[Double-tract reconstruction after gastrectomy for gastric cancer in patients with concomitant cardiovascular diseases]. / Rekonstruktsiya double-tract posle gastrektomii po povodu raka zheludka u patsientov s konkuriruyushchimi serdechno-sosudistymi zabolevaniyami.

OBJECTIVE: To demonstrate the capabilities and advantages of double-tract reconstruction after gastrectomy for gastric cancer and simultaneous approach in surgical treatment of patients with cardiovascular diseases and gastric cancer. MATERIAL AND METHODS: We present two cases of double-tract reconstruction after gastrectomy and the gastric stump extirpation as a part of simultaneous surgical approach to patients with gastric cancer and cardiovascular diseases. A 62-year-old patient underwent simultaneous gastrectomy with double-tract reconstruction (for the first time In Russia) and aortofemoral replacement. A 61-year-old patient underwent simultaneous coronary artery bypass surgery, gastric stump extirpation with esophagogastrostomy and double-tract reconstruction. RESULTS: In 1 case, postoperative period was complicated by subcompensated stenosis of the right ureter due to hematoma near the right common iliac artery. This event required endoscopic stenting of the right ureter with positive effect. Both patients were discharged in 16 and 23 days after surgery. CONCLUSION: This method may be alternative to modern reconstructions. Currently, digestive tract reconstruction after gastrectomy is still important and requires further study. Simultaneous procedures in patients with cancer and cardiovascular disease became more widespread. To objectify our statements, further research is needed.

[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 treatment of extensive metastatic tumor of the left ribs III-V and lung in 13 years after resection of cylindroma of the soft palate]. / Khirurgicheskoe lechenie obshirnoi metastaticheskoi opukholi III­V reber i legkogo sleva spustya 13 let posle udaleniya tsilindromy myagkogo neba.

Metastatic chest lesion is rare in patients with soft palate tumors. We present a 52-year-old patient with metastatic lesion of the left ribs III-V and lung in 13 years after resection of cylindroma of the soft palate. The patient underwent successful chest reconstruction and atypical resection of the left lung. Isolation of the pleural cavity by xenopericardial patches and preoperative 3D CT modeled titanium implants meet all the requirements for maintaining the chest function. This approach also positively affects postoperative period and recovery. The above-described method of replacing chest defects is highly effective.

[The first experience of small intestinal autotransplantation for advanced digestive cancer]. / Pervyi opyt autotransplantatsii tonkoi kishki pri mestno-rasprostranennykh opukholyakh zheludochno-kishechnogo trakta.

Usually, gastrointestinal tumors (GIT) invading great vessels are acknowledged to be irresectable. Along with that, we can expect positive oncological results only when there is combination treatment with radical surgery (R0 resection). In this article we share the first experience of small intestinal autotransplantation as a method of radical surgery in locally advanced GIT. We conducted the analysis of outcomes of three patients (with pancreas cancer (n=2) and neuroendocrine tumor of caecum (n=1), with neoplastic process involving to superior mesenteric artery and vein. We analyzed intraoperative aspects and algorithm of small intestinal autotransplantation. Long-term outcomes with 1.5-13 months of observing time are presented. On the basis of conducted analysis the authors suggest the possibility of small intestinal autotransplantation in referral centers with strict personalized approach and multidisciplinary surgical team.

[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.

[Feasibility of cardiac surgical techniques for intrathoracic tumors]. / O tselesoobraznosti ispol'zovaniya kardiokhirurgicheskikh tekhnologii pri vnutrigrudnykh opukholyakh.

