[Long-term result of aortic root remodeling using the Florida sleeve technique in a patient with connective tissue dysplasia and aortic root aneurysm without aortic insufficiency]. / Otdalennyi rezul'tat ekzoprotezirovaniya kornya aorty po metodike Florida Sleeve u bol'nogo s soedinitel'notkannoi displaziei i anevrizmoi kornya aorty bez aortal'noi nedostatochnosti.

Aortic root remodeling using the Florida sleeve technique was proposed as a simpler alternative to classical reconstructive interventions in patients with aortic root aneurysm without aortic insufficiency. We present a 10-year result of valve-sparing surgical treatment using the Florida sleeve technique in a patient with connective tissue dysplasia and aortic root aneurysm.

[Clinical, biochemical and histological indicators of Del Nido cardioplegia efficacy in patients with severe myocardial hypertrophy]. / Klinicheskie, biokhimicheskie i gistologicheskie pokazateli effektivnosti kardioplegicheskogo rastvora Del Nido u patsientov s vyrazhennoi gipertrofiei miokarda.

OBJECTIVE: To evaluate the effectiveness of two cardioplegia techniques in patients with severe myocardial hypertrophy undergoing septal myectomy or aortic valve replacement. MATERIAL AND METHODS: A comparative pilot prospective single-center randomized study included 46 patients between 2022 and 2023. Patients were randomized into 2 groups: Del Nido (n=23) and Custodiol (n=23). We analyzed perioperative echocardiography data, troponin I at several time points, perioperative complications and histological data. RESULTS: Both groups were comparable in time of myocardial ischemia, cardiopulmonary bypass, duration of anesthesia and surgery (p>0.05). The maximum ischemia time in the Del Nido group was 84 min. The same group showed significantly higher percentage of spontaneous rhythm recovery (65.2% vs. 30%, p=0.008). None patient required mechanical support, high-dose inotropes or vasopressors. Troponin I in 2 hours after cardiopulmonary bypass (p=0.415), 12 (p=0.528) and 24 hours after admission to the intensive care unit (p=0.281) were similar in both groups. No significant difference was found in ventilation time, ICU- and hospital-stay. CONCLUSION: Del Nido cardioplegia has some advantages compared to Custodiol and does not lead to perioperative complications in case of aortic cross-clamping time <90 min in patients with myocardial hypertrophy.

[Mitral valve replacement in patients with obstructive hypertrophic cardiomyopathy]. / Protezirovanie mitral'nogo klapana u bol'nykh obstruktivnoi gipertroficheskoi kardiomiopatiei.

OBJECTIVE: To analyze the incidence and causes of mitral valve replacement in patients with obstructive hypertrophic cardiomyopathy (HCM). MATERIAL AND METHODS: There were 172 patients (98 women and 74 men) with obstructive HCM and severe mitral valve insufficiency between November 2017 and May 2023. All patients complained of chronic heart failure NYHA class III. Surgical correction of left ventricular outflow tract (LVOT) obstruction and mitral valve repair with elimination of systolic anterior motion were technically successful in 160 (93.0%) patients. RESULTS: The need for mitral valve replacement was noted in 12 (7.0%) patients. Mean cardiopulmonary bypass time was 83.5±19.2 min (94; 127), aortic cross-clamping - 62.8±14.3 min (70; 102). In 5 cases, primary mitral valve replacement was scheduled due to obvious organic lesion of the mitral valve (tearing of chords, rheumatic lesion with leaflet restriction). In 7 patients, valve replacement was forced after ineffective primary septal myectomy (LVOT pressure gradient, severe mitral insufficiency). CONCLUSION: Mitral valve replacement is an involuntary strategy after ineffective myectomy with severe mitral insufficiency and high LVOT pressure gradient.

[In-hospital and mid-term results of aortic root remodeling and aortic valve annuloplasty in patients with aortic root aneurysm and no severe aortic valve disease]. / Gospital'nye i sredneotdalennye rezul'taty remodelirovaniya kornya aorty s annuloplastikoi aortal'nogo klapana u bol'nykh s anevrizmoi kornya aorty bez vyrazhennogo organicheskogo porazheniya aortal'nogo klapana.

