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Aim. To evaluate in-hospital and long-term results of surgical treatment of patients with infective endocarditis of the tricuspid valve, to compare the effectiveness of valve repair and valve replacement techniques, and to identify risk factors of mortality and reoperations. Materials and methods. 31 surgical patients with tricuspid valve infective endocarditis were evaluated. Patients were divided into 2 groups. In Group 1 (n = 14) repairs of the tricuspid valve were performed, in Group 2 (n = 17) patients had undergone tricuspid valve replacements. Epidemiological, clinical, microbiological and echocardiographic data were studied. Methods of comparative analysis, the Kaplan-Meier method, and Cox risk models were applied. Results. The most common complication of in-hospital stay was atrioventricular block (17.7% of cases in Group 2). In Group 1, this type of complication was not found. Hospital mortality was 7.14% in Group 1, and 0% in Group 2. Long-term results have shown the signifi cant reduction of heart failure in general cohort and in both groups. In Group 1 the severity of heart failure in the long term was less than in Group 2. No signifi cant differences in the severity of tricuspid regurgitation were found between the groups. In 7-year follow up no cases of death were registered in Group 1. Cumulative survival rate in Group 2 within 60 months was 67.3 ± 16.2%. No reoperations were performed in patients from Group 1. In Group 2, the freedom from reoperation within 60 months was 70.9 ± 15.3%. Combined intervention was found as predictor of postoperative mortality. Prosthetic valve endocarditis was identifi ed as risk factor for reoperation. Conclusion. Valve repair and valve replacement techniques of surgical treatment of tricuspid valve endocarditis can provide satisfactory hospital and long-term results. Tricuspid valve repair techniques allowed reducing the incidence of postoperative atrioventricular block. In the long-term, patients after tricuspid valve repair have shown less severity of heart failure as well as better rates of survival and freedom from reoperation. Combined intervention and prosthetic endocarditis were found to be main risk factors for adverse outcome.

The study included 238 cases of surgical treatment of patients with infectious endocarditis of left parts of heart. The operations of single or multivalve reconstruction or restoration in conditions of artificial circulation were made to these patients. The patients were divided into groups depending on the type of cardioplegic solution. The influence of methods of cold crystalloid (extracellu-lar and intracellular), and blood cardioplegia on clinical and laboratory indices, which characterize the severity of myocardial damage in intra - and postoperative periods, was studied. The obtained results showed that the use of all types of cardioplegic solutions allows to provide the myocardial protection during the operation and to decrease the risk of life-threatening complications in this category of patients. The increase in the level of laboratory parameters of myocardial damage was registered in the use of all types of cardioplegic solutions in patients with long anoxia. The lowest intensity of changes in the levels of blood lactate marked using a solution for cold crystalloid intracellular cardioplegia. The greatest changes of this indicator were identified in patients receiving blood potassium cardioplegia. The use of cardioplegic solution "Custodial" caused the greatest intensity of acidosis in the intra-operative period.

To determine the diagnostic validity of histological study and the feasibility of using this type of data for the correction of treatment tactics, the comparison of the data obtained on the basis of morphometric analysis of remote intracardiac structures in patients operated on for valve infective endocarditis of left parts of the heart, with the main clinical, microbiological and echocardiographic characteristics of the disease was performed in this research. Data were studied from 62 patients with left part of infective endocarditis in the period from 2010 to 2013. This study showed that the morphological and histological criteria allow more detail to describe the notion «active endocarditis» and to choose the most adequate treatment strategy. In the control group of patients the severity of morphological changes according to most of the criteria corresponds to the severity of clinical manifestations that determine the severity of the condition and the forecast in infective endocarditis. It is necessary to use a comprehensive approach, including histological and morphological criteria of infective endocarditis.

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