[Surgical treatment of heart valve disease and cardiac tumors via the right-sided minithoracotomy]. / Opyt lecheniya priobretennykh, vrozhdennykh porokov serdtsa i opukholei serdtsa s ispol'zovaniem pravostoronnei mini-torakotomii.

OBJECTIVE: To evaluate the early outcomes of surgical treatment of heart valve disease and cardiac tumors via the right-sided minithoracotomy. MATERIAL AND METHODS: There were 77 interventions via the right-sided minithoracotomy for the period from 2017 to March 2021 (29 men (37.7%) and 48 women (62.3%) aged 50.9±13 years (95% CI 48-53.9)). Heart failure NYHA class III prevailed (45.5%). The following interventions were performed: mitral valve replacement - 32 (41.5%) patients, mitral valve repair - 22 (28.6%) patients, atrial septal defect closure - 13 (16.9%) patients, resection of the left atrial myxoma - 4 (5.2%) patients, atrial septal defect closure + tricuspid valve repair - 2 (2.6%) patients, tricuspid valve replacement - 2 (2.6%) patients, mitral valve repair + atrial septal defect closure - 1 (2.6%) patient, mitral valve repair + atrial septal defect closure + right middle lobectomy - 1 (2.6%) patient. RESULTS: There were no in-hospital mortality and major cardiac events. Conversion was required in 1 case (1.3%). Enlargement up conventional to thoracotomy was required in 1 case (1.3%). Surgery time was 217 min (Q1-Q3 188-258), cardiopulmonary bypass time - 106 min (Q1-Q3 91-124), aortic cross-clamping time - 82±29 min (95% CI 76-89). Intraoperative blood loss was 500 ml (Q1-Q3 400-600). Mean postoperative hospital-stay was 6.7±1.8 days (95% CI 6.3-7.1). CONCLUSION: Heart valve surgery and resection of cardiac tumors via the right-sided minithoracotomy is a safe and effective approach to ensure chest stability, fast postoperative recovery and favorable cosmetic result. Surgery time is decreased along the learning curve.

[Sinus septal defect closure with correction of partial anomalous pulmonary vein drainage through mini-thoracotomy]. / Plastika sinus septum defekta s korrektsiei chastichnogo anomal'nogo drenazha legochnykh ven iz minitorakotomnogo dostupa.

Mini-thoracotomy is one of the most popular minimally invasive approaches. This approach is used in the treatment of congenital and acquired heart diseases and characterized less surgical trauma, intraoperative blood loss, pain syndrome severity, risk of infectious complications and better cosmetic results. Successful correction of atrial septal defect (ASD) through right-sided mini-thoracotomy is reported in the article.

[Evolution of mitral valve replacement]. / Évoliutsiia protezirovaniia mitral'nogo klapana.

Historical development of mitral valve surgery at Petrovsky Russian Research Center for Surgery is described in the article. Evolution of artificial heart valves design and development of surgical techniques are presented.

[The isolated prosthetics of the aortic valve in elderly patients].

Demographic changes and increase of the average life span led to the increase of elderly patients, who need cardiac surgery. The issue highlights the results of surgical activity of cardiosurgery department of SCS among elderly patients.

[Surgical treatment of patients with nonrheumatic aortic valve failure and ischemic heart disease].

54 patients aged 65-88 years (mean age 68,4±5,9) were operated during 1994-2009. 50 patients underwent aortic valve replacement combined with coronary bypass grafting, 3 patients underwent aortic and mitral valve replacement combined with bypass grafting. Ascending aorta replacement according to Bentall - de Bono method with coronary bypass grafting was carried out to 1 patient. Aortic root plasty was applied in 4 observations. 106 distal bypasses with coronary bed were formed in 54 patients; myocardial revascularization index amounted 1,9. Hospital mortality amounted 3,7% (2 patients). Causes of lethal outcome were: complex rhythm disturbances, augmenting cardiovascular failure. Low hospital mortality and low amount of complications allow recommending more aggressive approach in establishing indications for operative treatment in this group of patients.

[Decalcification of anterior cusp of mitral valve at marked calcification of aortic valve].

Short-term and long-term results of surgical treatment were analyzed in 108 patients with aortic valve disease, complicated significant calcinosis spreading on anterior cusp of mitral valve. Mean age of the patients - 53,5±10,8 years (from 25 to 88 years). All patients underwent aortic valve replacement and decalcification of anterior cusp of mitral valve. Coronary bypass grafting was additionally carried out in 10 cases (from 1 to 5 shunts, 1,9 - in average). Hospital lethality was absent. Functional improvement of mitral valve was observed basing on postoperative echocardiography and remained in long-term period.

[Prosthesis of the aortal valve in adult patients with "narrow" aortic root].

Results of treatment of 54 patients with aortal valvular disease and "narrow" aortic root are analyzed. Only adult patients were included in the study, their age ranged from 16 to 64 years (mean age 41.5+/-14.7 yrs). Thirty-four (63%) patients of them have undergone aortic valve replacement with disk prosthesis, in 20 (37%) patients this surgery was supplemented with dillative plasty of fibrous ring and aortic root by Nicks's method. The proposed algorithm of choosing the most effective operation in patients with the aortal defect and narrow aortal root permits one to avoid pathologic pressure gradient between the left ventricle and the aorta after surgery and to achieve the most favorable clinical effect.