OBJECTIVE: To analyze early and mid-term results of aortic root remodeling with aortic valve annuloplasty in patients with aortic root aneurysm and no severe aortic valve disease. MATERIAL AND METHODS: There were 33 patients with connective tissue dysplasia, aneurysm of aortic root and/or ascending aorta and aortic regurgitation between September 2019 and December 2022. All patients underwent aortic root remodeling with aortic valve annuloplasty. RESULTS: Mean time of cardiopulmonary bypass was 138.5±21.5 min, aortic clamping - 115.3±20.5 min. According to postoperative transthoracic echocardiography, mild aortic regurgitation was observed in 28 patients, 5 patients had moderate regurgitation. Postoperative follow-up period varied from 3 months to 2 years. There was no in-hospital mortality or significant cardiovascular complications. Two-year freedom from moderate-to-severe aortic regurgitation was 93.9%, overall survival - 100%. CONCLUSION: Aortic root remodeling is characterized by favorable hemodynamic efficiency and low complication rate.

[Aortic root remodeling and aortic valve annuloplasty in patients with aortic root aneurysm and no severe aortic valve disease]. / Remodelirovanie kornya aorty s annuloplastikoi aortal'nogo klapana u bol'nykh s anevrizmoi kornya aorty bez vyrazhennogo organicheskogo porazheniya aortal'nogo klapana.

OBJECTIVE: Analysis of the outcomes after aortic root remodeling with aortic valve annuloplasty in patients with aortic root aneurysm and no severe aortic valve disease. MATERIAL AND METHODS: There were 19 patients with connective tissue dysplasia, aneurysm of aortic root and/or ascending aorta and aortic regurgitation between September 2020 and December 2021. All patients underwent aortic root remodeling with aortic valve annuloplasty. RESULTS: Mean time of cardiopulmonary bypass was 148.7±23.5 min, aortic clamping - 117.3±19.5 min. According to postoperative transthoracic echocardiography, mild aortic regurgitation was observed in 6 patients, 13 patients had no regurgitation. There was no in-hospital mortality or significant cardiovascular complications. Freedom from moderate-to-severe aortic regurgitation after 14 months was 94.7%, overall survival - 100%. CONCLUSION: Aortic root remodeling is characterized by favorable hemodynamic efficiency and low complication rate. Further accumulation of data with clinical analysis are planned for a more accurate assessment of effectiveness of surgical treatment, determination of predictors of successful reconstruction, development of indications, contraindications and a personalized algorithm for patient selection.

[Surgical treatment of obstructive hypertrophic cardiomyopathy combined with muscle bridging of the left anterior descending artery]. / Khirurgicheskoe lechenie obstruktivnoi gipertroficheskoi kardiomiopatii v sochetanii s miokardial'nym mostikom perednei niskhodyashchei arterii.

Myocardial bridging is often detected during diagnostic coronary angiography in patients with congenital and acquired heart defects. In most cases, muscle bridging does not require surgical treatment. Myocardial bridging and tunnels causing compression of one or more major coronary arteries is a potential cause of myocardial ischemia in patients with hypertrophic cardiomyopathy. The authors report surgical treatment of a patient with obstructive hypertrophic cardiomyopathy and myocardial bridging of the left anterior descending artery.

[Surgical approaches to interventricular septum in hypertrophic cardiomyopathy]. / Varianty dostupa k mezhzheludochkovoi peregorodke serdtsa pri gipertroficheskoi kardiomiopatii.

Hypertrophic cardiomyopathy (HCM) is a hereditary myocardial disease characterized by ventricular wall and interventricular septum thickening not associated with heart valve disease or any other external cause. Considering different localization of left ventricular obstruction, surgeons should be aware of various surgical approaches to various segments of interventricular septum. A personalized approach to each patient is essential to achieve favorable postoperative effect with minimal incidence of complications. This review is devoted to various surgical approaches to interventricular septum for different phenotypic variants of HCM.

