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The First Experience Of Using A "sutureless" Perceval S Prosthesis In A Combined, Hybrid Operation
Rustam Yarbekov, Saidmurod Ismailov,
Oybek Ilkhomov, Maksud Murodov, Abboskhon Abrorkhonov, Alisher Khaidarov, Denis Chernov, Nasirullo Nishonov;
RSSPMCS named after Academician V. Vakhidov, Tashkent, Uzbekistan
BACKGROUND: The purpose of the study is to present a clinical case of the use of a "sutureless" prosthesis Perceval S in a simultaneous, hybrid operation: aortic valve replacement, with coronary bypass grafting through mini-thoracotomy access and coronary artery stenting.
METHODS:Patient O. aged 53, with a diagnosis of combined aortic defect with a predominance of stenosis. Severe calcification of AV. Competing diagnosis: ischemic heart disease angina pectoris FC III. Complication: CHF stage IIB, FC IV according to NYHA. Mitral valve insufficiency (MVI) II grade. According to the EuroScore II scale the risk is 11.2%. According to the ECG: sinus rhythm, heart rate 75 per minute. Ischemic changes along the lateral and posterior wall of the left ventricle. Echocardiography: EDV 184 ml, EF 30%, AV - severe fibrosis and calcification. The diameter of the annulus fibrous AV is 1.9 cm. Systolic pressure gradient 85 mmHg. AV insufficiency I grade. MV insufficiency II grade. According to CAG: RCA occlusion of the proximal third. LAD - 70% stenosis of the middle third. LCX was unchanged. The right dominant coronary blood supply.
RESULTS:Preoperative preparation of the patient included the infusion of levosimendan the day before surgery. At the first stage, a distal anastomosis of the vein graft with the RCA imposed, in parallel, access provided for peripheral EC through the femoral artery. Then the stage of AV prosthesis started under conditions of peripheral IR, and a sutureless, biological AV prosthesis Perceval S №21 implanted. EC time - 43 min, aortic cross-clamping time - 24 min, total operation time 240 min. After that, the patient transported to the angiographic laboratory, where direct LAD stenting was performed. The patient extubated after 18 hours, the time spent in the ICU was 42 hours. The course of the postoperative period proceeded relatively smoothly.
CONCLUSIONS:The described case of successful surgical treatment of severe AV stenosis and coronary artery disease demonstrates the possibility of using modern minimally invasive technologies, combined, hybrid tactics of surgical treatment. The chosen method made it possible to reduce the time of surgical intervention, and reduce the volume of surgical trauma, which in turn significantly reduced the risk of fatal complications.
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