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Пятилетний опыт транскатетерной имплантации биопротезов аортального клапана в ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России
Пятилетний опыт транскатетерной имплантации биопротезов аортального клапана в ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России
Имаев Т.Э., Комлев А.Е., Саидова М.А. и др. Пятилетний опыт транскатетерной имплантации биопротезов аортального клапана в ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. Consilium Medicum. 2015; 17 (10): 67–72. DOI:10.26442/2075-1753_2015.10.67-72
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Аннотация
Стеноз аортального клапана (АК) – патология с неуклонно прогрессирующим течением, характеризующаяся неблагоприятным прогнозом. Развитие новых технологий позволило разработать новые методы протезирования АК, в частности, в настоящее время используется транскатетерная имплантация аортального клапана (ТИАК), применяемая исключительно у пациентов высокого хирургического риска. С февраля 2010 г. по июнь 2015 г. в отделе сердечно-сосудистой хирургии ФГБУ РКНПК ТИАК выполнена 152 пациентам с критическим аортальным стенозом. Сравнительная характеристика основных исходов ТИАК, полученных в ФГБУ РКНПК, схожа с результатами других исследований. Госпитальная летальность за весь период наблюдения составила 7,8%, что соответствует данным разных международных регистров. Таким образом, процедура ТИАК представляет собой хорошую альтернативу хирургического протезирования АК у пожилых больных с сопутствующими заболеваниями. Важнейший аспект успеха ТИАК – координированные действия мультидисциплинарной команды в составе сердечно-сосудистого хирурга, кардиолога, специалистов по разным методам исследования, анестезиолога, а также младшего медицинского персонала, наличие которой специально подчеркивается в рекомендациях. В настоящее время исследователи находятся в поиске ответов на такие насущные вопросы, как снижение частоты инсультов и транзиторных ишемических атак после ТИАК, применение ТИАК у более молодых пациентов и больных с более низким риском.
Ключевые слова: аортальный клапан, аортальный стеноз, транскатетерная имплантация аортального клапана.
Ключевые слова: аортальный клапан, аортальный стеноз, транскатетерная имплантация аортального клапана.
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Aortic valve (AV) stenosis is a disease with steadily progressive course and associated with poor prognosis. The development of new technologies helps to develop new methods of AV prostheses; in particular, we use transcatheter aortic valve implantation (TAVI) especially in high-risk surgical patients, nowadays. TAVI was performed in 152 patients with critical aortic stenosis in the Department of cardiovascular surgery of Russian Cardiological Scientific-Industrial Complex, from February 2010 till June 2015. The comparative characteristics of primary TAVI outcomes, received in RCSIC, were similar to the results of the other studies. Hospital mortality during the observation period was 7.8%; these data were appropriate to various international registers. Thus, the TAVI procedure was a good alternative to surgical AV prosthesis in elderly patients with concomitant diseases. Important aspect of TAVI success was coordinated action of multidisciplinary team consisting of cardio-vascular surgeon, cardiologist, and specialists of the various research methods, the anesthesiologist, as well as paramedics, which was specifically emphasized in the recommendations.
Currently, researchers are trying to get answers to questions concerning the reduction of stroke rate and transient ischemic attacks after TAVI, the application of TAVI in young patients and in patients with lower risk.
Key words: aortic valve, aortic stenosis, transcatheter aortic valve implantation.
Currently, researchers are trying to get answers to questions concerning the reduction of stroke rate and transient ischemic attacks after TAVI, the application of TAVI in young patients and in patients with lower risk.
Key words: aortic valve, aortic stenosis, transcatheter aortic valve implantation.
Полный текст
Список литературы
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24. Sedaghat A, Sinning J-M, Vasa-Nicotera M et al. The revised EuroSCORE II for the prediction of mortality in patients undergoing transcatheter aortic valve implantation. Clin Res Cardiol 2013; 102 (11): 821–9.
25. Johansson M, Nozohoor S, Zindovic I et al. Prediction of 30-day mortality after transcatheter aortic valve implantation: a comparison of logistic EuroSCORE, STS score, and EuroSCORE II. J Heart Valve Dis 2014; 23 (5): 567–74.
26. Kodali SK, Williams MR, Smith CR et al. PARTNER Trial Investigators. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012; 366 (18): 1686–95.