[Hemostatic measures in reconstructive aortic root surgery]. / Metody kontrolya krovotecheniya v rekonstruktivnoi khirurgii kornya aorty.

Bleeding is a significant cause of complications and mortality in surgery for ascending aorta and aortic root disease. This is especially true after complex reconstructions associated with hypothermic circulatory arrest and long-standing cardiopulmonary bypass. The review is devoted to modern methods of hemostasis in reconstructive aortic root surgery.

[Redo tricuspid valve replacement with mechanical prosthesis for repeated early bioprosthetic valve failure]. / Reprotezirovanie trikuspidal'nogo klapana mekhanicheskim protezom u patsientki s povtornoi rannei disfunktsiei bioproteza.

Tricuspid leaflet lesion following infective endocarditis is a severe condition requiring surgical treatment in most cases. Currently, tricuspid valve replacement with mechanical prosthesis is still essential in the treatment of patients ineligible for reconstructive surgery or bioprosthesis implantation. The authors describe redo tricuspid valve replacement with mechanical prosthesis for repeated early bioprosthetic valve failure.

[Results of endocardial pulmonary vein cryoablation in patients with atrial fibrillation undergoing on-pump cardiac surgery]. / Rezul'taty krioablyatsii ust'ev legochnykh ven u patsientov s fibrillyatsiei predserdii pri kardiokhirurgicheskikh operatsiyakh v usloviyakh iskusstvennogo krovoobrashcheniya.

OBJECTIVE: To analyze the results of endocardial pulmonary vein cryoablation in patients with atrial fibrillation (AF) undergoing on-pump cardiac surgery. MATERIAL AND METHODS: The authors report postoperative outcomes in 19 patients after on-pump coronary artery bypass grafting and/or heart valve surgery and endocardial pulmonary vein cryoablation for concomitant AF. All procedures were performed for the period from September 2018 to December 2020. RESULTS: Successful procedure was determined by restoration of stable sinus rhythm in postoperative period. In 14 (79%) patients, sinus rhythm was restored in early postoperative period. In 5 (21%) patients (2 women, 3 men), AF recurred within 6-12 days after surgery. In one patient, postoperative period was complicated by atrioventricular blockade grade I. CONCLUSION: Endocardial pulmonary vein cryoablation is effective for AF. This procedure is expedient in patients with concomitant cardiac disease scheduled for open heart surgery.

[Simultaneous surgical correction of post-infarction left ventricular aneurysm and residual ventricular septal defect in long-term period after transcatheter implantation of occluders]. / Sochetannaya khirurgicheskaya korrektsiya postinfarktnoi anevrizmy levogo zheludochka i rekanalizovannogo defekta mezhzheludochkovoi peregorodki v otdalennom periode posle transkateternoi implantatsii okklyuderov.

Post-infarction ventricular septal defect (VSD) is a rare but formidable complication of myocardial infarction following mortality rate up to 90% without invasive treatment. Surgical closure is preferred for VSD. The authors report successful surgical treatment of a patient with post-infarction LV aneurysm and residual post-infarction VSD in 5 years after implantation of two occluders.

[Ascending aorta and aortic arch hypoplasia in a patient with connective tissue dysplasia and multiple deficit of coagulation factors]. / Gipoplaziya voskhodyashchego otdela i dugi aorty u bol'nogo s displaziei soedinitel'noi tkani i kombinirovannym defitsitom plazmennykh faktorov svertyvaniya.

Connective tissue dysplasia (CTD) is an urgent problem, especially in young and employable people. Damage to cardiovascular system and, in particular, aorta is predominant factor determining the incidence of various complications and mortality in patients with CTD. The authors report surgical treatment of aortic hypoplasia in an adolescent patient with connective tissue dysplasia syndrome and combined deficiency of coagulation factors.

[aortic root remodeling with external aortic ring annuloplasty]. / Remodelirovanie kornia aorty s ékzoprotezirovaniem fibroznogo kol'tsa aortal'nogo klapana.

An efficacy and safety of valve-sparing aortic root surgery with aortic ring annuloplasty have been demonstrated in various trials. The main technical features of aortic root remodeling with external aortic ring annuloplasty are reported in the article.

