Habilitacijos procedūrai teikiamoje mokslo darbų apžvalgoje apibendrinama Vilniaus universiteto Širdies ir kraujagyslių ligų klinikos Širdies chirurgijos centro patirtis, pakartotinai operuojant ligonius po širdies vožtuvų protezavimo. Įvertintas mažai trombogeniškų protezų efektyvumas. Nustatyta, kad labai sunkių ligonių su infekuotais protezais mirštamumas nemažėja, nors pastaraisiais metais daugiau operuojame III funkcinės klasės ligonių ir jų operacijų rezultatai puikūs. Dėl pasiūlyto radikalesnio triburio vožtuvo nesandarumo gydymo pirminių operacijų metu, efektyviai mažėja pakartotinių šio vožtuvo operacijų. Įteisinta planinė seno rutulinio protezo pakeitimo operacija. Įdiegti nauji širdies pjūviai, įdiegtos krūtinės ląstos pjūvių atlikimo metodikos, farmakologiniai ir nefarmakologiniai perioperacinio kraujavimo stabdymo būdai efektyviai sumažina kraujavimo pavojų. Pasiūlytas originalus kairio skilvelio drenavimo būdas per atskira torakotominį pjūvį padeda sumažinti pooperacinį širdies nepakankamumą. Šiame darbe remiuosi kartu su bendradarbiais atliktų operacijų rezultatais. Šiuo metu kaip skyriaus, kuriame gydomi ligoniai su vožtuvų patologija, vadovas atlieku daugiau kaip pusę pakartotinių operacijų. Moksliniai pranešimai apie pakartotinių operacijų rezultatus buvo daryti Lietuvos, Pasaulio ir Europos kongresuose ir suvažiavimuose. / The review of scientific work presented for habilitation procedure summarizes the experience of redo operations of patients after replacement of heart valves accumulated at the Heart Surgery Centre of Vilnius University Clinic of Angiology and Cardiology. The efficacy of low thrombogenicity valve prostheses was evaluated. It was found out that the mortality rate of very severely ill patients with infected did not decrease; however the larger number of patients in functional class III were being operated during the period of recent years and the results of these operations were excellent. The rate of redo tricuspid valve operations had decreased effectively because of more radical surgery treatment of this valve during the primary operation. The operation of replacement of old ball prosthesis has been validated. The new incisions of the heart were introduced as well as new methods of performance of chest box incisions and pharmacologic and non-pharmacologic methods of perioperative hemostasis; the methods mentioned above effectively reduced the risk of bleeding. The original method of the left ventricle venting via separate thoracotomy incision enabled to reduce postoperative heart failure. This work is based on the results of operations performed in cooperation with co-workers. As a chief of the department where the patients with pathology of heart valves are treated, I am performing more than a half of redo operations. The scientific presentations concerning the results of... [to full text]

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13328号 / 論医博第2196号 / 新制||医||1044(附属図書館) / (主査)教授 柳田 素子, 教授 佐藤 俊哉, 教授 長船 健二 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Objectives: As surgical experience with infective endocarditis following transcatheter aortic valve replacement is scarce, this study compared the perioperative and short-term outcomes of patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement. Methods: Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE. Among them, 98 were operated on for endocarditis following surgical aortic valve replacement and 22 for endocarditis following transcatheter aortic valve replacement. Results: The median EuroSCORE II (52.1 (40.6–62.0) v/s 45.4 (32.6–58.1), p = 0.207) and STS-PROM (1.8 (1.6–2.1) v/s 1.9 (1.4–2.2), p = 0.622) were comparable. Endocarditis following transcatheter aortic valve replacement accounted for 13.7% of the aortic prosthetic valve endocarditis between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020.Concomitant procedures were performed in 35 patients (29.2%). The operative mortality was 26.5% in the endocarditis following surgical aortic valve replacement group and 9.1% in the endocarditis following transcatheter aortic valve replacement group (p = 0.098). Upon follow-up, survival at 6 months was found to be 98% in the group with endocarditis following surgical aortic valve replacement and 89% in the group with endocarditis following transcatheter aortic valve replacement (p = 0.081). Conclusions: Patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement present with comparable risk profiles and can be surgically treated with comparable results. Surgery as a curative option should not be rejected even in this intermediate-risk cohort