A personalized aortic valve replacement using computed tomography-guided aortic valve neocuspidization. Analysis of mid-term results compared to standard Ozaki technique.

BACKGROUND: The original Ozaki technique involves sizing the neovalve cusps during cross-clamp. It leads to prolonging the ischemic time compared to standard surgical AVR. Measurements taken on the collapsed Aortic Root (AR) may also be inaccurate. We use preoperative Computed Tomography (CT) to perform more accurate sizing in physiological conditions and shorten the ischemic time. This study analyzes the results of the CT-guided Aortic Valve Neocuspidization (AVNeo) compared with the Ozaki technique. METHODS: The validity of the concept was evaluated ex vivo. Experimental valves underwent geometric, CT, and hydrodynamic controls. In the clinical phase of the study, we prospectively analyzed patients who received CT-guided AVNeo (N â€‹= â€‹7, Group 1). The control group enrolled patients who were operated on after the standard AVNeo technique (N â€‹= â€‹15, Group 2). RESULTS: In Group 1, Aortic Cross-Clamp (70.3 â€‹± â€‹17.0 vs. 91 â€‹± â€‹21.3 â€‹min, ρ â€‹= â€‹0.026) and Bypass times (92.9 â€‹± â€‹21.0 vs. 123 â€‹± â€‹24.8 â€‹min, ρ â€‹= â€‹0.011) were significantly shorter. At discharge, the peak (11.7 â€‹± â€‹2.75 vs. 15.4 â€‹± â€‹4.66 â€‹mm Hg, ρ â€‹= â€‹0.032) and mean Aortic Valve (AV) gradient (6.29 â€‹± â€‹1.25 vs. 7.87 â€‹± â€‹2.33 â€‹mm Hg, ρ â€‹= â€‹0.052) were lower in Group 1. Only one patient in Group 2 had Aortic Insufficiency (AI) greater than mild. The mean follow-up was 49.6 â€‹± â€‹6.9 months in both groups. There were no late deaths or any valve-related events detected in any patient. EchoCG revealed that peak (10.0 â€‹± â€‹2.65 vs. 12.6 â€‹± â€‹4.05 â€‹mm Hg, ρ â€‹= â€‹0.090) and mean AV gradient (5.14 â€‹± â€‹1.35 vs. 6.73 â€‹± â€‹2.25 â€‹mm Hg, ρ â€‹= â€‹0.054) also were lower in Group 1. AI indexes were stable in both Groups. CONCLUSIONS: CT-guided AVNeo is an example of personalized medicine in the surgical treatment of heart valve pathology. It allows the development of a biological AV that adapts to the patient's anatomy, shortens ischemic time, and results in better hemodynamics. A more significant number of clinical observations and longer follow-up are warranted to prove the viability of the concept.

ECHOCARDIOGRAPHIC ASPECTS OF ASSESSMENT OF MITRAL INSUFFICIENCY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION.

OBJECTIVE: The aim is to analyze patients with acute myocardial infarction with reduced ejection fraction in order to determine risk factors for mitral insufficiency. PATIENTS AND METHODS: Materials and methods: The study included 149 patients with acute myocardial infarction. Among the patients, there were 113 males (75.8%) and 36 females (24.2%). The age of the patients ranged from 43 to 86 years. Echocardiography was performed using a Phillips Epiq 7 machine. Patients were examined three times: upon admission to the hospital, after revascularization, and six months after discharge. Patients received transthoracic echocardiography, which was used to determine the presence and degree of mitral regurgitation. RESULTS: Results: According to the results of the study, it was found that the presence of concomitant somatic pathology worsens the course of an acute myocardial infarction, in turn increasing the likelihood of valvular pathology. An increase in left ventricular volume indicators, such as end-diastolic volume, end-systolic volume, end-diastolic index, and the index of contractile function (ejection fraction) contributes to the development of mitral valve insufficiency. CONCLUSION: Conclusions: The presence of mitral regurgitation in patients with acute myocardial infarction and reduced left ventricular ejection fraction worsens the course of the disease and negatively affects the prognosis.

Isolated giant aortic arch aneurysm repair in a 13-year-old girl: a case report.

