cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2024-39-2-46-57cardiotomsk-2307Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESХирургическое лечение пациентов с умеренной и пограничной ишемической митральной недостаточностью на современном этапеModern challenges of surgical management of patients with moderate and borderline ischemic mitral regurgitationhttps://orcid.org/0000-0002-1773-0160РядинскийМ. Э.RyadinskyM. E.

Рядинский Михаил Эдуардович, ординатор 1-го года обучения по специальности «сердечно-сосудистая хирургия»

190020, Санкт-Петербург, наб. реки Фонтанки, 154

Michail E. Ryadinsky, 1st year Medical Resident

154, Fontanka River emb., St. Petersburg, 190020

mryadinskiy17101998@mail.ruhttps://orcid.org/0000-0002-3338-9855ФилипповА. А.FilippovA. A.

Филиппов Алексей Александрович, канд. мед. наук, врач сердечно-сосудистый хирург, кардиохирургическое отделение с кабинетом рентгенэндоваскулярных диагностики и лечения

190020, Санкт-Петербург, наб. реки Фонтанки, 154

Aleksey A. Filippov, Cand. Sci. (Med.), Cardiovascular Surgeon, Cardiac Surgery Department with Radioendovascular Diagnostics and Treatment Room

154, Fontanka River emb., St. Petersburg, 190020

aleksei.filippov.chb@gmail.comhttps://orcid.org/0000-0003-2267-2580КаменскихМ. С.KamenskikhM. S.

Каменских Максим Сергеевич, канд. мед. наук, врач сердечно-сосудистый хирург, заведующий кардиохирургическим отделением с кабинетом рентгенэндоваскулярных диагностики и лечения

190020, Санкт-Петербург, наб. реки Фонтанки, 154

Maksim S. Kamenskikh, Cand. Sci. (Med.), Cardiovascular Surgeon, Head of Department of Cardiac Surgery

154, Fontanka River emb., St. Petersburg, 190020

kamen-maksim@yandex.ruhttps://orcid.org/0000-0002-9344-5724КимГ. И.KimG. I.

Ким Глеб Ирламович, канд. мед. наук, врач сердечно-сосудистый хирург, кардиохирургическое отделение с кабинетом рентгенэндоваскулярных диагностики и лечения

190020, Санкт-Петербург, наб. реки Фонтанки, 154

Gleb I. Kim, Cand. Sci. (Med.), Cardiac Surgeon

154, Fontanka River emb., St. Petersburg, 190020

gikim.cor@gmail.comКапушевР. Ю.KappushevR. Y.

Капушев Руслан Юсуфович, врач сердечно-сосудистый хирург, кардиохирургическое отделение с кабинетом рентгенэндоваскулярных диагностики и лечения

190020, Санкт-Петербург, наб. реки Фонтанки, 154

Ruslan Y. Kappushev, Cardiovascular Surgeon

154, Fontanka River emb., St. Petersburg, 190020

kara4ai@inbox.ruhttps://orcid.org/0009-0009-8523-5194ПровотороваЮ. Д.ProvotorovaJ. D.

Провоторова Юлия Дмитриевна, врач кардиолог, кардиохирургическое отделение с кабинетом рентгенэндоваскулярных диагностики и лечения

190020, Санкт-Петербург, наб. реки Фонтанки, 154

Julia D. Provotorova, Cardiologist, Cardiac Surgery Department with Radioendovascular Diagnostics and Treatment Room

154, Fontanka River emb., St. Petersburg, 190020

yulia.potopalskaya@yandex.ruhttps://orcid.org/0009-0003-0468-1675АсадуллинИ. Ш.AsadullinI. Sh.

Асадуллин Ильшат Шамилевич, врач сердечно-сосудистый хирург, кардиохирургическое отделение с кабинетом рентгенэндоваскулярных диагностики и лечения

190020, Санкт-Петербург, наб. реки Фонтанки, 154

Ilshat Sh. Asadullin, Cardiovascular Surgeon, Cardiac Surgery Department with Radioendovascular Diagnostics and Treatment Room

154, Fontanka River emb., St. Petersburg, 190020

ilshat-asadullin@yandex.ruhttps://orcid.org/0000-0002-1296-8161ШматовД. В.ShmatovD. V.

