[A trial of the use of EMIKS and LIKS disk prostheses over 10 years]. / Opyt primeneniia diskovykh protezov EMIKS i LIKS v techenie 10 let.

A total of 2575 EMIKS and LIKS prostheses were implanted to 2309 patients from January 1, 1983 to January 1, 1993. The results were assessed in 1349 patients with primary isolated prostheses of the mitral (PMV), aortic (PAV), and mitral and aortic (PMV + PAV) valves. Mitral valves were replaced in 592 patients, with hospital mortality 3.3%. Aortic valves were replaced in 463 patients, hospital mortality being 2.5. Both the valves were replaced in 289 patients, with hospital mortality 7.6%. A total of 91.8% of patients were examined in periods of up to 9 years after surgery; those were operated on before January 1, 1992. Survival rate by the 9th year postoperation was 88.9 +/- 0.75% of patients with PMV, 88.2 +/- 0.79% with PAV, and 82.1 +/- 0.82% with PMV + PAV. Prosthesis thromboses were observed in 0.05% percent/patient/years, thromboembolism in 1.09% percent/patient/year, prosthetic endocarditis in 0.52 percent/patient/year, paraprosthetic fistulae in 0.63 percent/patient/year. By the 9th year postoperation 86.9 +/- 0.61% of patients with PMV, 96.8 +/- 0.25% of those with PAV, and 88.7 +/- 0.64% of those with PMV + PAV were free from thromboembolic complications.

[Surgical treatment of mitral and tricuspid valve defects]. / Khirurgicheskoe lechenie mitral'no-trikuspidal'nykh porokov serdtsa.

The results of surgical treatment of 265 patients with mitral-tricuspid valvular diseases are analysed. The operations were carried out in the period from Jan. 1, 1977 to Jan. 1, 1990 with various plastic procedures on the tricuspid valve. Hospital mortality was 13.2%. The late-term results were studied in follow-up periods of 6 months to 12 years in 207 (90%) patients. The results were good in 187 (75.9%), satisfactory and poor in 28 (13.5%) patients; 22 (10.6%) patients died. With the hospital losses taken into account, 5-year survival came to 73% and 10-year survival to 54%. Stability of good postoperative results was 79% by the 5th year and 49% by the 10th year. Among the surviving patients 85% are related to functional classes I and II and lead an active life. Plastic operations on the tricuspid valve can be undertaken in 92% of patients with mitral-tricuspid valvular diseases; they produce good late-term results in most cases, ensure stable normalization of hemodynamics, and should be performed more often in clinical practice.

[Experience in the use of Soviet-made disk prostheses EMIKS and LIKS]. / Opyt primeneniia otechestvennykh diskovykh protezov EMIKS i LIKS.

Experience in the application of and disc prostheses in 614 patients in generalized. Mitral prosthetics was conducted in 256, aortic in 229, and mitral++-aortic in 129 patients. Hospital lethality was, respectively, 3.9, 4.8, and 8.5%. In postoperative follow-up periods of up to 7 years 92.1% of patients were examined. Survival was 88.1 +/- 0.71% in the mitral, 87.0 +/- 0.62% in the aortic, and 80.2 +/- 0.84% in the mitral-aortic group. No thromboembolic complications occurred in 88.7 +/- 0.64%, 96.9 +/- 0.31%, and 88.3 +/- 0.68% of patients, respectively. In the mitral position the mid-diastolic gradient was 4.0 +/- 0.31 mm Hg on the prosthesis and 3.8 +/- 0.82 mm Hg on the prosthesis; in the aortic position the peak systolic gradient was, respectively, 23.2 +/- 0.58 and 22.4 +/- 0.7 mm Hg. At the time of examination 97% of patients belonged to I and II functional classes.

[Comparative evaluation of Soviet-made mechanical prostheses in the mitral position]. / Sravnitel'naia otsenka otechestvennykh mekhanicheskikh protezov v mitral'noi pozitsii.

