[Mitral valve surgery via minimally invasive and conventional access]. / Mitral'naya khirurgiya iz mini- i traditsionnogo dostupov.

OBJECTIVE: To compare the immediate results of mini-thoracotomy and sternotomy in patients with mitral valve disease. MATERIAL AND METHODS: The study included 52 patients who underwent mitral valve surgery (25 cases - mini-thoracotomy, 27 cases - sternotomy). RESULTS: Aortic cross-clamping time was significantly longer in sternotomy compared to mini-thoracotomy group - 110 vs 94 min (p=0.03). Ventilation time was also significantly longer in the sternotomy group (12 vs. 8 hours, p=0.01). Postoperative morbidity was similar (postoperative wound infection, neurological complications, coronavirus disease, overall in-hospital mortality). CONCLUSION: In addition to cosmetic effect, minimally invasive approach in mitral valve surgery has some other advantages including less duration of aortic cross-clamping and mechanical ventilation, availability of reconstructive interventions due to better exposition of the mitral valve and subvalvular structures.

[Surgical concepts for atrial fibrillation in patients with concomitant mitral valve disease]. / Sravnitel'nyi analiz dvukh kontseptsii khirurgicheskogo lecheniya fibrillyatsii predserdii u patsientov s soputstvuyushchim porazheniem mitral'nogo klapana.

OBJECTIVE: To analyze in-hospital results after «Cox-maze III¼ and «Cox-maze IV¼ procedures with concomitant mitral valve surgery. MATERIAL AND METHODS: This study included patients who underwent «Cox-maze III¼ and «Cox-maze IV¼ procedures between January 2015 and February 2022. We distinguished 2 groups using propensity score matching: «Cox-maze III¼ group (n=15), «Cox-maze IV¼ group (n=14). All patients had preoperative atrial fibrillation: paroxysmal (3 (10.3%) patients), persistent (5 (17.2%)) and long-standing persistent (21 (72.4%) patients). Mean duration of AF before surgery was 11 [9-60] months in both groups. We used standard statistical methods using the IBM SPSS Statistics 26.0 software package (USA). RESULTS: Aortic cross-clamping time was significantly less in the «Cox-maze IV¼ group (p<0.001). There was no in-hospital mortality in both groups. Mean duration of mechanical ventilation was significantly less in the «Cox-maze IV¼ group (5 [3.5-9] vs. 14 [12-18] hours, respectively, p<0.001). Drainage output in the first postoperative day was significantly less in the «Cox-maze IV¼ group (295 [220-370] vs. 400 [325-500] ml, respectively, p=0.02). Temporary pacemaker was required in 73.3% and 42.8% of cases, respectively (p=0.03). CONCLUSION: We should emphasize high efficiency of sinus rhythm recovery after both procedures without significant difference (p=0.16). However, time of aortic cross-clamping, mechanical ventilation and volume of postoperative bleeding were significantly less in the «Cox-maze IV¼ group.