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10 8. (81,6%). 49,86 ± 25,91 ( 12, 104 ). ( 9 ). 3 12, 2, 3 5 :, ( ) 6- ( ), «MLHFQ». SPSS for Windows 19.0). 1- ( ) 0,05. t- Student - (ANOVA), - U- Mann Whitney Wilcoxon Signed Ranks Test (AUC) (ROC- ).. -., Log-rank ,
11 9. (n = 40) 57,5% (23 40),. 17 : (n = 9), (n = 7), (n = 1).,. 24 ( 2) ,2% Carpentier, 20,8% Hetzer, 16,7%, 8,3%. 41,7 % (n = 10) (> 2+ ). 10,., Carpentier., 28,6%, (4 14)., 1-. 4,3% 1- (n = 2),,. ± :
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13 11 44,7% (17 38) ( 3). 21,1% (n = 8),., 65,8% (n = 25) ,2% (n = 13) (n = 12) (n = 1) (n = 6) (n = 7). 2-,. 3. ( 4): 18 ) (n = 7) c (n = 1) ; (n = 8);, (n = 7), (n = 1). (n = 6). 4.
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17 (r = 0,507; p < 0,001), 2- (r = 0,368; p = 0,042). 2-,, ( 6) ( 20..) ( > 20..) (6,74 ± 2,82 3,78 ±1,86, ; p = 0,012). 1-,. (R 2 = 0,257; F = 15,945; p < 0,001)., ROC-,. ROC- 0,821 (p = 0,012, 95% 0,681 0,962).»,, ( 20..), ) 5,0. 5,0
18 16 83,3%, 73,8%. 1-89,6% 87,5%, 83,3%. (-2 Log likelihood = 28,972), 5, ( ) = 0,58 (95% 0,356 0,934), p = 0, ). 7 NYHA,, «MLHFQ» p NYHA 1,40 ± 0,61 1,36 ± 0,60 0,770, 474,80 ± 77,59 453,00 ± 66,44 0,217 «MLHFQ» 19,35 ± 17,39 21,28 ± 14,10 0,604,, 8,,, (p = 0,002) 3- (76,8% 2-100% 1- ) ( 7). 7. -, (p < 0,1),, (p = 0,023),
19 17 Euroscore > 4 (p = 0,062), 5 (p = 0,007).. ( 8 9)
20 18 1., (100%- 5- ). : (p < 0,001) (p = 0,033), (p < 0,001) (p < 0,001). 12 (p = 0,007 p = 0,002 ), (p < 0,001), [1, 2, 3, 5, 6, 7, 8, 9, 10, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24]. 2., (p = 0,009 p < 0,001 ), (p < 0,001 p = 0,002 ). 12 (p > 0,05), (p = 0,003) (p = 0,044), (p = 0,006). (24 42,1% ) 3- (76,8% 100%, log-rank test p = 0,002) [2, 5, 7, 8, 10, 18, 19, 20, 23, 24]. 3.,,,, ( 1,35 5,50, p < 0,001). (p = 0,399 p = 0,161 ), 12,
21 19 (p = 0,001 p = 0,020, ), [2, 6, 7, 8, 10, 11, 18, 19, 20, 23, 24]. 4., 5, = 0,58 (95% 0,356 0,934), p = 0, ,3%, 73,8% ( 1-89,6% 87,5%, 83,3%) [6, 7, 11]. 5., (p = 0,887 p = 0,511 ), (p = 0,946 p = 0,207 ),,, (p > 0,05) [2, 7, 24]. 6.,,. [1, 2, 4, 6, 7, 8, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 23, 24] Messmer c, 5,0.
