Transcatheter mitral valve edge-to-edge repair in patients with severe mitral regurgitation: data from the MitraClip Russia Trial

Aim. To study the immediate and short-term outcomes of transcatheter mitral valve edge-to-edge repair with the MitraClip NT in patients with severe mitral regurgitation as part of the MitraClip Russia prospective single-center study.Material and methods. The study included 16 patients (men, 10; women, 6) with mean age of 70,1±2,1 years (mean Euroscore II, 6,90±5,56%; STS, 6,33±3,94%). Immediate technical success was defined as successful access, delivery, and removal of the device, and adequate placing the clip(s) to reduce the mitral regurgitation to grade 2 or below without the need for device- or procedure-related reintervention.Results. Immediate technical success was achieved in all patients. The average number of implanted clips per 1 patient was 1,7. In 1 patient (6,3%), a clip was attached to one mitral leaflet, which required an non-scheduled implantation of a second clip. In hospital mortality was 6,3%: a 92-year-old patient on the 3rd day after the operation had a sudden cardiac arrest followed by coma, hemispheric ischemic stroke and death on the 6th day. An autopsy revealed an iatrogenic atrial septal defect. Echocardiography performed on the 10th and 30th day after surgery showed a decrease in mitral regurgitation grade in 15 patients, while grade 3 residual mitral regurgitation did not reveal in any patient.Conclusion. Transcatheter mitral valve edge-to-edge repair with the MitraClip is a minimally invasive method for treating severe symptomatic mitral regurgitation (degenerative and functional). The results demonstrate high immediate efficacy and an acceptable safety profile in high surgical risk patients. Based on the analysis of death causes, the authors conclude that it is necessary to include initial pulmonary hypertension above 75 mm Hg as a relative contraindication to this procedure. The study limitations are the small sample size and short follow-up period

Риск развития кровотечений, требующих гемотрансфузии, после транскатетерной имплантации аортального клапана у пациентов с сопутствующей ишемической болезнью сердца

Introduction. Perioperative bleeding is a potentially life-threatening complication of surgical intervention. The incidence of perioperative bleeding during transcatheter aortic valve implantation (TAVI) reaches 6%. An increased risk of perioperative bleeding is noted in patients requiring constant antiplatelet therapy, which includes patients with concomitant coronary artery disease (CAD).Aim. The study of risk factors of bleeding, which require blood transfusion in candidates for TAVI with concomitant CAD.Materials and methods. A retrospective study. The patients with concomitant CAD who underwent TAVI from 2016 to 2021 with hemodynamically significant coronary artery stenosis (n = 270) were included in this study. The incidence of early postoperative bleeding requiring blood transfusions was analyzed. Risk factors of bleeding development were evaluated.Results. The average age of the patients was 77.7 ± 7.2 years, the number of male and female patients was comparable (45.9 and 54.1%).The majority of patients were diagnosed with chronic heart failure (90.4%), more than half of the patients suffered from pulmonary hypertension (51.9%). The incidence of bleeding that required blood transfusion was 9.3%. The risk factors of the bleeding were dual antiplatelet therapy, baseline anemia (hemoglobin less than 120 g/l), history of stroke, chronic renal failure and critical aortic stenosis. The risk factors were included in the predictive model.Conclusion. Bleeding requiring blood transfusion in patients with severe aortic stenosis and CAD after TAVR occurs in 9.3%. It can be partially predicted using the predictive model. The using of the predictive model may be useful in determining the predominant risk of thrombotic or bleeding events after surgery.Введение. Периоперационное кровотечение является потенциально жизнеугрожающим осложнением хирургического вмешательства.Встречаемость периоперационных кровотечений при транскатетерной имплантации аортального клапана (ТИАК) достигает 6%. Повышенный риск развития периоперационных кровотечений отмечается у пациентов, требующих постоянной антиагрегантной терапии, к которой относятся пациенты с сопутствующей ишемической болезнью сердца (ИБС).Цель. Изучить факторы риска развития кровотечений, требующих гемотрансфузии, у пациентов, госпитализированных для проведения ТИАК, при сопутствующей ИБС.Материалы и методы. Проведено ретроспективное исследование. Рассмотрены пациенты, перенесшие ТИАК в период с 2016 по 2021 г., при сопутствующей ИБС с гемодинамически значимым поражением коронарных артерий (n = 270). Изучена частота развития ранних послеоперационных кровотечений, требующих проведения гемотрансфузий. Выполнена оценка факторов риска развития кровотечений.Результаты. Средний возраст исследуемых составил 77,7 ± 7,2 года, количество пациентов мужского и женского пола было сопоставимо – 45,9 и 54,1%. У большинства пациентов была диагностирована хроническая сердечная недостаточность (90,4%), у половины – легочная гипертензия (51,9%). Частота развития кровотечений, потребовавших проведения гемотрансфузии, составила 9,3%. Повышение риска развития кровотечений, требующих гемотрансфузии, ассоциировано с наличием следующих факторов риска: двойная антиагрегантная терапия, исходная анемия (гемоглобин менее 120 г/л), инсульт в анамнезе, хроническая почечная недостаточность и критический аортальный стеноз. Полученные факторы риска включены в прогностическую модель.Заключение. У 9,3% пациентов с тяжелым аортальным стенозом и сопутствующей ИБС при проведении ТИАК развиваются кровотечения, требующие гемотрансфузии. Развитие кровотечения можно частично спрогнозировать с помощью предложенной в исследовании модели. Ее использование в клинической практике может быть полезным для определения превалирующего риска тромботических или геморрагических событий в послеоперационном периоде