The authors appraised comparatively the 25 ball prosthesis (group 1), the rotational-disk prosthesis (group 2) and the prostheses (group 3) in 180 patients who underwent operation in the period between 1983 and 1988. The hospital lethality was 7.5% in group 1, 2.7% in group 2, and 4.8% in group 3. After dismissal from the clinic 98.2% of patients were studied in postoperative periods of 6 months to 5 years. Five-year survival after operation was 76.6 +/- 3.6%, 97.3 +/- 0.8%, and 87.7 +/- 1.2%, respectively. By the 5th postoperative year, no thromboembolic complications were encountered in 88.3 +/- 3.6% of patients in group 1, 97.3 +/- 0.8% of patients in group 2, and 91.5 +/- 2.4% of patients in group 3. The mean diastolic gradient was 7.05 +/- 0.75 mm Hg on the prosthesis, 3.98 +/- 0.44 mm Hg on the prosthesis, and 4.27 +/- 0.47 mm Hg on the prosthesis. At the time of the examination, 87.5% of group 1 patients, 88.2% of group 2 patients, and 87.1% of group 3 patients were related to I and II functional classes.

[Clinical characteristics of the Soviet low-profile heart valve prostheses EMIKS and LIKS]. / Klinicheskaia kharakteristika otechestvennykh nizkoprofil'nykh protezov klapanov serdtsa EMIKSA i LIKS.

The present work is devoted to the clinical assessment of the Soviet-made cardiac valve prostheses 'EMIKS' and 'LIKS'. From 1983 to May 1, 1988, 632 prostheses were implanted to 508 patients. A group of 348 patients were assessed: 139 after mitral (M) replacement, 130 after aortal (A) replacement, and 79 after mitral-aortal (M+A) replacement. Hospital mortality rate was: in M group--4.3 per cent, in A group--5.3 per cent, in M+A group--8.8 per cent. Survival rate on the fifth postoperative year was: in M group--89.5 +/- 9.2 per cent, in a group--90.0 +/- 4.2 per cent, in M+A group--91.0 +/- 6.2 per cent, the stability of the good results being 85.5 +/- 7.2, 79.5 +/- 6.2, and 75.0 +/- 9.1 per cent, respectively. At year 5 of the follow-up, patient numbers without thromboembolic complications amounted to 95.0 +/- 4.7 per cent in M group, 95.5 +/- 4.2 per cent in A group, and 85.0 +/- 9.1 in M+A group. 95.1 per cent patients belong to functional classes I and II. In mitral replacement, the mean 'EMIKS' gradient was 4.2 +/- 0.58 mm Hg, the 'LIKS' one--4.58 +/- 0.62 mm Hg. Intravascular hemolysis was not observed. The 'EMIKS' and 'LIKS' prostheses match the models produced in other countries. No significant differences between the two models were found.

[Clinico-morphological comparisons in thrombosis and insufficiency of mitral valve prosthesis]. / Kliniko-morfologicheskie sopostavleniia pri thromboze i nedostatochnosti proteza mitral'nogo klapana.

Clinical and morphological comparisons were conducted in 31 patients with thrombosis and insufficiency of mitral valve prostheses. The morphology of these complications was studied on the basis of autopsy data in 19 cases, and in 12 reoperations. Prosthetic thrombosis was observed in 18 patients. The leading causes of the functional disorders in the prosthesis were septic complications, persisting hypotension in the early postoperative period, errors of anticoagulation therapy. The clinical manifestations of thrombosis of a prosthesis depend on the extent and localization of the thrombus. An important role in the diagnosis of such complications belongs to a dynamic observation, especially to repeated phonocardiographic examinations. A phonocardiographic semiotics of the complications is presented. The results of reoperations for thrombosis of a mitral valve prosthesis and its insufficiency are also presented. The rationale of secondary interventions is demonstrated.