No abstract

Intramural hematoma of the ascending aorta has been considered a rare form of an acute aortic syndrome, remaining a tremendous clinical problem in management paradigm. Purpose. To present the clinical case of a patient with intramural hematoma of the ascending aorta (type A) and to analyze the surgical management. Materials and methods. A 52-year-old female patient was hospitalized with complaints for chest pain over the last year which abruptly increased a few days before hospitalization during high-intensity exercise. A full range of additional examinations was provided. Results and discussion. Hematoma occurs without the formation of a false lumen and in the absence of the initial limit of the vascular wall rupture. Intramural hematoma of the ascending aorta requires careful analysis and management through the combination of well-established recommendations and a personalized approach. Prosthetic repair of the ascending aorta was performed with the formation of hemiarch distal anastomosis using retrograde cerebral perfusion. Conclusion. Choosing the optimal management is an important clinical task with implications affecting primary and long-term outcomes. Based on numerous guidelines and recommendations, we have developed an integrated rapid algorithm to pick-up the most suitable management option for the patient with intramural hematoma of the ascending aorta.

diagnostic department of coordination of scientific researches of introduction and protection of intellectual property rights and advanced training of personnel, Kyiv

The aim – to systematize information on key features of echocardiographic evaluation of transcatheter aortic valve implantation (TAVI) procedure stages and their effectiveness in cardiac surgery, in patients with severe aortic valve stenosis.Materials and methods. We initiated a single-center clinical study to evaluate the XPand device and initial analysis of the primary results was performed. Patients met the inclusion criteria underwent a full range of examinations and TAVI procedures using the XPand device. The key parameters for echocardiographic examination in TAVI, which influence the formation of further procedure strategy, have been determined for the cardiac surgeon.Results and discussion. Based on the determined echocardiographic parameters, we obtained the primary outcomes of TAVI XPand in patients (n=7), the result of implantation was good. Minimal paravalvular insufficiency absence was found in 71.5 % of patients and minimal insufficiency in 14,5 %. In one patient to moderate insufficiency was observed. There was a statistically significant improvement in the ejection fraction (p<0.05) and a decrease in the mean gradient at the aortic valve (p<0.01).Conclusions. Echocardiographic parameters at all TAVI stages in patients over 75 years allow to control the implementation of the procedure and to improve the immediate post procedural outcome. The first experience of using the novel device for transcatheter implantation of the XPand aortic valve prosthesis confirms its effectiveness and safety in elderly patients with severe aortic stenosis.

The aim: to reveal early results after transapical TAVI with a new self-manufactured XPand system, comparing them with SAVR and common transfemoral TAVI outcomes. Materials and methods: Eighty-four patients (mean age 79,5±10,2 years) with severe aortic stenosis were operated on from January 2016 to February 2019. Nine patients had undergone the TAVI (two with transfemoral access route and seven with transapical, using the XPand system). SAVR was performed in seventy five patients. For the latter, we estimate the in-hospital mortality, complication rates, intensive care unit and total hospital length of stay. Results: There was no intraoperative mortality. In the TAVI group, the frequency of intraoperative and postoperative complications was significantly lower (p<0.01). The SAVR group showed higher median intensive care unit length of stay (104 h, IQR 72 –112 versus 29 h, IQR 20–35,p<0.01), hemodynamic support duration (100,98 ± 78 minutes versus 11.13 ± 7.89 minutes, p<0.01) and paravalvular leakage causality (9,33% versus 0%). No significant difference in results depending on the TAVI access routes was obtained. Conclusions: We conclude that TAVI provides an alternative to the conventional approach in patients with severe aortic stenosis aged over 75 years. No significant difference in mortality rate between TAVI and SAVR groups was found. A novel transapical TAVI device is associated with good short-term results and lower complication rate.