surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2017-7-3-4-12surgonco-235Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИРАННИЕ ОСЛОЖНЕНИЯ И ОТСРОЧЕННЫЕ РЕЗУЛЬТАТЫ ПОВТОРНЫХ ОПЕРАЦИЙ НА АОРТАЛЬНОМ КЛАПАНЕ. ОПЫТ ЦЕНТРА СЕРДЦА УНИВЕРСИТЕТА ЛЕЙПЦИГА (ГЕРМАНИЯ)EARLY AND LATE OUTCOME AFTER REPAID AORTIC VALVE SURGERY - THE SINGEL CENTRE EXPERIANCE OF HEART CENTER LEIPZIG (GERMANY)ЛеонтьевС. А.LeontyevSergey

Леонтьев Сергей Андреевич – доктор медицинских наук, профессор, Клиника кардиохирургии, Университет Лейпцига.

Лейпциг.

Leontyev Sergey Andreevich – MD, Department of Cardiac Surgery, Heart Center, University of Leipzig.

Leipzig.

Sergey.leontyev@medizin.uni-leipzig.deЛеонтьеваН. В.LeontevaNataliya V.

Леонтьева Наталья Владимировна – доктор медицинских наук, профессор кафедры внутренних болезней и нефрологии СЗГМУ им. И.И. Мечникова.

Санкт-Петербург.

Leonteva Nataliya Vladimirovna – Doctor of Medical Sciences, Professor of the Internal Diseases and Nephrology Department, Mechnikov I.I. North-Western State Medical University.

SaintPetersburg.

ДмитриеваЯ.DmitrievaYaroslava

Дмитриева Ярослава – кандидат медицинских наук, Клиника кардиохирургии, Университет Лейпцига.

Лейпциг.

Dmitrieva Yaroslava - MD, Department of Cardiac Surgery, Heart Center, University of Leipzig.

Leipzig.

ДавиервалаП.DavierwalaPiroze

Давиервала Пироце – доктор медицины, Клиника кардиохирургии, Университет Лейпцига.

Лейпциг.

Davierwala Piroze – MD, Department of Cardiac Surgery, Heart Center, University of Leipzig.

Leipzig.

БоргерМ.BorgerMichael A.

Боргер Михаэль – доктор медицинских наук, профессор, Клиника кардиохирургии, Университет Лейпцига. 

Лейпциг.

Borger Michael A. – MD, PhD, Department of Cardiac Surgery, Heart Center, University of Leipzig.

Leipzig.

Университет Лейпцига, Центр сердца, Департамент кардиохирургии.ГерманияHeart Center, Department of Cardiac Surgery, University of Leipzig.GermanyСеверо-западный государственный медицинский университет им. И.И. Мечникова, кафедра внутренних болезней и нефрологии.РоссияMechnikov I.I. North-Western State Medical University, The Internal Diseases and Nephrology Department.Russian Federation20172709201773412Copyright © Леонтьев С.А., Леонтьева Н.В., Дмитриева Я., Давиервала П., Боргер М.A., 20172017Леонтьев С.А., Леонтьева Н.В., Дмитриева Я., Давиервала П., Боргер М.Leontyev S., Leonteva N.V., Dmitrieva Y., Davierwala P., Borger M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surgonco.ru/jour/article/view/235

Введение. Ввиду постоянного роста популяции пациентов, перенесших протезирование аортального клапана, количество нуждающихся в проведении повторных операций на клапанном аппарате сердца в связи с дисфункцией или дегенерацией ранее имплантированных протезов постоянно увеличивается. Цель нашего исследования заключалась в оценке клинических результатов повторных хирургических вмешательств на аортальном клапане, проведенных на базе Центра сердца Университета Лейпцига (Германия) с 1994 по 2008 годы. Материалы и методы. В исследование были включены 155 пациентов, из которых 86-ти провели репротезирование аортального клапана без реконструкции корня аорты (рПАК) и 69 пациентам протезирование корня аорты (ПКА). Среднее время между операциями составило 6,7±7,9 года для всех пациентов; 2,9±3,1 и 8,8±6,7 года для пациентов с имплантированными биопротезными и механическими клапанами соответственно. Результаты. Установлено, что ранняя летальность составляет 4,5% для всех пациентов (3,5% для ПАК без корня и 5,8% для рПКА, p = 0,5). Пяти- и восьмилетняя выживаемость составляет 66 ± 5% и 61±6% для всех пациентов и не различается между хирургическими группами. Фракция выброса левого желудочка менее 30% (OR 9,2, 95% CI 1,1-80,3) и исходный неврологический дефицит (OR 22,1, 95% CI 2,3197,4) являются независимыми предикторами ранней летальности. Независимыми предикторами летальности в отсроченном периоде установлены функциональный класс NYHA IV (HR 2,2, 95% CI = 1,5-3,2, p <0,01) и инфекционный эндокардит (HR 2,2, 95% CI = 1,4-3,1 р <0,01). Заключение. Таким образом, повторные оперативные вмешательства при патологиях аортального клапана связаны с приемлемыми ранними и отсроченными показателями выживаемости и частотой осложнений.

Introduction. The number of patients that need repeated operations on aortic valve due to dysfunction or degeneration of previously implanted prosthesis is constantly increasing throughout the world because of the constant growth of number of operated patients. The aim of our study was to assess the clinical outcomes of repeated surgeries for aortic valves, held at the Heart Centre of the University of Leipzig (Germany) from 1994 to 2008. Materials and methods. The study included 155 patients, 86 patients of which have had aortic valve prosthesis without reconstruction of the aortic root (rAVS) and 69 patients aortic root replacement (rAVR). The average time between operations amounted to 6.7 ± 7.9 years for all patients; 2.9 ± 3.1 and 8.8 ± 6.7 years for patients with implanted mechanical and biological valves, respectively. Results. The findings showed early lethality of 4.5% for all patients (3.5% for rAVS without root and 5.8% for rAVR with root, p = 0.5). Five-and eight-year survival is 66 ± 5% and 61 ± 6% for all patients and does not differ between surgical groups. Left ventricular ejection fraction is less than 30% (OR 9.2, 95% CI 1.1 -80.3) and initial neurological deficit (OR 22.1, 95% CI 2.3 -197.4) were independent predictors of early mortality. Independent predictors of late mortality were: NYHA functional class IV (HR, 95% CI 2.2 = 1.5, p -3.2 < 0.01) and infective endocarditis (HR 2.2, 95% CI = 1.4 -3.1 p < 0.01). Conclusions. Thus, repeated surgeries on aortic valve is associated with the acceptable early and late survival.

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