27. Panchal HB, Ladia V, Amin P et al. A meta-analysis of mortality and major adverse cardiovascular and cerebrovascular events in patients undergoing transfemoral versus transapical transcatheter aortic valve implantation using Edwards Valve for severe aortic stenosis. Am J Cardiol 2014; 114 (12): 1882–90.
28. Conrotto F, D'Ascenzo F, Francesca G et al. Impact of access on TAVI procedural and midterm follow-up: a meta-analysis of 13 studies and 10,468 patients. J Interv Cardiol 2014: 27 (5): 500–8.
29. Bleiziffer S, Ruge H, Mazzitelli D et al. Survival after transapical and transfemoral aortic valve implantation: talking about two different patient populations. J Thorac Cardiovasc Surg 2009; 138 (5): 1073–80.
30. Buellesfeld L, Wenaweser P, Gerckens U et al. Transcatheter aortic valve implantation: predictors of procedural success – the Siegburg-Bern experience. Eur Heart J 2010; 31 (8): 984–91.
31. Rodés-Cabau J, Dumont E, De LaRochellière R et al. Feasibility and initial results of percutaneous aortic valve implantation including selection of the transfemoral or transapical approach in patients with severe aortic stenosis. Am J Cardiol 2008; 102 (9): 1240–6.
32. Moat NE, Ludman P, De Belder MA et al. Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry. J Am Coll Cardiol 2011; 8; 58 (20): 2130–8.
33. Leon MB, Smith CR, Mack M et al. PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363: 1597–607.
34. Sabaté M, Cánovas S, García E et al. In-hospital and mid-term predictors of mortality after transcatheter aortic valve implantation: data from the TAVI National Registry 2010–2011. Rev Esp. Cardiol 2013; 66 (12): 949–58.
35. Bagur R, Webb JG, Nietlispach F et al. Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J 2010; 31: 865–74.
36. Elhmidi Y, Bleiziffer S, Piazza N et al. Incidence and predictors of acute kidney injury in patients undergoing transcatheter aortic valve implantation. Am Heart J 2011; 161: 735–9.
37. Nuis RJ, Van Mieghem NM, Tzikas A et al. Frequency, determinants, and prognostic effects of acute kidney injury and red blood cell transfusion in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2011; 77: 881–9.
38. Mack MJ, Brennan JM, Brindis R et al. Outcomes following transcatheter aortic valve replacement in the United States. JAMA 2013; 310 (19): 2069–77.
2. Aspelund T, Gudnason V, Magnusdottir BT et al. Analysing the large decline in coronary heart disease mortality in the Icelandic population aged 25–74 between the years 1981 and 2006. PLoS One 2010; 5 (11): e13957.
3. Palmieri L, Bennett K, Giampaoli S, Capewell S. Explaining the decrease in coronary heart disease mortality in Italy between 1980 and 2000. Am J Public Health 2010; 100 (4): 684–92.
4. Andreev E.M., Kvasha E.A., Khar'kova T.P. Prodolzhitel'nost' zhizni v Rossii: vosstanovitel'nyi rost. Demoskop. 2014; 621. [in Russian]
5. Salive ME. Multimorbidity in older adults. Epidemiol Rev 2013; 35: 75–83.
6. WHO. Global status report on noncommunicable diseases 2010: description of the global burden of NCDs, their risk factors and determinants. Geneva: World Health Organization, 2011.http://www.who.int/nmh/publications/ncd_report2010/en/ (accessed Dec 22, 2011)
7. Heidenreich PA, Trogdon JG, Khavjou OA et al. Forecasting the Future of Cardiovascular Disease in the United States A Policy Statement From the American Heart Association. Circulation 2011; 123: 933–44.
8. Waller BF, Howard J, Fess S. Pathology of aortic valve stenosis and pure aortic regurgitation: A clinical morphologic assessment. Clin Cardiol 1994; 17: 85.
9. Otto CM, Burwash IG, Legget ME et al. Prospective study of asymptomatic valvular aortic stenosis clinical, echocardiographic and exercise predictors of outcome. Circulation 1997; 95: 2262–70.
10. Rosenhek R, Binder T, Porenta G et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med 2000; 343: 611–7.
11. Bouma BJ, Van den Brink RBA, Van der Meulen JHP et al. To operate or not on elderly patients with aortic stenosis: the decision and its consequences. Heart 1999; 82: 143–8.