BACKGROUND: Aortic arch aneurysm is a very rare condition in children. Surgery is the life saving procedure but it performing might be challenging due to the complex anatomy. CASE PRESENTATION: We describe a 13-year-old girl who was diagnosed to have an isolated giant aortic arch aneurysm. This girl was referred to our institution with persistent cough as a leading symptom, which started two months ago. Surgery was performed as combined approach: left-sided thoracotomy and midline sternotomy. The left subclavian artery was re-implanted via supraclavicular approach to the left common carotid artery end-to-side anastomosis. Aneurysm was excised after midline sternotomy and initiation of cardiopulmonary bypass under mild hypothermia. Histological evaluation of the wall of the aneurysm revealed no evidence of any specific changes. CONCLUSIONS: The using of the combined method was characterised by a good postoperative surgical results. Pediatricians should be aware of persistent cough in children as a symptom of mediastinal mass of different origin and identity.

FIRST EXPERIENCE WITH OCCLUTECH PLD OCCLUDER TO CLOSE PARAVALVULAR LEAKS PROSTHETICS OF THE MITRAL VALVE. CASE REPORT.

This clinical case presents the results of using the Occlutech PLD occluder for transcatheter closure of a paravalvular leak (PVL) via a transapical approach in the remote period after mitral valve prosthetics. According to our results and to the literature, the procedure for closing the PVL of the mitral valve from a transapi¬cal approach using a special Occlutech PLD occluder is characterized by relative safety for patients, clinical effectiveness in terms of eliminating or reducing the degree of regurgitation and related symptoms.

Computed tomography-guided aortic valve neocuspidization: details of preoperative assessment and surgical technique.

The original Ozaki technique involves sizing and trimming the neovalve cusps during cross-clamp. It leads to prolongation of the ischaemic time, as compared to standard aortic valve replacement. We use preoperative computed tomography scanning of the patient's aortic root to develop personalized templates for each leaflet. With this method, autopericardial implants are prepared before the initiation of the bypass. It permits maximally adopting the procedure to the patient's individual anatomy and to shorten the cross-clamp time. We present a case of a computed tomography-guided aortic valve neocuspidization and concomitant coronary artery bypass grafting with excellent short-term results. We discuss the feasibility and technical details of the novel technique.

Synchronized diaphragmatic stimulation for heart failure using the VisONE system: a first-in-patient study.

AIMS: Synchronized diaphragmatic stimulation (SDS) modulates intrathoracic and intra-abdominal pressures with favourable effects on cardiac function for patients with a reduced left ventricular ejection fraction (LVEF) and heart failure (HFrEF). VisONE-HF is a first-in-patient, observational study assessing the feasibility and 1 year effects of a novel, minimally invasive SDS device. METHODS AND RESULTS: The SDS system comprises a pulse generator and two laparoscopically delivered, bipolar, active-fixation leads on the inferior diaphragmatic surface. Fifteen symptomatic men with HFrEF and ischaemic heart disease receiving guideline-recommended therapy were enrolled (age 60 [56, 67] years, New York Heart Association class II [53%] /III [47%], LVEF 27 [23, 33] %, QRSd 117 [100, 125] ms, & N terminal pro brain natriuretic peptide [NT-proBNP] 1779 [911, 2,072] pg/mL). Implant success was 100%. Patients were evaluated at 3, 6, and 12 months for device-related or lead-related complications, quality of life (SF-36 QOL), 6 min hall walk distance (6MHWd), and by echocardiography. No implant procedure or SDS-related adverse event occurred, and patients were unaware of diaphragmatic stimulation. By 12 months, left ventricular end-systolic volume decreased (136 [123, 170] mL to 98 [89, 106] mL; P = 0.05), 6MHWd increased (315 [300, 330] m to 340 [315, 368] m; P = 0.004), and SF-36 QOL improved (physical scale 0 [0, 0] to 25 [0, 50], P = 0.006; emotional scale 0 [0, 33] to 33 [33, 67], P = 0.001). Although neither reached statistical significance, LVEF decreased (28 [23, 40]% vs. 34 [29, 38]%; P = ns) and NT-proBNP was lower (1784 [920, 2540] pg/mL vs. 1492 [879, 2028] pg/mL; P = ns). CONCLUSIONS: These data demonstrate the feasibility of laparoscopic implantation and delivery of SDS without raising safety concerns. These encouraging findings should be investigated further in adequately powered randomized trials.