OBJECTIVE: To analyse safety and expediency of cardiac surgical technologies including cardiopulmonary bypass (CPB) in patients with locally advanced lung cancer and invasive tumors of the mediastinum. MATERIAL AND METHODS: Cardiac surgical techniques and CPB were used in 23 patients (group 1) with locally advanced thoracic tumors between 2005 and 2015. For the same period, there were 22 patients (group 2) who underwent combined surgeries and could have had similar techniques. However, these techniques were not used for various reasons. Mediastinal malignancies and non-small cell lung cancer were diagnosed in 26 (57.8%) and 19 (42.2%) patients, respectively. Invasion of superior vena cava (n=15), aorta (n=13) and pulmonary artery (n=12) was the most common. Lesion of innominate vein (n=8), left atrium (n=6) and innominate artery (n=4) was less common. A total of 21 pneumonectomies were performed (14 in the first group and 7 in the second group). Lobectomy was less common (one patient in each group). Sublobar lung resection was performed in 10 patients (2 patients in the first group and 8 ones in the second group). All resections were total in the first group (R0) that was confirmed by routine morphological examination of resection margins of different organs and vessels. The situation was worse in the second group (R1 in 19 (86.4%) patients, R2 in 3 (13.6%) patients). RESULTS: Total postoperative morbidity was 53.3%, mortality - 8.2%. These values are higher compared to patients undergoing surgical treatment for thoracic malignancies. Incidence of postoperative complications was higher in the first group (16 (69.6%) and 8 (36.4%), respectively). Four patients died in the first group. Sepsis (n=2), acute right ventricular failure (n=1) and acute myocardial infarction (n=1) caused death. There were no lethal outcomes in the second group. Various postoperative complications were diagnosed only in 8 (36.4%) patients. The long-term results were followed-up in 80% of patients. In the first group, 3- and 5-year survival rates were 30.5% and 25%, respectively (median 43.8 months). In the second group, these values were 25% and 2%, respectively (median 24.9 months). Long-term mortality in the second group was caused by progression of malignant process, including local recurrence, after palliative surgery (R1, R2 resection). CONCLUSION: Higher risk of postoperative complications and mortality in patients undergoing on-pump surgery is compensated by significantly better long-term results. Further progress is associated with higher safety of CPB, as well as solving some organizational and educational problems.

[Simultaneous surgery for upper gastrointestinal cancer and cardiovascular diseases]. / Simul'tannye operatsii pri rake zheludka, pishchevoda i serdechno-sosudistykh zabolevaniyakh.

OBJECTIVE: To analyze the immediate and long-term results of simultaneous surgical treatment in patients with upper gastrointestinal cancer and cardiovascular diseases. MATERIAL AND METHODS: There were 9 patients with upper gastrointestinal cancer and cardiovascular diseases who underwent simultaneous surgical treatment. We assessed safety and efficacy of this approach. Mean age of patients was 65.7±5.7 years. Coronary artery disease was diagnosed in 3 patients, aortic valve disease - 1 patient, abdominal aortic aneurysm - 2; 4 patients suffered from isolated mitral valve disease, stenosis of the left vertebral artery, internal and external carotid arteries and Leriche syndrome. RESULTS: Considering immediate and long-term postoperative results, we can emphasize advisability of simultaneous surgeries in appropriate patients.

Case report: Autopericardial aortic valve replacement and mitral homograft implantation in a patient with ankylosing spondylitis.

INTRODUCTION AND IMPORTANCE: Bekhterev's disease, or ankylosing spondylitis (AS), is a chronic inflammatory rheumatic disease closely related to the human leukocyte antigen (HLA)-B27. Cardiac damage in AS occurs in 2-10 % of patients more commonly as aortic insufficiency, aortitis, mitral valve fibrosis, or cardiac conduction abnormalities. CASE PRESENTATION: In this article we present a clinical case of a 52-year-old female patient with Bekhterev's disease, who underwent aortic valve reconstruction with autopericardium and mitral homograft implantation in mitral position. CLINICAL DISCUSSION: The use of homografts and reconstructive surgeries using autologous materials allow not only avoiding lifelong intake of anticoagulants, but also maintaining hemodynamic profile comparable to that of native valves. CONCLUSION: This clinical case shows that treatment of patients with rheumatic diseases is a complex treatment problem that requires a personalized approach.

