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MODERN TRENDS IN HEART VALVE PROSTHETICS
Aripov Dilshodbek Murodilloevich
https://orcid.org/ 0009-0004-1840-0819
Bukhara State Medical Institute named after Abu Ali ibn Sino,
Uzbekistan, Bukhara.
Abstract.
Currently, it is becoming clear that standard techniques for heart valve
replacement are suboptimal. Non-physiological hemodynamics, the presence of
prosthesis-dependent complications in the form of thrombosis, prosthetic endocarditis,
early biodegradation are the main factors that do not allow these prostheses to be an
"ideal replacement" for the affected valve. Modern operations on the aortic valve allow
almost complete reproduction of the natural anatomy and give encouraging results of
application. This review is devoted to the discussion of modern trends in heart valve
replacement.
Keywords:
heart valve replacement, cardiac surgery, heart valves, cardiovascular
complications.
СОВРЕМЕННЫЕ ТЕНДЕНЦИИ ПРОТЕЗИРОВАНИЯ КЛАПАНОВ СЕРДЦА
Арипов Дилшодбек Муродиллоевич https://orcid.org/ 0009-0004-1840-0819
Бухарский государственный медицинский институт имени Абу Али ибн Сино,
Узбекистан, г. Бухара.
Аннотация.
В настоящее время становится ясно, что стандартная техники
протезирования клапанов сердца являются субоптимальными. Нефизиологичная
гемодинамика, наличие протеззависимых осложнений в виде тромбоза,
протезного эндокардита, ранней биодеградации – основные факторы, которые не
позволяют данным протезам быть «идеальной заменой» пораженного клапана.
Современные операции на аортальном клапане позволяют почти полностью
повторить естественную анатомию и дают обнадеживающие результаты
применения. Данный обзор посвящен обсуждению современным тенденциям
протезирования клапанов сердца.
Ключевые слова
: протезирования клапанов сердца, кардиохирургия,
сердечные клапаны, сердечно-сосудистые осложнения.
Relevance of the research
Congenital and acquired valvular heart defects are an important medical and
social problem both in the Russian Federation and worldwide. In our country,
approximately 60 thousand patients require heart valve replacement, while only about
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20 thousand operations are performed per year [1]. Many cardiac surgery centers
currently have old prosthetic technologies available, which significantly limits the
indications for surgery. Modern minimally invasive and endovascular technologies are
used extremely sparingly, not to mention high-tech interventions for the most
physiological replacement of the affected valve [2].
The gold standard of heart valve replacement is frame prosthetics. Frame heart
valve prostheses have the following design: they consist of a supporting apparatus,
usually made of titanium, and a locking element made of a rigid material, such as
carbide, or biological tissue. Such prostheses are fixed to a rigid support ring with U-
shaped sutures. This technology is standardized, modern design bureaus produce entire
lines of sizes for selecting a prosthesis based on the size of the support ring. Due to a
clearly developed algorithm, the time of aortic clamping and the operation time is at
the level of 40-50 minutes, which is quite acceptable for modern anesthetic care and
carries minimal risks [3]. At the same time, the use of standard frame prostheses is
limited. If a mechanical valve prosthesis is used, the patient who received it is doomed
to lifelong anticoagulation with warfarin, a vitamin K antagonist [4].
This drug is extremely difficult to dose; when its concentration is exceeded, the
hemostasis system shifts towards hypocoagulation, which is associated with a high risk
of hemorrhagic complications (these complications can occur idiopathically, for
example, hemorrhagic stroke, or be associated with trauma, due to which the patient is
limited in physical activity and must protect himself from injuries). An insufficient
dose, on the contrary, is associated with hypercoagulation - thrombosis of the
mechanical prosthesis occurs due to suboptimal prosthetic hemodynamics and
foreignness of the locking element of the structure. In addition, the activity of the drug
strongly depends on its metabolism in the liver, which can change throughout life [5].
Nevertheless, blocking vitamin K-dependent components of the hemostasis
system is the only method of effective anticoagulation in the presence of a mechanical
heart valve prosthesis in a patient. Other anticoagulants do not have such a broad
suppression of the internal pathway of activation of the coagulation link of hemostasis,
and therefore the use of modern safe drugs is not yet possible [6]. Thus, the currently
available mechanical prostheses of the heart valves are not a physiological replacement
for native valves; they cannot be safely installed in patients with coagulopathies, some
systemic diseases, and in old age. At the same time, this type of prosthetics, in fact,
disables the patient [7].
An alternative to mechanical prostheses is biological prostheses on a supporting
frame. These prostheses have a fundamental difference - their locking element consists
of biological tissue taken from an animal of another species. This allows you to get rid
of lifelong anticoagulation and taking any drugs that affect hemostasis, which is an
absolute advantage of bioprostheses. Bioprostheses allow the patient to lead an active
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lifestyle, play sports, and women of reproductive age can safely carry a fetus and give
birth [8]. The flaps of biological heart valve prostheses consist of a natural elastic
material processed in a special way. Most often, this is processed cattle pericardium.
This material “takes root” in the div much better, but at the same time, it does
not have high biocompatibility, since it is taken from an animal of a different species.
In addition, it is non-viable, since it has been deprived of antigenic properties by
removing cellular elements with various ionic and non-ionic detergents. As a result,
this material, although more physiological, is not able to exist in the patient’s div for
a long time. It does not have living cells in its structure, and therefore cannot renew
itself. This leads to the fact that bioprostheses are only suitable for work for 7-8 years,
after which their flaps are destroyed and the prosthesis must be changed. In addition,
their implantation is associated with an increased risk of prosthetic infectious
endocarditis, since the bioflaps have an adhesive surface and are not covered with
endothelium [9]. Thus, non-optimal technologies of heart valve replacement are still
used, which do not qualitatively affect the functional state of the patient and do not
give a chance for a complete cure. Developing new technologies can significantly
change this area of cardiac surgery [10].
Due to the limited use of new technologies of heart valve replacement, there is no
clear understanding of the possibilities of cardiac surgery in the domestic medical
community. This problem is especially relevant among non-specialized specialists.
Cardiologists, gynecologists, therapists, rheumatologists and other specialists treating
patients for the underlying disease may have an incorrect idea of the cardiac prognosis
and modern trends in valve cardiac surgery.
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