Шматов Дмитрий Викторович, д-р мед. наук, кардиохирург, заместитель директора по медицинской части (кардиохирургия)

190020, Санкт-Петербург, наб. реки Фонтанки, 154

Dmitry V. Shmatov, Dr. Sci. (Med.), Cardiac Surgeon, Deputy Director (Cardiac Surgery)

154, Fontanka River emb., St. Petersburg, 190020

dv.shmatov@gmail.comКлиника высоких медицинских технологий имени Н.И. Пирогова, Санкт-Петербургский государственный университет (СПбГУ)РоссияThe Pirogov Clinic of High Medical Technologies at St Petersburg UniversityRussian Federation2024090720243924657Copyright © Рядинский М.Э., Филиппов А.А., Каменских М.С., Ким Г.И., Капушев Р.Ю., Провоторова Ю.Д., Асадуллин И.Ш., Шматов Д.В., 20242024Рядинский М.Э., Филиппов А.А., Каменских М.С., Ким Г.И., Капушев Р.Ю., Провоторова Ю.Д., Асадуллин И.Ш., Шматов Д.В.Ryadinsky M.E., Filippov A.A., Kamenskikh M.S., Kim G.I., Kappushev R.Y., Provotorova J.D., Asadullin I.S., Shmatov D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/2307

Одним из наиболее частых осложнений ишемической болезни сердца (ИБС) является ишемическая митральная недостаточность (ИМН). Около 20% больных ИБС страдают от возникновения и прогрессирования ИМН, чаще она наблюдается у пациентов, перенесших инфаркт миокарда нижней стенки левого желудочка (ЛЖ). Известно, что наличие митральной регургитации (МР) снижает выживаемость пациентов независимо от наличия ИБС. Накопленный опыт в области диагностики и тактики хирургического лечения ИМН на сегодняшний день неоднозначен, несмотря на множество проводимых исследований. В частности, остаются нерешенными такие важные проблемы, как определение предикторов и факторов риска возникновения рецидива ИМН после хирургического лечения, а также показания к вмешательству на митральном клапане, выбор оперативной тактики для коррекции умеренной и пограничной ИМН. Определение факторов риска неблагоприятного исхода каждого метода хирургического лечения пограничной ИМН поможет специалисту принять правильное решение в вопросе лечения вышеупомянутой патологии. В данном обзоре литературы представляется весь спектр современных хирургических методов лечения пограничной и умеренной ишемической митральной дисфункции, оцениваются результаты наиболее распространенных изолированных и сочетанных операций, анализируются факторы риска неблагоприятного исхода в отдаленном периоде после их выполнения, предлагаются оригинальные подходы к тактике хирургического лечения ИМН.

One of the most common complications of ischemic heart disease is ischemic mitral regurgitation (IMR). About 20% of patients with coronary artery disease suffer from the onset and progression of IMR. It is more often observed in patients who have suffered a myocardial infarction of the inferior wall of the left ventricle (LV). It is known that the presence of mitral regurgitation (MR) reduces patient survival regardless of the presence of ischemic heart disease. The accumulated experience in the field of diagnosis and tactics of surgical treatment of IMR is currently ambiguous, despite many studies being conducted. In particular, such important problems as determining predictors and risk factors for recurrent IMR after surgical treatment, as well as indications for mitral valve intervention and the choice of surgical technique for correcting moderate and borderline IMR remain unresolved. Determining the risk factors for an unfavorable outcome of each specific method of surgical treatment of borderline IMR will help the specialists make the right decision regarding the treatment of this pathology. This literature review shows the full range of modern surgical methods for the treatment of borderline ischemic mitral dysfunction, evaluates the results of the most common isolated and combined operations, analyzes the risk factors for unfavorable outcome in the long-term period after their implementation, and also offers original approaches to the tactics of surgical treatment of IMR.

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The authors declare that there are no conflicts of interest present.