RESOURCES OF CARDIOLOGICAL CARE (ON THE EXAMPLE OF THE KYIV REGION OF UKRAINE).

OBJECTIVE: The aim: To analyze the network, resources of outpatient clinics in the Kyiv region (Ukraine) that provide cardiac care. PATIENTS AND METHODS: Materials and methods: With the help of the medical - statistical method the analysis of the network of outpatient clinics of the Kyiv region which render cardiological medical care and their resources in dynamics from 1995 to 2019 was carried out. During the analysis the methods of statisticalgrouping, compilation, generalization, statisticalcomparisonwere used. The materials for the analysis were the data of reporting statistical forms № 20 "Report of the treatment and prevention institution" and form № 17 "Report on medical staff" of the Kyiv region individual institutions and districts, as well as statistical directories of the information-analytical center. CONCLUSION: Conclusions: On the basis of the analysis of the network, resources and activity of outpatient clinics of the Kyiv region that provide cardiac care the existing problems of this type of care were revealed. The provision of cardiac diagnostic tests over five years did not change, which is proved by analysis made. It is established that at the present stage of providing high-quality and affordable cardiac medical services within the existing system of cardiac outpatient care to the population of the Kyiv region has great difficulties and needs to be solved.

ULTRASONIC DECALCIFICATION OF AORTIC VALVE IN MODERN ERA: A CASE REPORT.

Aortic stenosis (AS) - a constantly progressing disease characterized by thickening and calcification of leaflets of the valve, which leads to obstruction of the blood outflow from the left ventricular (LV), inadequate cardiac output, heart failure, and even sudden death. Prevalence of stenosis consistently increases with age, 0.2% incidence observes in the 50-59 year cohort of patients and almost 10% in patients from the 80-89 year cohort. We report the case of a 78-year-old man who presented with severe aortic valve stenosis. Since conventional valve replacement was problematic because of a small annular diameter we performed ultrasonic aortic valve decalcification. As a result, the systolic pressure gradient across the aortic valve decreased from 106 mm Hg to 22 mm Hg. Our case demonstrated that even in modern era ultrasonic aortic valve decalcification can be an effective option for restoration of mobility of the aortic valve cusps. We advocate the use of it for elderly patients with small aortic annulus in which surgical or transcatheter valve replacement, valve reconstruction could be extremely difficult or unavailable and consider ultrasonic valve decalcification as an additional tool in cardiac surgeon's hands.

Pulmonary valve neocuspidization and tricuspid valve replacement in intravenous drug abusers with infective endocarditis: Report of two cases.

Right-sided infective endocarditis accounts for 5-10% of endocarditis cases. It occurs predominantly among intravenous drug abusers. The pulmonary valve is involved in fewer than 2% of patients with endocarditis. Literature data are limited and optimal medical strategy, including surgical technique, remains non-standardized in this clinical situation. We present 2 patients treated surgically for tricuspid and pulmonary valve endocarditis and discuss a method of pulmonary valve neocuspidization based on the Ozaki technique.

ASSOCIATION OF FRACTIONAL FLOW RESERVE WITH CLINICAL AND ANGIOGRAPHIC CHARACTERISTICS OF PATIENTS WITH STABLE CORONARY ARTERY DISEASE.

