RU2268005C2 - Method for implanting carcass-free biological cardiac valves in patients with infectious endocarditis - Google Patents

Abstract

FIELD: medicine, cardiosurgery.

SUBSTANCE: the present innovation deals with surgical treatment of endocarditis of an aortic valve. For this purpose, during prosthetics or reprosthetics one should fulfill inferior row of sutures with P-shaped sutures, and superior row of sutures should be made from the middle of sinuses towards commissures due to three uninterrupted blanket sutures. Moreover, due to suturing a fibrous ring, a xenopericardiac cuff of bioprosthesis and tightening the sutures it is necessary to isolate cavities remained after removal of abscesses or foci of tissue destruction against circulation. The method enables to prevent the development of paraprosthetic endocarditis.

EFFECT: higher efficiency of implantation.

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Description

The present invention relates to medicine, namely to cardiac surgery.

A known method of surgical treatment of endocarditis of the aortic valve, including valve prosthetics or mechanical prosthetics prosthetics (1). Xenobioprostheses treated with glutaraldehyde having a cuff lined with synthetic tissue are not used for active infectious valvular endocarditis.

However, the prototype has a drawback: there remains a porous cuff of a mechanical prosthesis that absorbs bacteria on itself. That is, there remains a substrate for the infection to penetrate into the cells of the tissue base with the formation of a lesion, which leads to a relapse of endocarditis with the possible formation of blood clots, abscesses and para-prosthetic fistulas.

The aim of the invention is the replacement of a native valve destroyed by an infectious process or an infected mechanical prosthesis with the simultaneous elimination of a local infectious focus and prevention of the development of paraprosthetic endocarditis by implanting an infection-resistant epoxy-treated frameless xenobioprosthesis.

The method is as follows.

After performing access to the heart, they begin to isolate the main vessels. Next - ensuring the conditions of a "dry" heart in conditions of cardiopulmonary bypass. The intracardiac stage begins with an audit of the cavities of the heart. Transverse aortotomy. Remediation of the foci of infection is carried out: destroyed valve flaps are excised, vegetations, abscesses and purulent-necrotic tissues are removed. When abscessing at the implantation site of a previously installed mechanical valve, it is removed. Chemical treatment is performed: the bottom of the abscesses, the necrotic tissue sites are treated with antiseptic solutions (alcohol solution), the heart cavity is washed with dioxidine solution (50 ml of 1% dioxidine solution per 250 ml of physiological solution) with the removal of wash water. An epoxy-treated frameless xenobioprosthesis is then prepared and implanted. When implanting the AB-Composite-Kemerovo frameless xenobioprosthesis in the aortic position, the lower row of sutures is performed with separate U-shaped sutures, while the needle is injected through the unchanged tissues of the output section of the left ventricle. After flashing the fibrous ring, xenopericardial cuff of the bioprosthesis and tying the sutures of the cavity, the remaining ones after removal of abscesses or foci of tissue destruction are isolated from blood flow. In this case, the blood flow passing through the aorta is isolated from the infected areas of the tissue of the aortic root by the walls of the prosthesis. The top row of seams is three continuous twisting seams: from the middle of the sinuses to the commissures, where the threads are brought out and tied on gaskets.

An example of the method.

Patient Sh., 44 years old, and / b No. 3285-01. Received at the Novosibirsk Scientific Research Institute of Blood Circulation Pathology in July 2001. On December 17, 1980, the aortic valve was prosthetized with the AKCh-2-06 prosthesis at the Scientific Research Institute for PK. Was admitted to the hospital due to worsening conditions: the appearance of shortness of breath, pain in the heart, subfebrile condition.

In the clinic of the Scientific Research Institute of PK the diagnosis was established: paraprosthetic endocarditis 1-2 tbsp.act. Aortic valve prosthetics operation in 1980. Prosthesis thrombosis. Mitral defect with a predominance of stenosis, 3 tbsp. NK II A. Attacks of left ventricular failure.

Echocardiography: AOK - the shadow of a mechanical valve prosthesis, floating prostheses up to 15 mm on the braids of the prosthesis, a blood clot on the ventricular surface, a peak systolic gradient of 99.6 mm Hg, no regurgitation.

MK - marginal fibrosis of the valves, the chords are fibrotic, the MO area is 1.1-1.25 sq. Cm, the peak diastolic gradient is 22 (average 16.4) mm Hg, regurgitation is 1 tbsp., Insignificant in volume.

The presence of the stenosing effect of the aortic prosthesis, mitral valve stenosis, the risk of embolism, requires prompt correction of the defect, despite the activity of endocarditis 2 tbsp.

On August 7, 2001, an operation was performed: mitral valve prosthesis with a KemKor-26 xenobioprosthesis, annuloplasty of the fibrous ring with a xenopericardium patch, aortic valve reprosthesis with an AB-Composite-Kemerovo-24 xenobioprosthesis, Body-type tricuspid valve plastic surgery. On the operation: in the aortic position, the AKCH-2-06 prosthesis, the pannus on the braid crawling from the side of the left ventricle, when the rack was grasped, the prosthesis was easily separated from the bed. The prosthesis bed is dark in color, partially calcined, if possible, calcium masses and fibrous tissue are removed. The aortic orifice hardly passes through bougie No. 24. Performed annuloplasty of the fibrous ring with a xenopericardium patch. The prosthesis "AB-Composite-Kemerovo" was implanted. MK - a hole of a slit-like shape, 12 * 5 mm in size, coarse fibrosis of the valves, commissures are overgrown, chords are shortened and thickened. The valve is excised. Implanted prosthesis "KemKor". Pathological examination: mitral valve - endocardium with severe destructive changes, moderate sclerosis and mild inflammatory changes; aortic prosthesis: endocardium with fibrosis, sclerosis and calcification, with chronic inflammatory changes.

The postoperative period was accompanied by the activation of infectious endocarditis, complicated by the development of reactive complete av blockade, on which an endocardial electrode for temporary EX was installed on 08/10/01. Control Echocardiography: the function of bioprostheses is not impaired, vegetation on the prostheses has not been identified.

Follow-up examination after 6 months: minimal complaints. According to laboratory data, the activity of the infectious process is minimal. The function of bioprostheses is adequate. There are no signs of inflammation on the echocardiography; no vegetation has been identified.

In total, with active infectious endocarditis, 32 frameless xenobioprostheses were implanted. Hospital mortality - 12.5%. In all other cases, a positive therapeutic effect was obtained.

Literature

1. Polyakov V.P., Shorokhov S.E., Bely B.C. et al. Valve prosthetics for infectious endocarditis: 14 years of experience. // Thoracic and cardiovascular surgery. - 2001 - No. 5, - P.24.

Claims (1)

The method of implanting frameless biological epoxy-treated heart valves in patients with infectious endocarditis in the aortic position, including prosthetics, characterized in that patients with the development of the infectious process undergo prosthetics or reprosthetics, the lower row of sutures is performed with separate U-shaped sutures, the upper row of sutures is performed from the middle of the sinuses to commissures with three continuous twisted seams, while by stitching the fibrous ring, xenopericardial cuff of the bioprosthesis and ovaries anija seams cavity remaining after removal of abscesses or foci of tissue destruction, isolated from the blood flow.