Peculiarities of hemodynamic changes during high thoracic epidural anesthesia in beating heart surgery

Aim: Myocardial protection during off-pump coronary artery bypass surgery is a multifactorial problem. Careful, individualized choice of graft sequence and maintenance of stable systemic hemodynamics are of central importance. Patients with coronary artery disease have a high risk of adverse cardiac outcome during and after surgery. Thoracic epidural anesthesia (TEA) aims at a more specific reversible blockade of cardiac sympathetic efferents provides effective intra- and postoperative analgesia. Methods: 82 patients (mean age 69.2±14 years) undergoing off-pump coronary surgery have been divided into 2 groups (traditional general anesthesia (50), TEA combined anesthesia (32) (Naropin). Results: In the TEA group heart rate (HR) was low (12.6%, p<0.05) compared with the group of traditional anesthesia during the construction of the anastomoses for any of the three surgical setting. Parameters of cardiac index had no difference between groups, but stroke index was higher (17.4%) in TEA group that specifies to more optimum work of heart at which the greatest duration of diastole is kept for improvement of the coronary blood flow. Myocardial oxygen consumption decreases due to decreased heart rate and low peripheral vascular resistance (11.8 %) and pulmonary vascular resistance (26.3%) in comparison with control group. Coronary perfusion pressure does not suffer in the setting of epidural blockade, no significant differences between groups were found in systemic arterial pressure. Conclusion: TEA provides better hemodynamic control and analgesia compared with traditional anesthesia. Exposure and stabilization of the three main coronary arteries during beating heart surgery does not produce any appreciable change in the systemic blood pressure and heart rate

ALGORITHMS OF PROTECTING THE ASSETS AND EQUITYBASIS OF THE FINANCIAL OF SUBJECTS OF ENTERPRISE

Protection algorithms for the assets and the business entities’ equity guarantee the inviolability of the owners’ private property rights, the inability of the wrongful seizure of the founders’ property, the security of the financial condition integrity and the equity of business entities.Financial risks determine the entities’ reactions that define the effects of financial security blunders. Each reaction corresponds to the effect of its own financial blunders. A general algorithm for financial security is defined by the steps and the events.General principles that define financial security make programs to counteract the influence of the market and the changes in financial stability and independence; to preserve the subjects’ finance and to maintain the owners’ requirements

First experience of transcatheter implantation of new-generation self-expanding bioprosthesis Acurate neo

Aim. To evaluate immediate single-center results of transcatheter aortic valve implantation (TAVI) with use of novel self-expanding bioprosthesis Acurate neo.Material and methods. TAVI procedure was performed in 69 high-tointermediate surgical risk patients (mean age 76,8±6,1years, 31 males, 68 females) with severe calcified aortic stenosis and diverse comorbidity. Concomitant coronary artery disease was observed in 43 (62%), atrial fibrillation in 23 (33%), diabetes mellitus type 2 in 26 (38%) patients. Median Euroscore II was 4,9 (2,8; 9,0). VARC-2 criteria were applied to assess early effectiveness and safety of the procedure.Results. There were no all-cause mortality, surgical conversion, acute coronary syndrome and stroke in the study group. In-hospital and 30-day mortality was also 0%. Duration of the procedure was 100 min (75;120), hospital stay — 7 (6;8) days. Patient’s haemodynamics and clinical status were significantly improved after TAVI. Mean aortic valve pressure gradient significantly decreased from 57,4±17,6 to 11,8±4,4 mm Hg, effective aortic valve area increased from 0,65±0,17 up to 1,8±0,41 mm Hg (p&lt;0,001). Left ventricle ejection fraction increased from 54,5±13,2 mm Hg to 57,7±12,3 before discharge (p&lt;0,001). Moderate paravalvular aortic regurgitation was observed in only 13% of patients. Permanent pacemaker rate was 5,8%. NYHA class reduced from 2,9 to 2,0 (p&lt;0,001).Conclusion. First Russian prospective study of TAVI with use of Acurate neo showed satisfactory hemodynamic characteristics, safety indicators and clinical efficacy of this device. Relative disadvantages of this non-repositionable valve could be generally overcome due to its distinctive features allowing precise planning, adequate navigation and accurate implantation

Transcatheter “valve-in-valve” implantation of bioprosthesis in failed surgical tricuspid bioprosthesis (first experience in Russia)

Aim. In the issue we report first in Russia experience of transcatheter “valve-invalve” implantation (TVIV) for treatment of severe tricuspid stenosis due to the structural deterioration of surgical tricuspid bioprosthesis.Material and methods. TVIV was performed in 4 high-risk redo patients (1 to 3 previous sternotomies) of various ages across (18-68 years) with structural deterioration of surgical tricuspid bioprosthesis.Results. Technical success was achieved in 100% cases. Diastolic gradients on tricuspid valve markedly decreased in all patients. Peak transtricuspidal gradient decreased from 20,4 to 10 mmHg in average. Clinical improvement as assessed by 6-minute walk test after TVIV was observed in 3 patients with congestive heart failure. In 1 patient with asymptomatic right ventricle dysfunction TVIV resulted in the enhancement of echocardiographic parameters.Conclusion. TVIV is a mininvasive alternative to conventional surgical tricuspid valve redo replacement. Based on available data including own experience TVIV should be considered an effective and safe treatment option for failed TV bioprostheses in high-risk patients of different age. Further studies are needed to assess long-term results of the method