evrazkarЕвразийский Кардиологический ЖурналEurasian heart journal2225-16852305-0748Евразийская ассоциация кардиологов10.38109/2225-1685-2025-3-110-116evrazkar-6543Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL PAPERSГодичные результаты транскатетерной имплантации по методике «клапан-в-клапан» при дегенерации митрального протезаOne-year results of transcatheter implantation using the "valve-in-valve" technique for mitral valve degenerationhttps://orcid.org/0000-0002-1263-3361ХуламхановаА. З.KhulamkhanovaA. Z.

Хуламханова Амина Залимовна, аспирант лаборатории гибридных методов лечения, отдел сердечно-сосудистой хирургии 

ул. Академика Чазова, дом 15а, г. Москва 121552 

Amina Z. Khulamkhanova, postgraduate student, Laboratory of hybrid treatment methods, Department of cardiovascular surgery 

15a Akademika Chazovа St., Moscow 121552 

amina.96@list.ruhttps://orcid.org/0000-0002-5736-5698ИмаевТ. Э.ImaevT. E.

Имаев Тимур Эмвярович, д.м.н., руководитель лаборатории гибридных методов лечения сердечно-сосудистых заболеваний, отдел сердечно-сосудистой хирургии 

Ул. Академика Чазова, дом 15а, Г. Москва 121552 

Timur E. Imaev, Dr. of Sci. (Med.), Head of the Laboratory of hybrid methods of treating cardiovascular diseases, Department of cardiovascular surgery 

15a Akademika Chazovа St., Moscow 121552 

https://orcid.org/0000-0003-1534-3965СергиенкоИ. В.SergienkoI. V.

Сергиенко Игорь Владимирович, д.м.н., руководитель лаборатории фенотипов атеросклероза 

Ул. Академика Чазова, дом 15а, Г. Москва 121552 

Igor V. Sergienko, Dr. of Sci. (Med.), Head of the Laboratory of Atherosclerosis phenotypes 

15a Akademika Chazovа St., Moscow 121552 

https://orcid.org/0000-0001-6908-7472КомлевА. Е.KomlevA. E.

Комлев Алексей Евгеньевич, врач-кардиолог, отдел сердечно-сосудистой хирургии 

Ул. Академика Чазова, дом 15а, Г. Москва 121552 

Aleksey E. Komlev, Cardiologist, Department of Cardiovascular Surgery 

15a Akademika Chazovа St., Moscow 121552 

https://orcid.org/0000-0003-2979-2542ЛепилинП. М.LepilinP. M.

Лепилин Петр Михайлович, к.м.н., сердечно-сосудистый хирург, старший научный сотрудник, отдел сердечно-сосудистой хирургии 

Ул. Академика Чазова, дом 15а, Г. Москва 121552 

Petr M. Lepilin, Cand. of Sci. (Med.), cardiovascular surgeon, senior researcher, Department of Cardiovascular Surgery 

15a Akademika Chazovа St., Moscow 121552 

https://orcid.org/0000-0002-5054-1310КолегаевА. С.KolegaevA. S.

Колегаев Александр Сергееевич, к.м.н., старший научный сотрудник, лаборатория гибридных методов лечения сердечно-сосудистых заболеваний 

Ул. Академика Чазова, дом 15а, Г. Москва 121552 

Alexander S. Kolegaev, Cand. of Sci. (Med.), senior researcher, Laboratory of Hybrid Methods of Treatment of Cardiovascular Diseases 

15a Akademika Chazovа St., Moscow 121552 

Федеральное Государственное Бюджетное Учреждение «Национальный медицинский исследовательский центр кардиологии имени академика Е.И. Чазова» Министерства здравоохранения Российской ФедерацииРоссияNational Medical Research Centre of Cardiology Named after Academician E.I. ChazovRussian Federation20252509202503110116Copyright © Хуламханова А.З., Имаев Т.Э., Сергиенко И.В., Комлев А.Е., Лепилин П.М., Колегаев А.С., 20252025Хуламханова А.З., Имаев Т.Э., Сергиенко И.В., Комлев А.Е., Лепилин П.М., Колегаев А.С.Khulamkhanova A.Z., Imaev T.E., Sergienko I.V., Komlev A.E., Lepilin P.M., Kolegaev A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.heartj.asia/jour/article/view/6543Цель

Цель. Оценить эффективность и безопасность данного метода у пациентов с тяжелой дисфункцией протеза митрального клапана.

Материал и методы

Материал и методы. С мая 2015 г. по март 2024 г в отделе сердечно-сосудистой хирургии было проведено лечение 25 пациентов с нарушением работы протеза митрального клапана вследствие дегенеративных изменений. Пациентам была проведена трансапикальная имплантация протеза в митральную позицию по методике «клапан-в-клапан» с использованием клапанных систем Edwards Sapien XT (Edwards Lifesciences США – Калифорния) и Myval (Meril Life Sciences, Вапи, Индия) трансфеморальным доступом.

Результаты

Результаты. Имплантация прошла успешно во всех случаях, конверсии в открытое вмешательство зарегистрировано не было. При сравнении предоперационных и послеоперационных параметров эхокардиографии выявлено статистически значимое уменьшение уровня среднего и максимального транспротезных градиентов давления (12 [9,5;16,2] против 6 [4,7;6] и 29,5 [22;33,5] против 12 [10;14,75] соответственно, р<0,0001), а также уровня СДЛА с 76 [62;95] до 40 [35;45] мм рт. ст., р<0,0001.

Заключение

Заключение. Транскатетерная имплантация в митральную позицию по методике «клапан-в-клапан» для лечения пациентов с высоким хирургическим риском с дегенерацией протеза митрального клапана является эффективной и безопасной методикой. Важным этапом в проведении данного вмешательства является тщательное предоперационное планирование с подбором протеза необходимого размера и оценка неблагоприятного клинического исхода в зависимости от анатомических особенностей пациента.

Objective

Objective. To evaluate the efficacy and safety of this method in patients with severe dysfunction of the mitral valve prosthesis.

Materials and methods

Materials and methods. From May 2015 to March 2024, 25 patients with mitral valve prosthesis failure due to degenerative changes were treated in the Department of Cardiovascular Surgery. The patients underwent transapical implantation of the prosthesis in the mitral position using the valve-in-valve technique using the Edwards Sapien XT (Edwards Lifesciences USA – California) and Myval (Meril Life Sciences, Vapi, India) valve systems via transfemoral access.

Results

Results.Implantation was successful in all cases, no conversion to open intervention was registered. Comparison of preoperative and postoperative echocardiographic parameters revealed a statistically significant decrease in the level of mean and maximum transprosthetic pressure gradients (12 [9.5; 16.2] versus 6 [4.7; 6] and 29.5 [22; 33.5] versus 12 [10; 14.75], respectively, p<0.0001), as well as the level of SPPA from 76 [62; 95] to 40 [35; 45] mmHg, p<0.0001

Conclusion

Conclusion. Transcatheter implantation in the mitral position using the "valvein-valve" technique for the treatment of patients with high surgical risk with degeneration of the mitral valve prosthesis is an effective and safe technique. An important stage in this intervention is careful preoperative planning with the selection of a prosthesis of the required size and assessment of an unfavorable clinical outcome depending on the anatomical features of the patient.

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