Патология кровообращения и кардиохирургия1681-34722500-311910.21688/1681-3472-2026-2-20-33OtherСтруктурная дегенерация биологических кондуитов: аналитический обзор механизмов кальцификацииStructural degeneration of biological conduits: mechanisms of calcification: an analytical review of calcification mechanismsНичайН.Р.NichayNataliya R.n_nichay@meshalkin.ruhttps://orcid.org/0000-0002-1763-9535Meshalkin National Medical Research CenterNovosibirskRussian FederationФГБУ «Национальный медицинский исследовательский центр имени Е.Н. Мешалкина» Минздрава РоссииНовосибирскРоссийская Федерация1008202630220331505202611062026https://creativecommons.org/licenses/by/4.0/CC BY 4.0https://journal.meshalkin.ru/index.php/heartjournal/article/view/1427

Актуальность. В хирургии врожденных пороков сердца (ВПС) протезирование легочной артерии остается наиболее частой процедурой замены клапана. Имплантация легочного кондуита является важной частью коррекции большинства сложных ВПС и выполняется в пять раз чаще, чем протезирование других клапанов у детей. Однако все клапаносодержащие легочные кондуиты, помимо отсутствия потенциала к росту, неизбежно подвержены структурной дегенерации, ограничивающей их долговечность. Кальцификация представляет собой основное проявление и ведущий патофизиологический механизм дегенеративных изменений. Цель. Представить всестороннее описание детерминантов патологической кальцификации и их роли в патогенезе минерализации биологических кондуитов. Материалы. Проанализированы литературные источники, включающие как клинические, так и экспериментальные данные. Результаты. В этом аналитическом обзоре рассматриваются основные механизмы патологической кальцификации, обусловленные как факторами метаболизма и иммунного ответа реципиента, структурой и химическим составом биоматериала, так и механическим воздействием на трансплантат. Заключение. Понимание основных механизмов минерализации биоматериала является необходимым условием для решения проблем, связанных с ранней дисфункцией протеза. Стратегии, нацеленные на эти механизмы, могут лечь в основу разработки кондуитов нового поколения с повышенной устойчивостью к минерализации ткани и улучшенной долговечностью.

Introduction: In congenital heart surgery, pulmonary valve replacement remains the most common valve substitution procedure. Pulmonary valved conduit implantation is essential for correcting most complex congenital heart defects and is performed five times more frequently than other valve replacements in children. However, all pulmonary valved conduits lack growth potential and inevitably undergo structural valve degeneration (SVD), limiting their long-term durability. Calcification constitutes the principal manifestation and predominant pathophysiological process of SVD. Objective: To provide a comprehensive overview of the factors contributing to pathological calcification and their role in the pathogenesis of mineralization in biological conduits. Materials: Literature sources, including both clinical and experimental studies, were analyzed. Results: This narrative review examines the key drivers of pathological calcification, including recipient metabolic and immune factors, biomaterial structure and composition, and mechanical stress on the implant. Conclusions: Understanding the basic mechanisms of biomaterial mineralization is essential for addressing early prosthesis dysfunction. Strategies targeting these mechanisms could underpin the development of next-generation conduits with greater resistance to tissue mineralization and improved long-term durability.

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