[Surgical treatment of recurrent locally advanced pheochromocytoma]. / Khirurgicheskoe lechenie retsidivnoi mestnorasprostranennoi feokhromotsitomy nadpochechnika.

The authors present a patient with locally advanced recurrent pheochromocytoma of the left adrenal gland three years after open adrenalectomy. The patient underwent resection of recurrent tumor of the left adrenal gland, left-sided nephrectomy, splenectomy, resection of pancreatic tail, left dome of the diaphragm and descending colon. Postoperative period was uneventful. The patient was discharged in 12 days after surgery.

[Priorities of national surgery. Evgeny Illarionovich Zakharov. Stomach repair with small bowel substitutes]. / Prioritety otechestvennoi khirurgii. Evgenii Illarionovich Zakharov. Tonkokishechnaya plastika zheludka.

The manuscript is devoted to the outstanding Russian surgeon Zakharov E.I.. He first performed gastrojejunoduodenoplasty in 1938 (distal stomach repair with small bowel substitute). Zakharov E.I. developed the method of post-resection stomach repair with jejunum segment interposed between the esophagus and duodenum (esophagojejunoduodenoplasty). Further studies confirmed functional advantage of gastroplasty procedures with preserved duodenal passage.

[Comparative analysis of safety of carotid endarterectomy performed in acutest and acute periods of ischaemic stroke]. / Sravnitel'nyi analiz bezopasnosti vypolneniia karotidnoi éndarteréktomii v ostreishii i ostryi periody ishemicheskogo insul'ta.

Surgical revascularization of the carotid basin in the acutest period of ischaemic stroke, i.e., within 72 hours, will make it possible to prevent the development of recurrent stroke by removing an embologenically dangerous atherosclerotic plaque of the symptomatic carotid artery and to improve cerebral blood supply, having eliminated haemodynamic stenosis of the carotid artery. However, the problem of safety of carotid endarterectomy in patients during the acutest period of ischaemic stroke still remains debatable. PURPOSE: To comparatively analyse safety of eversion carotid endarterectomy performed in the acutest (0-72 hours) and acute (4-14 days) periods of minor ischaemic stroke. PATIENTS AND METHODS: Between January 2015 and December 2019, specialists of the Department of Vascular Surgery of Municipal Clinical Hospital # 7 of Kazan performed a total of 80 eversion carotid reconstructions in the period of minor ischaemic stroke within 14 days. The patients were divided into 2 groups depending on the terms of performing carotid endarterectomy. The first group comprised 32 (40.0%) patients operated on in the acutest period of ischaemic stroke, i.e., within 72 hours from the onset of first symptoms of neurological deficit. The second group included 48 (60.0%) patients subjected to carotid endarterectomy within 4 to 14 days from the onset of first signs of neurological deficit. RESULTS: According to the obtained findings, haemorrhagic transformation in the early postoperative period occured in 2 Group Two patients, with one lethal outcome on POD 3. Cerebral ischaemia increased in one patient of each group without enlargement of the ischaemic zone according to brain computed tomography, with residual neurological deficit in Group I in remote period (Rankin scale score 1) and complete restoration in Group II (Rankin scale score 0). Recurrent minor ischaemic stroke on POD 1 developed in Group II with formation of a new lacunar region of ischaemia of the brain in the operated carotid basin and was verified by the findings of cerebral MRI with persisting neurological deficit for 6 months (Rankin scale score 2). The comparative assessment of severity of stroke on the day of operation and at discharge, as well as that of neurological symptomatology during the 1st and 6th months of follow up in both groups proved positive. No events of acute coronary syndrome, recurrent strokes or lethal outcomes were observed during the follow-up period. CONCLUSION: According to the findings of our study, patients with acute cerebral circulation impairment caused by embologenically dangerous lesions of internal carotid arteries should be operated on within the first 72 hours, if there are no accompanying changes requiring time for correction thereof.