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23 21 1.,.. /..,.. // /..,..,..,..,..,..,..,.. // C /..,..,..,..,..,.. // ,.. /.. // ,.. /.. // , 4. C /..,..,..,..,.. // , 6. C /..,..,..,..,..,..,.. // ? /..,..,..,..,..,..,.. // : :..-..,, /..-.,... ;.:..,...,
24 22 9. :, /..,..,..,..,..,..,..,..,.. // : :..-..,, /..-.,... ;.:..,..., ,.. : /.. //, :......,, /..-.,... ;...., /..,..,..,..,.. //, :.. II....,, /..-.,... ;...., /..,..,..,..,..,.. // :.. II..,, /...., /..,..,..,..,..,..,.. // XVIII :...,, /... [..] , Hypertrophic obstructive cardiomyopathy: early results of surgical treatment in the Republic of Belarus / V. Adzintsou, Y. Ostrovsky, A. Shket, S. Komissarova, S. Spirydonau, A. Mozgova, M. Shchatsinka // Abstract book of 4th Joint Scandinavian Conference in Cardiothoracic Surgery, Vilnius, August 2012 / SATS. Vilnius, P
25 : /..,..,..,..,..,..,..,.. // :.. I..,, /.... [..] [ ] /..,..,..,..,..,..,.. // XX - :...,, ] , Immediate and midterm outcomes of surgical treatment for hypertrophic obstructive cardiomyopathy / V. Adzintsou, A. Shket, S. Komissarova, S. Spirydonau, M. Schatsinka, T. Sevruk, I. Ustinova, S. Kurganovich, Y. Ostrovsky // Abstract book of 6th Congress of the Czech Society for Cardiovascular Surgery, Brno, 9 14 Listopadu Brno, P , /..,..,..,..,..,..,..,.. // :.. V..,, /...., C Surgical treatment for hypertrophic obstructive cardiomyopathy: early and midterm outcomes / V. Adzintsou, A. Shket, S. Komissarova, U. Andrushchuk, S. Spirydonau, Y. Ostrovsky // The 64th International Congress of the European Society of Cardiovascular and Endovascular Surgery, Istanbul, March 2015 / ESCVS. [Publ.] J. of Cardiovasc. Surg Vol. 56, 2, suppl. 1. P Underwent either not underwent mitral valve replacement in surgical treatment of HOCM: midterm outcomes / V. Adzintsou, S. Spirydonau, V. Podpalov, Y. Ostrovsky // Abstract book of 7th Joint Scandinavian Conference in Cardiothoracic Surgery, Bergen, 3 5 September Bergen, P /..,..,..,..,.. // :.. VI..,,
26 /..., C /..,..,..,.. // IV :..,, / [..] :? /..,..,..,..,..,..,.. // IV :..,, / [..] Long-term follow-up of associated mitral valve replacement in surgical treatment of hypertrophic obstructive cardiomyopathy (HOCM): single-center initial experience / V. Adzintsou, A. Shket, U. Andrushchuk, V. Shumavets, S. Spirydonau, M. Shchatsinka, Y. Ostrovsky // The 66th International Congress of the European Society of Cardiovascular and Endovascular Surgery, May 2017, Thessaloniki. [Publ.] The J. of Cardiovasc. Surg Vol. 58, 3, suppl. 2. P
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29 27 SUMMARY Vitali Alegavich Adzintsou Differentiated tactics in the surgical treatement of hypertrophic obstructive cardiomyopathy Key words: hypertrophic obstructive cardiomyopathy, septal myectomy, mitral valve replacement, left ventricle outflow tract, peak systolic gradient, mass of excised myocardium. Study objectives: to develop a differentiated tactics of surgical treatment of hypertrophic obstructive cardiomyopathy. Study methods: clinical, instrumental, statistical. Results: for the first time a comprehensive study of surgical treatment results in hypertrophic obstructive cardiomyopathy has been performed based on the belarusian cohort of patients 8-year prospective observation. The influence of myocardium mass, excised during septal myectomy without associated mitral valve replacement, on the effectiveness in decrease of left ventricle outflow tract peak systolic gradient was proved for the first time. The minimum threshold myocardial excision mass is required for achievement of optimal residual left ventricle outflow gradient was justified mathematically for the first time. It has been established that when the septal myectomy is combined with the mitral valve replacement, the residual left outflow tract gradient value does not depend on the mass of the excised myocardium, since reduction of the pressure gradient in these cases is achieved mainly due to mitral valve replacement. The absence of mitral valve replacement positive effect on left ventricle remodeling in postoperative follow-up has been established. It has been proven that mitral valve replacement is characterized by a significant number of postoperative complications and negatively affects the operated patients survival. During the late follow-up, the absence of negative influence on life quality and physical activity tolerance of mild-to-moderate residual mitral regurgitation, as well as implanted permanent pacemaker, was proved. Based on the comparative analysis of the treatment results, an algorithm for surgical tactics selection was developed. Areas of application: cardiac surgery.
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