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Aim. In the issue we report first in Russia experience of transcatheter “valve-invalve” implantation (TVIV) for treatment of severe tricuspid stenosis due to the structural deterioration of surgical tricuspid bioprosthesis.Material and methods. TVIV was performed in 4 high-risk redo patients (1 to 3 previous sternotomies) of various ages across (18-68 years) with structural deterioration of surgical tricuspid bioprosthesis.Results. Technical success was achieved in 100% cases. Diastolic gradients on tricuspid valve markedly decreased in all patients. Peak transtricuspidal gradient decreased from 20,4 to 10 mmHg in average. Clinical improvement as assessed by 6-minute walk test after TVIV was observed in 3 patients with congestive heart failure. In 1 patient with asymptomatic right ventricle dysfunction TVIV resulted in the enhancement of echocardiographic parameters.Conclusion. TVIV is a mininvasive alternative to conventional surgical tricuspid valve redo replacement. Based on available data including own experience TVIV should be considered an effective and safe treatment option for failed TV bioprostheses in high-risk patients of different age. Further studies are needed to assess long-term results of the method.

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department of cardio-vascular surgery. moscow, Russia. 2 i.m. Sechenov First moscow State medical university of the ministry of health Of RF, moscow Russia. Facultyofmedicine. SummaryStructural degeneration of biological prostheses occurs in 10-40% cases after 7-10 years requiring further valve reoperation. patients with dysfunction of tricuspid valve prostheses are often complicated and transcatheter valve-in-valve technology may be the most effective and safe procedure for this group of patients. Surgical strategy in pacemaker-dependent patients remains unclear because of possible intraoperative complications such as mechanical lead damage during valve-in-valve procedure. epicardial pacing and further endocardial lead removal prior to the valve-invalve procedure provides stable ventricular pacing during the operation, however possible increase in the ventricular pacing threshold during the follow-up period is adverse for pacemaker-dependent patients. This clinical case describes transcatheter tricuspid valve-in-valve implantation in a pacemaker-dependent patient and further ventricular pacing through a coronary sinus lead as a safe pacing method to avoid possible lead damage.ФГБу «нмиЦ кардиологии» мЗ РФ, отдел сердечно-сосудистой хирургии, москва 2 ФГаОу ВО первый мГму им. и.м. Сеченова минздрава России, международная школа «медицина будущего», направление «персонализированная медицина». РезюмеСтруктурная дегенерация биологических протезов происходит в 10-40% случаев в течение 7-10 лет, требуя повторной операции на клапане. пациенты с повторной реконструкцией трикуспидального клапана (Тк) относятся к категории высокого риска, и для них транскатетерная имплантация по методу «клапан-в-клапан» является наиболее эффективной процедурой с минимальным риском периоперационных осложнений. у стимулятор-зависимых больных хирургическая стратегия остается неоднозначной ввиду риска повреждения электрода в ходе операции при выполнении методики «клапан-в-клапан». Эпикардиальная имплантация желудочкового электрода с последующим удалением эндокардиального обеспечивает стабильную желудочковую стимуляцию в ходе операции, однако в дальнейшем возможно повышение порога, что является неблагоприятным фактором для стимулятор-зависимого пациента. Данный клинический пример демонстрирует транскатетерную имплантацию Тк по методике «клапан-в-клапан» у стимулятор-зависимого больного и возможность последующей имплантации желудочкового электрода через коронарный синус как один из вариантов стимуляции с минимальными рисками вероятного повреждения электрода в отдаленном периоде.Ключевые слова: транскатетерная имплантация трикуспидального клапана, клапан-в-клапан, постоянная желудочковая стимуляция.

Aim. To evaluate immediate single-center results of transcatheter aortic valve implantation (TAVI) with use of novel self-expanding bioprosthesis Acurate neo.Material and methods. TAVI procedure was performed in 69 high-tointermediate surgical risk patients (mean age 76,8±6,1years, 31 males, 68 females) with severe calcified aortic stenosis and diverse comorbidity. Concomitant coronary artery disease was observed in 43 (62%), atrial fibrillation in 23 (33%), diabetes mellitus type 2 in 26 (38%) patients. Median Euroscore II was 4,9 (2,8; 9,0). VARC-2 criteria were applied to assess early effectiveness and safety of the procedure.Results. There were no all-cause mortality, surgical conversion, acute coronary syndrome and stroke in the study group. In-hospital and 30-day mortality was also 0%. Duration of the procedure was 100 min (75;120), hospital stay — 7 (6;8) days. Patient’s haemodynamics and clinical status were significantly improved after TAVI. Mean aortic valve pressure gradient significantly decreased from 57,4±17,6 to 11,8±4,4 mm Hg, effective aortic valve area increased from 0,65±0,17 up to 1,8±0,41 mm Hg (p<0,001). Left ventricle ejection fraction increased from 54,5±13,2 mm Hg to 57,7±12,3 before discharge (p<0,001). Moderate paravalvular aortic regurgitation was observed in only 13% of patients. Permanent pacemaker rate was 5,8%. NYHA class reduced from 2,9 to 2,0 (p<0,001).Conclusion. First Russian prospective study of TAVI with use of Acurate neo showed satisfactory hemodynamic characteristics, safety indicators and clinical efficacy of this device. Relative disadvantages of this non-repositionable valve could be generally overcome due to its distinctive features allowing precise planning, adequate navigation and accurate implantation.