12. Rosenhek R, Zilberszac R, Schemper M et al. Natural history of very severe aortic stenosis. Circulation 2010; 121: 151–6.
13. Ross J, Braunwald E. Aortic Stenosis. Circulation 1968; 38: 61–7.
14. Petrovskii B.V., Solov'ev G.M., Shumakov V.I. Protezirovanie klapanov serdtsa. M: Meditsina, 1966; 232. [in Russian]
15. Hufnagel СA, Harwey WP. Aortic plastic valvular prosthesis. Bull Georgetown Univ Med Center 1952; 4: 1.
16. Imaev T.E., Komlev A.E., Akchurin R.S. Transkateternaia implantatsiia aortal'nogo klapana. Sostoianie problemy, perspektivy v Rossii. Rats. farmakoterapiia v kardiologii. 2015; 11 (1): 53–9. [in Russian]
17. Cribier A, Eltchaninoff H, Bash A et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 2002; 106: 3006–8.
18. Mack MJ, Holmes DR, Webb J et al. Patient selection for transcatheter aortic valve replacement. J Am Coll Cardiol 2013; 62: S1–10.
19. Leon MB, Smith CR, Mack M et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363: 1597–607.
20. Kodali SK, Williams MR, Smith CR et al. PARTNER Trial Investigators. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012; 366 (18): 1686–95.
21. Adams DH, Popma JJ, Reardon MJ et al. Transcatheter aortic-valve я replacement with a self-expanding prosthesis N Engl J Med 2014; 370 (19): 1790–8.
22. Vahanian A, Baumgartner H, Bax J. The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007; 28: 230–68.
23. Bonow RO, Carabello BA, Chatterjee K et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006; 48: e1–148.
24. Sedaghat A, Sinning J-M, Vasa-Nicotera M et al. The revised EuroSCORE II for the prediction of mortality in patients undergoing transcatheter aortic valve implantation. Clin Res Cardiol 2013; 102 (11): 821–9.
25. Johansson M, Nozohoor S, Zindovic I et al. Prediction of 30-day mortality after transcatheter aortic valve implantation: a comparison of logistic EuroSCORE, STS score, and EuroSCORE II. J Heart Valve Dis 2014; 23 (5): 567–74.
26. Kodali SK, Williams MR, Smith CR et al. PARTNER Trial Investigators. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012; 366 (18): 1686–95.
27. Panchal HB, Ladia V, Amin P et al. A meta-analysis of mortality and major adverse cardiovascular and cerebrovascular events in patients undergoing transfemoral versus transapical transcatheter aortic valve implantation using Edwards Valve for severe aortic stenosis. Am J Cardiol 2014; 114 (12): 1882–90.
28. Conrotto F, D'Ascenzo F, Francesca G et al. Impact of access on TAVI procedural and midterm follow-up: a meta-analysis of 13 studies and 10,468 patients. J Interv Cardiol 2014: 27 (5): 500–8.
29. Bleiziffer S, Ruge H, Mazzitelli D et al. Survival after transapical and transfemoral aortic valve implantation: talking about two different patient populations. J Thorac Cardiovasc Surg 2009; 138 (5): 1073–80.
30. Buellesfeld L, Wenaweser P, Gerckens U et al. Transcatheter aortic valve implantation: predictors of procedural success – the Siegburg-Bern experience. Eur Heart J 2010; 31 (8): 984–91.
31. Rodés-Cabau J, Dumont E, De LaRochellière R et al. Feasibility and initial results of percutaneous aortic valve implantation including selection of the transfemoral or transapical approach in patients with severe aortic stenosis. Am J Cardiol 2008; 102 (9): 1240–6.
32. Moat NE, Ludman P, De Belder MA et al. Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry. J Am Coll Cardiol 2011; 8; 58 (20): 2130–8.
33. Leon MB, Smith CR, Mack M et al. PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363: 1597–607.
34. Sabaté M, Cánovas S, García E et al. In-hospital and mid-term predictors of mortality after transcatheter aortic valve implantation: data from the TAVI National Registry 2010–2011. Rev Esp. Cardiol 2013; 66 (12): 949–58.
35. Bagur R, Webb JG, Nietlispach F et al. Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J 2010; 31: 865–74.
36. Elhmidi Y, Bleiziffer S, Piazza N et al. Incidence and predictors of acute kidney injury in patients undergoing transcatheter aortic valve implantation. Am Heart J 2011; 161: 735–9.
