kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2018-7-2-10-24kpccz-418Research ArticleПЕРЕДОВАЯ СТАТЬЯEDITORIALМЕХАНИЗМЫ РАЗВИТИЯ ДИСФУНКЦИЙ БИОЛОГИЧЕСКИХ ПРОТЕЗОВ КЛАПАНОВ СЕРДЦАMECHANISMS UNDERLYING BIOPROSTHETIC HEART VALVE DYSFUNCTIONSБарбарашЛ. С.BarbarashL. S.

доктор медицинских наук, профессор, академик РАН, главный научный сотрудник

PhD, Professor, Academician of the Russian Academy of Sciences, Chief Researcher

РогулинаН. В.RogulinaN. V.

кандидат медицинских наук, научный сотрудник лаборатории кардиоваскулярного биопротезирования

Researcher at the Laboratory of Bioprosthetic Replacement

rogunv@kemcardio.ruРутковскаяН. В.RutkovskayaN. V.

доктор медицинских наук, старший научный сотрудник лаборатории кардиоваскулярного биопротезирования

PhD, Senior Researcher at the Laboratory of Bioprosthetic Replacement

ОвчаренкоЕ. А.OvcharenkoE. A.

кандидат технических наук, заведующий лабораторией новых биоматериалов отдела экспериментальной и клинической кардиологии

Ph.D., Head of the Laboratory of Novel Biomaterials, Department of Experimental and Clinical Cardiology

Федеральное государственное бюджетное учреждение «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний»РоссияFederal State Budgetary Institution «Research Institute for Complex Issues of Cardiovascular Diseases»Russian Federation201828062018721024Copyright © Барбараш Л.С., Рогулина Н.В., Рутковская Н.В., Овчаренко Е.А., 20182018Барбараш Л.С., Рогулина Н.В., Рутковская Н.В., Овчаренко Е.А.Barbarash L.S., Rogulina N.V., Rutkovskaya N.V., Ovcharenko E.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/418

В настоящей работе проведен анализ современных публикаций по механизмам развития дисфункций биологических протезов (БП) клапанов сердца. На основании литературных данных о хорошо известных, а также в настоящее время активно изучаемых причин нарушения работы БП предпринята попытка выделить основные патогенетические направления формирования дисфункции БП. Помимо процесса естественного старения (износа) ткани клапана, развивающегося в ходе непрерывных циклических механических воздействий, и сопровождающегося формированием очагов кальцификации путем пассивного и активного процесса минералообразования, проведен анализ возможного неблагоприятного влияния протез-обусловленных и реципиент-ассоциированных факторов. К протез-обусловленным причинам развития дисфункций были отнесены технологические и технические факторы, неблагоприятное воздействие которых на клапан, возможно на этапе предимплантационной подготовки и непосредственно в ходе имплантации. С позиций реципиент-ассоциированных неблагоприятных условий для долгосрочного функционирования биологического протеза рассмотрены основные дисметаболические, иммунные, гемостазиологические и гиперпролиферативные (гиперпластические) состояния. На основании этого впервые предложена классификация дисфункций БП, основанная на патогенетических механизмах формирования нарушения работы клапана с учетом их морфологических проявлений.

The article presents new insights into the mechanisms underlying bioprosthetic heart valve dysfunctions based on the medical literature analysis. We highlighted the main pathogenetic mechanisms causing dysfunctions of bioprosthetic heart valves among the well-known and recently studied ones. In addition to the process of natural “aging” of the valve tissue that develops during continuous cyclic mechanical loads and is accompanied by the formation of calcification foci (passive and active calcification process), the negative impact of prosthesis- and recipientrelated factors has been evaluated. The prosthesis-related factors contributing to the development of dysfunctions include technological and technical factors, which may produce negative effects on bioprosthetic heart valves during the preimplantation preparation and implantation itself. Main dysmetabolic, immune, hemostasis and hyperproliferative (hyperplastic) mechanisms have been reviewed from the standpoint of the recipient-related factors that may shorten the lifespan of bioprostheses. Therefore, we propose a classification of bioprosthetic heart valve dysfunctions based on the underlying pathogenetic mechanisms and specific morphological patterns.

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