[Prosthetic repair of aortic valve cusps with autopericardium in children. State of the art and prospects]. / Protezirovanie stvorok aortal'nogo klapana autoperikardom u detei. Sovremennoe sostoianie problemy i perspektivy.

According to the results of modern researchers, the main techniques used in congenital pathology of the aortic valve in children include balloon catheter dilatation of the aortic valve, surgical valvuloplasty, the Ross procedure and replacement of the aortic valve with a mechanical prosthesis. Many surgeons point out that these techniques in congenital pathology of the aortic valve yield suboptimal results. This is often due to the lack of a clear-cut definition between surgeons as to what operation should be performed in a particular age group. According to the reports of the majority of researchers, biological prostheses undergo early degeneration and structural changes in paediatric cardiac surgery and yield the worst results. Comparing the main techniques, optimal haemodynamics is observed after the Ross procedure. A disadvantage of this operation is the necessity of repeat intervention on the right ventricular outflow tract, which is required in 20 to 40%. Concomitant surgery of the mitral valve and/or aortic arch during the Ross procedure significantly increases the lethality and the risk of postoperative complications. Compared with an adult cohort of patients, children after prosthetic repair of the aortic valve using a mechanical prosthesis are more often found to have postoperative complications and a higher mortality rate. Yet another problem encountered in paediatric valve surgery is the unavailability of commercial prostheses sized ?19 mm. The duration of the intraoperative parameters for reconstructions of the aortic valve, the Ross procedure, and replacement of the aortic valve by the results of many studies averagely amounts to 74±34 min, 100±56 min, and 129±71 min, respectively. Yet another method which can be used for neocuspidization of the aortic valve in reconstructive surgery of the aortic root in paediatric patients is the use of glutaraldehyde-treated autologous pericardium. In our opinion, given the simplicity of the procedure, duration of the intraoperative parameters, and acceptable initial results reported by some researchers, the Ozaki procedure may be performed in children.

[Сardiac myxoma: challenge in diagnostics. Case report].

Cardiac myxoma is the most common primary benign cardiac tumor (up to 50% of all primary cardiac neoplasms). The implementation of the modern imaging techniques into the clinical practice, particularly, 2D echocardiography, computed tomography and magnetic resonance tomography (MRI) results to the prompt diagnosis of the myxoma. However, the absence of specific clinical features, insufficient awareness of this condition among the physicians along with a rare prevalence, may lead to a misdiagnosis. This case report is notable for the relatively late diagnosis of a giant left atrial myxoma due to a number of circumstances but with successful surgical treatment.

[Method of surgical treatment of venous thrombosis using proximal protection]. / Sposob khirurgicheskogo lecheniia venoznogo tromboza s ispol'zovaniem proksimal'noi zashchity.

Pulmonary embolism ranks third among causes of death from cardiovascular diseases after acute coronary syndrome and impairment cerebral circulation. A factor provoking pulmonary embolism in the majority of cases is thrombosis of deep veins of lower limbs. Presented in the article is a clinical case report concerning treatment of a 35-year-old female patient with acute bilateral phlebothrombosis of internal iliac veins with floatation of thrombotic heads in the inferior vena cava and common iliac vein on the left. By means of a hybrid technique, we successfully performed operative intervention: thrombectomy from the inferior vena cava and common iliac veins on both sides with the use of proximal protection TREX (thromboextractor). Control X-ray contrast tomography and ultrasound examination of lower limb veins showed no evidence of rethrombosis. After surgical treatment, the woman received anticoagulant therapy. On POD 5, she was discharged home in a satisfactory condition.

[Current problems of simultaneous surgery of the aortic valve and ischaemic heart disease]. / Aktual'nye voprosy simul'tannoi khirurgii aortal'nogo klapana i ishemicheskoi bolezni serdtsa.