37. Nuis RJ, Van Mieghem NM, Tzikas A et al. Frequency, determinants, and prognostic effects of acute kidney injury and red blood cell transfusion in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2011; 77: 881–9.
38. Mack MJ, Brennan JM, Brindis R et al. Outcomes following transcatheter aortic valve replacement in the United States. JAMA 2013; 310 (19): 2069–77.
2. Aspelund T, Gudnason V, Magnusdottir BT et al. Analysing the large decline in coronary heart disease mortality in the Icelandic population aged 25–74 between the years 1981 and 2006. PLoS One 2010; 5 (11): e13957.
3. Palmieri L, Bennett K, Giampaoli S, Capewell S. Explaining the decrease in coronary heart disease mortality in Italy between 1980 and 2000. Am J Public Health 2010; 100 (4): 684–92.
4. Андреев Е.М, Кваша Е.А., Харькова Т.П. Продолжительность жизни в России: восстановительный рост. Demoскоп. 2014; 621. / Andreev E.M., Kvasha E.A., Khar'kova T.P. Prodolzhitel'nost' zhizni v Rossii: vosstanovitel'nyi rost. Demoskop. 2014; 621. [in Russian]
5. Salive ME. Multimorbidity in older adults. Epidemiol Rev 2013; 35: 75–83.
6. WHO. Global status report on noncommunicable diseases 2010: description of the global burden of NCDs, their risk factors and determinants. Geneva: World Health Organization, 2011.http://www.who.int/nmh/publications/ncd_report2010/en/ (accessed Dec 22, 2011)
7. Heidenreich PA, Trogdon JG, Khavjou OA et al. Forecasting the Future of Cardiovascular Disease in the United States A Policy Statement From the American Heart Association. Circulation 2011; 123: 933–44.
8. Waller BF, Howard J, Fess S. Pathology of aortic valve stenosis and pure aortic regurgitation: A clinical morphologic assessment. Clin Cardiol 1994; 17: 85.
9. Otto CM, Burwash IG, Legget ME et al. Prospective study of asymptomatic valvular aortic stenosis clinical, echocardiographic and exercise predictors of outcome. Circulation 1997; 95: 2262–70.
10. Rosenhek R, Binder T, Porenta G et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med 2000; 343: 611–7.
11. Bouma BJ, Van den Brink RBA, Van der Meulen JHP et al. To operate or not on elderly patients with aortic stenosis: the decision and its consequences. Heart 1999; 82: 143–8.
12. Rosenhek R, Zilberszac R, Schemper M et al. Natural history of very severe aortic stenosis. Circulation 2010; 121: 151–6.
13. Ross J, Braunwald E. Aortic Stenosis. Circulation 1968; 38: 61–7.
14. Петровский Б.В., Соловьев Г.М., Шумаков В.И. Протезирование клапанов сердца. М: Медицина, 1966; 232. / Petrovskii B.V., Solov'ev G.M., Shumakov V.I. Protezirovanie klapanov serdtsa. M: Meditsina, 1966; 232. [in Russian]
15. Hufnagel СA, Harwey WP. Aortic plastic valvular prosthesis. Bull Georgetown Univ Med Center 1952; 4: 1.
16. Имаев Т.Э., Комлев А.Е., Акчурин Р.С. Транскатетерная имплантация аортального клапана. Состояние проблемы, перспективы в России. Рац. фармакотерапия в кардиологии. 2015; 11 (1): 53–9. / Imaev T.E., Komlev A.E., Akchurin R.S. Transkateternaia implantatsiia aortal'nogo klapana. Sostoianie problemy, perspektivy v Rossii. Rats. farmakoterapiia v kardiologii. 2015; 11 (1): 53–9. [in Russian]
17. Cribier A, Eltchaninoff H, Bash A et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 2002; 106: 3006–8.
18. Mack MJ, Holmes DR, Webb J et al. Patient selection for transcatheter aortic valve replacement. J Am Coll Cardiol 2013; 62: S1–10.
19. Leon MB, Smith CR, Mack M et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363: 1597–607.
20. Kodali SK, Williams MR, Smith CR et al. PARTNER Trial Investigators. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012; 366 (18): 1686–95.
