития // Грудная и серд.-сосуд. хир. 1991. № 7. С. 21-25
Бокерия Л. А., Каграманов И. И., Кокшенев И. В. Новые биологические материалы и методы лечения в кардиохирургии. М.: НЦССХ им. А. Н. Бакулева РАМН, 2002.
Бокерия Л. А., Никонов С. Ф., Олофинская И. Е. Некоторые аспекты кардиохирургии у больных пожилого возраста: особенности, прогноз, качество жизни // Грудная и серд.-сосуд. хир. 2002. № 2. С. 46-52.
Быкова В. А., Фурсов В. А., Нарсия Б. Е. и др. Повторные операции по поводу первичной тканевой несостоятельности биологических протезов // Грудная и серд.-сосуд. хир. 1990. № 8. С. 16-19.
Караськов А. М., Семенов И. И., Астапов Д. А. и др. Биопротезы «КемКор» и «ПериКор» при хирургическом лечении пороков митрального клапана // Патол. кровообр. и кардиохир. 2008. № 1. С. 9-18.
Нарсия Б. Е. Повторные операции у больных с протезами клапанов сердца // Грудная и серд.- сосуд. хир. 1991. № 2. С. 45-47.
Фурсов Б. А., Зайцев В. В., Быкова В. А. и др. Биопротезы клапанов сердца серии «БИОНИКС». 6-летний опыт замещения митрального клапана // Грудная и серд.-сосуд. хир. 1991. № 10. С. 11-16.
Avery G. J., Ley J., Hill J. D. et al. Cardiac surgery in octogenarian: evolution of risk, cost and outcame // Ann. Thorac. Surg. 2001. Vol. 71. P. 591-596.
Balsam L. B., Grossi E. A., Greenhouse D. J. et al. Reoperative valve surgery in the elderly: predictors of risk and long-term survival // Ann. Thorac. Surg. 2010. Vol. 90. P. 1195-1201.
Biglioli P., Barili F., Polvani G. et al. What patients want: A new biological era in valvular prostheses // J. Thorac. Cardiovasc. Surg. 2006. Vol. 132. P. 443-444.
Borger M. A., Ivanov J., Armstrong S. et al. Twentyyear results of the Hancock II bioprosthesis // J. Heart Valve Dis. 2006. Vol.15. P. 49-56.
Craver J. M., Puskas J. D., Weintraub W. W. et al. 601 octogenarians undergoing cardiac surgery: outcome and comparison with younger age groups // Ann. Thorac. Surg. 1999. Vol. 67. P. 1104-1110.
Dalrymple-Hay M. J., Crook T., Bannon P. G. et al. Risk of reoperation for structural failure of aortic and mitral tissue valves // J. Heart Valve Dis. 2002. Vol. 11, № 3. P. 419-423.
Davis E. A., Gardner T. J., Gillinov A. et al. Valvular disease in elderly: Influence on surgical results // Ann. Thorac. Surg. 1993. Vol. 55. P. 333-338.
Edmunds L. H. Jr, Cohn L. H., Weisel R. D. Guidelines forreporting morbidity and mortality after cardiac valvular operations // Ann. Thorac. Surg. 1988. Vol. 46. Р. 257-259
Jamieson W. R. E., Lipinski O., Miyagishima R. T. et al. Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after mitral valve replacement // J. Thorac. Cardiovasc. Surg. 2005. Vol. 129. P. 1301-1308.
Khan S. S., Trento A., DeRobertis M. et al. Twentyyear comparison of tissue and mechanical valve replacement // J. Thorac. Cardiovasc. Surg. 2001. Vol. 122. P. 257-269.
Kirsch M., Nakashima K., Kubota S. et al. The risk of reoperative heart valve procedures in octogenarian patients // J. Heart Valve Dis. 2004. Vol. 13. P. 991-996.
KulikА.,Bйdard P., Lam B.-K. et al. Mechanical versus bioprosthetic valve replacement in middle-aged patients // Eur. J. Cardiothorac. Surg. 2006. Vol. 30. P. 485-491.
Logeais Y., Ingels A., Corbineau H. Cardiac surgery in the elderly // Bull. Acad. Natl. Med. 2006. Vol. 190. P. 855-871.
Mykйn P. S. U., Hansen О. В. A 20-year experience of 1712 patients with the Biocor porcine bioprosthesis // J. Thorac. Cardiovasc. Surg. 2009. Vol. 137. P. 76-81.
Rahimtoola S. H. Choice of prosthetic heart valve for adult patients // J. Am. Coll. Cardiol. 2003. Vol. 41. P. 893-904.