Surgical policy in treatment of patients suffering from concomitant valvular pathology and ischaemic heart disease is an extremely important problem of contemporary cardiac surgery. With the advent of advanced techniques and due to the improvement of old ones, there have over the last decades appeared new approaches to treatment of this cohort of patients. Presented in the article is a review of current publications regarding the problem of surgical treatment of patients with a combination of pronounced valvular pathology requiring surgical correction and ischaemic heart disease necessitating the need for myocardial revascularization. This is followed by providing the data concerning contemporary strategies of treatment of patients with concomitant pathology, as well as the comparison of various approaches and the effect of the chosen technique on the outcome.

[Complete myocardial revascularization in patients with multiple-vessel coronary artery disease and partial or complete absence of the grafts for coronary artery bypass surgery]. / Sovremennye podkhody k polnoi revaskulyarizatsii miokarda u patsientov s mnogososudistym porazheniem koronarnykh arterii i chastichnym ili polnym otsutstviem transplantatov dlya koronarnogo shuntirovaniya.

Complete revascularization in patients with multiple-vessel coronary artery disease and partial or complete absence of the grafts is still actual problem for cardiac surgeons. The main causes of the absence of conduits for coronary artery bypass surgery are aging of population, increased incidence of repeated coronary artery bypass surgery and prevalence of varicose vein disease of the lower extremities. The most perspective approaches characterized by acceptable early and long-term postoperative outcomes are bilateral internal mammary artery grafting, sequential bypass including autoarterial grafts, as well as hybrid revascularization methods. However, treatment strategy is individualized in each patient.

[Three-valve reconstruction with prosthetic repair of the ascending portion of the aorta in elderly patients]. / Trekhklapannaia rekonstruktsiia s protezirovaniem voskhodiashchego otdela aorty u bol'nogo pozhilogo vozrasta.

Elderly and aged patients appear to have a significantly increased risk from a cardiosurgical intervention combining three-valve reconstruction and prosthetic repair of the ascending portion of the aorta. Triple-valve pathology in pronounced mitral insufficiency is often accompanied by concomitant dilatation of the left atrium, i. e., atriomegaly. With the aim to eliminate the syndrome of compression of surrounding tissues and normalize intracardiac haemodynamics, reduction of the left atrium should become an inherent procedure for atriomegaly in patients with multiple-valve pathology.

[Combined surgical treatment of a patient with kidney cancer stage 4 and coronary artery disease]. / Sochetannoe radikal'noe khirurgicheskoe lechenie bol'nykh s rakom pochki IV stadii i ishemicheskoi bolezn'yu serdtsa.

We report 3 patients with coronary artery disease and kidney cancer followed by thrombosis of inferior vena cava and right cardiac chambers undergoing simultaneous surgery.

[Clinical and morphological observation of Löffler's endomyocarditis]. / Kliniko-morfologicheskoe nablyudenie endomiokardita Lefflera.

The article describes the case of a 42-year-old young woman with Löffler's endomyocarditis (fibroplastic endomyocarditis with eosinophilic syndrome). Pathomorphological (macroscopic and histological) criteria for the diagnosis of this rare form of restrictive cardiomyopathy are presented.

[Resection of recurrent hemangioma of the anterior mediastinum with aortic arch replacement and simultaneous resection of left atrial myxoma]. / Rezektsiya retsidiviruyushchei gemangiomy perednego sredosteniya s protezirovaniem dugi aorty i odnomomentnym udaleniem miksomy levogo predserdiya.

Patients with anterior mediastinum tumors fall into a difficult category due to high risk of invasion of vital structures and complexity of surgical correction. We report resection of recurrent hemangioma of anterior mediastinum with aortic arch replacement and simultaneous resection of left atrial myxoma in a 35-year-old woman. Successful treatment of these patients correlates with aggressive surgical approach followed by total resection of tumor and all affected vessels and other tissues.