21. Adams DH, Popma JJ, Reardon MJ et al. Transcatheter aortic-valve я replacement with a self-expanding prosthesis N Engl J Med 2014; 370 (19): 1790–8.
22. Vahanian A, Baumgartner H, Bax J. The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007; 28: 230–68.
23. Bonow RO, Carabello BA, Chatterjee K et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006; 48: e1–148.
24. Sedaghat A, Sinning J-M, Vasa-Nicotera M et al. The revised EuroSCORE II for the prediction of mortality in patients undergoing transcatheter aortic valve implantation. Clin Res Cardiol 2013; 102 (11): 821–9.
25. Johansson M, Nozohoor S, Zindovic I et al. Prediction of 30-day mortality after transcatheter aortic valve implantation: a comparison of logistic EuroSCORE, STS score, and EuroSCORE II. J Heart Valve Dis 2014; 23 (5): 567–74.
26. Kodali SK, Williams MR, Smith CR et al. PARTNER Trial Investigators. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012; 366 (18): 1686–95.
27. Panchal HB, Ladia V, Amin P et al. A meta-analysis of mortality and major adverse cardiovascular and cerebrovascular events in patients undergoing transfemoral versus transapical transcatheter aortic valve implantation using Edwards Valve for severe aortic stenosis. Am J Cardiol 2014; 114 (12): 1882–90.
28. Conrotto F, D'Ascenzo F, Francesca G et al. Impact of access on TAVI procedural and midterm follow-up: a meta-analysis of 13 studies and 10,468 patients. J Interv Cardiol 2014: 27 (5): 500–8.
29. Bleiziffer S, Ruge H, Mazzitelli D et al. Survival after transapical and transfemoral aortic valve implantation: talking about two different patient populations. J Thorac Cardiovasc Surg 2009; 138 (5): 1073–80.
30. Buellesfeld L, Wenaweser P, Gerckens U et al. Transcatheter aortic valve implantation: predictors of procedural success – the Siegburg-Bern experience. Eur Heart J 2010; 31 (8): 984–91.
31. Rodés-Cabau J, Dumont E, De LaRochellière R et al. Feasibility and initial results of percutaneous aortic valve implantation including selection of the transfemoral or transapical approach in patients with severe aortic stenosis. Am J Cardiol 2008; 102 (9): 1240–6.
32. Moat NE, Ludman P, De Belder MA et al. Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry. J Am Coll Cardiol 2011; 8; 58 (20): 2130–8.
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38. Mack MJ, Brennan JM, Brindis R et al. Outcomes following transcatheter aortic valve replacement in the United States. JAMA 2013; 310 (19): 2069–77.
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32. Moat NE, Ludman P, De Belder MA et al. Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry. J Am Coll Cardiol 2011; 8; 58 (20): 2130–8.
33. Leon MB, Smith CR, Mack M et al. PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363: 1597–607.
34. Sabaté M, Cánovas S, García E et al. In-hospital and mid-term predictors of mortality after transcatheter aortic valve implantation: data from the TAVI National Registry 2010–2011. Rev Esp. Cardiol 2013; 66 (12): 949–58.
35. Bagur R, Webb JG, Nietlispach F et al. Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J 2010; 31: 865–74.
36. Elhmidi Y, Bleiziffer S, Piazza N et al. Incidence and predictors of acute kidney injury in patients undergoing transcatheter aortic valve implantation. Am Heart J 2011; 161: 735–9.
37. Nuis RJ, Van Mieghem NM, Tzikas A et al. Frequency, determinants, and prognostic effects of acute kidney injury and red blood cell transfusion in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2011; 77: 881–9.
38. Mack MJ, Brennan JM, Brindis R et al. Outcomes following transcatheter aortic valve replacement in the United States. JAMA 2013; 310 (19): 2069–77.
Авторы
Т.Э.Имаев*, А.Е.Комлев, М.А.Саидова, А.А.Марголина, Р.С.Акчурин
ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15а
*imaev.timur@mail.ru
ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15а
*imaev.timur@mail.ru
________________________________________________
T.E.Imaev*, A.E.Komlev, M.A.Saidova, A.A.Margolina, R.S.Akchurin
Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, 3-ia Cherepkovskaia, d. 15a
*imaev.timur@mail.ru
Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, 3-ia Cherepkovskaia, d. 15a
*imaev.timur@mail.ru
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