OBJECTIVE: The aim: To identify clinical and angiographic factors, associated with fractional flow reserve (FFR), in stable coronary artery disease (CAD) patients. PATIENTS AND METHODS: Materials and methods: The study consecutively enrolled 68 patients with stable CAD (mean age (63±8,0) ys) and angiographically intermediate coronary lesions (diameter stenosis 50-90 %), with FFR assessment. Stable angina of CCS classes II and III was diagnosed in 42 (62 %) and 15 (22 %) patients, respectively; left ventricular hypertrophy (LVH) - 27 (40 %); severe coronary stenosis (SCS) (70-90 %) - 46 (68 %). The overall CAD complexity was assessed by SYNTAX score. FFR «negative¼ group (FFRNEG) included the patients with non-significant FFRs (>0,80) (n=28 [41 %]). In case of at least one significant FFR (≤0,80), a patient was assigned to FFR «positive¼ group (FFRPOS) (n=40 [59 %]). RESULTS: Results: FFRPOS (vs. FFRNEG, respectively) was characterized by the higher frequency of angina class III (32 % vs. 7 %; p<0,001), LVH (53 % vs. 21 %; p=0,010) and SCS (98 % vs. 25 %; p<0,001). The SYNTAX score was strongly associated with FFR ≤0,70 and ≤0,65, and moderately - with FFR ≤0,65. CONCLUSION: Conclusions: In patients with stable CAD and intermediate coronary artery stenosis, the presence of at least one functionally significant lesion (FFR ≤0,80) was associated with the higher prevalence of angina class III, LVH and more advanced coronary stenosis (≥70 %). The greater overall CAD complexity increased the probability for the angiographically significant coronary lesions to be more functionally compromised.

Veno-venous extracorporeal membrane oxygenation during COVID-19 pandemic: case series.

The course of COVID-19 with an incidence of 15-42% can be complicated by the development of acute respiratory distress syndrome (ARDS). The mortality rate with severe forms exceeds 60%, which sometimes requires extracorporeal methods of life support. AIM: The aim of this study was to analyse the therapeutic efficacy of V-V ECMO in patients with ARDS caused by SARS-CoV-2. MATERIALS AND METHODS: A retrospective analysis was performed in patients with acute lung injury caused by COVID-19 and treated with V-V ECMO within a period from February 2020 to May 2021 at the ECMO Center of the Heart Institute Ministry of Health of Ukraine. All patients had PCR testing for viral RNA particles using RT-PCR ELITe analyser. RESULTS: During this period, 7 cases reported of V-V ECMO for ARDS caused by COVID-19. Five of seven patients were urgently transferred to our ECMO Center from other medical institutions, while 2 patients were transferred to the hospital being already connected to ECMO, and one patient was connected to ECMO immediately after hospitalization. The most common ECMO complication was circuit thrombosis - 42.9% (3/7), which required oxygenator replacement - in 2 cases and circuit replacement - in 1 case. Three patients had bleeding at the cannulation site. ECMO mortality rate was 57.1% (4/ 7), while the 30-day mortality rate - 71.4% (5/7). CONCLUSIONS: In our case series, out of seven critically ill COVID-19 patients who required ECMO to maintain adequate oxygenation, inpatient mortality was observed in 71.4%.

Extracorporeal Membrane Oxygenation during Percutaneous Coronary Intervention in Patients with Coronary Heart Disease.

Extracorporeal membrane oxygenation (ECMO) has become an effective method in the treatment of adults and children with severe cardiac and pulmonary dysfunction that is resistant to conventional therapy. The aim of this article was to summarize an experience of ECMO usage for cardiac dysfunction, which develops in patients with coronary heart disease (CHD) during percutaneous transluminal coronary angioplasty. The study comprised a retrospective, single-center analysis of 23 patients with CHD (19 men and four women, average age 65.7 ± 12.3 years), who undertook the ECMO technique during percutaneous transluminal coronary angioplasty. A total of 13 (56.52%) patients died directly in the hospital, or 30 days after a discharge. Independent predictors of fatal outcomes were diabetes mellitus (odds ratio [OR] = 17.58; 95% confidence interval [CI] = 6.47-47.48; p = .00125), chronic renal failure (CRF) (OR = 20.81; 95% CI = 5.95-72.21; p = .00014), and damage to the right coronary artery (RCA) (OR = 25.51; 95% CI = 8.27-79.12; p = .00013). For deceased patients, the "no reflow" phenomenon was indicated in a larger percentage of cases (23.1% in the group of deceased, vs. 10% in the group of survivors). A routine connection to ECMO before the occurrence of cardiac events was significantly more often used in the group of survived patients (90% of cases) than in the deceased (p = .0000001). Diabetes mellitus, CRF, and damage to the RCA were independent predictors of mortality during percutaneous transluminal coronary angioplasty in patients with CHD. The routine use of ECMO in high-risk patients with percutaneous transluminal coronary angioplasty was a positive prognostic factor of patient survival.