[Surgical treatment of patients with obstructive hypertrophic cardiomyopathy]. / Khirurgicheskie i anesteziologicheskie aspekty lecheniia bol'nykh s gipertroficheskoi kardiomiopatiei.

OBJECTIVE: To analyze in-hospital results of surgical treatment of patients with obstructive hypertrophic cardiomyopathy. MATERIAL AND METHODS: There were 15 patients (8 women and 6 men) with obstructive hypertrophic cardiomyopathy and severe mitral insufficiency for the period from November 2017 to March 2019. Mean age of patients was 55.9±7.1 years. All patients had chronic heart failure NYHA class III and secondary coronary insufficiency. RESULTS: Surgical correction of LVOT obstruction and mitral valve repair with elimination of systolic anterior motion were technically successful in all cases. There was no need for mitral valve replacement in all patients. Heart failure NYHA class I-II in early postoperative period was observed in all cases. CONCLUSION: Careful preoperative planning with a comprehensive analysis of hemodynamic and anatomical features of LV and certain surgical experience are essential for adequate correction of LVOT obstruction without atrioventricular node injury and mitral valve repair.

[Successful surgical treatment of aortic heart disease as a complication after combined targeted therapy for cancer]. / Khirurgicheskoe lechenie aortal'nogo poroka serdtsa kak oslozhneniia posle kombinirovannoi targetnoi terapii raka.

Cardiovascular diseases and malignancies are leading causes of mortality in the world. Two categories of advanced age patients with cancer are observed in clinical practice. These are patients with cardiovascular diseases as comorbidities and patients with cardiovascular diseases as a complications of targeted therapy for cancer. Cardiac toxicity of chemotherapeutic drugs results myocardial dysfunction, occurrence or progression of heart valve disease, coronary artery disease, arterial hypertension and thromboembolism. A patient who underwent aortic valve replacement and coronary artery bypass surgery is discussed in the article. Aortic valve disease and coronary artery disease were complications of targeted radio- and chemotherapy for sigmoid colon cancer followed by lung and liver metastases. Questions of timely diagnosis and treatment of advanced age patients in multi-field surgical clinic are also analyzed.

[The results of coronary artery bypass grafting by using of surgical microscope]. / Gospital'nye rezul'taty koronarnogo shuntirovaniia s ispol'zovaniem operatsionnogo mikroskopa.

AIM: To analyze own experience of coronary artery bypass grafting (CABG) using microsurgical technique and operating microscope. MATERIAL AND METHODS: There were 100 patients with coronary artery disease who underwent CABG in the Petrovsky Russian Research Center for Surgery for the period from April 2017 to December 2018. Mean age of patients was 59.7 ± 8.9 years. Triple-vessel disease was noted in 83 (83%) patients, two-vessel - in 17 (17%) patients. Stenosis of left main coronary artery was observed in 34 (34%) patients. On-pump myocardial revascularization using microsurgical technique was performed in all patients. RESULTS: A total of 360 distal anastomoses with coronary arteries were formed in 100 patients using surgical microscope. Revascularization index was 3.6 ± 0.8, mean CPB time - 104 ± 24 min, aoric cross-clamping time - 72 ± 16 min. In-hospital mortality was absent. There were no cases of resternotomy for bleeding, infectious complications of postoperative wounds. One (1%) patient had intraoperative myocardial infarction. CONCLUSION: CABG using microsurgical technique and operating microscope may be appropriate in patients with multiple-vessel coronary lesion and small diameter of coronary arteries.

[Isolated transaortic mitral valve repair for left ventricular outflow tract obstruction]. / Izolirovannaia transaortal'naia plastika mitral'nogo klapana kak metod lecheniia obstruktsii vykhodnogo trakta levogo zheludochka.

Hypertrophic cardiomyopathy (HCM) is congenital heart disease with prevalence 1 per 500. There are still unclear issues regarding optimal surgical strategy despite more than 50-year research of this disease. It is presented case report of surgical treatment of patient with obstructive HCM by using of non-standard volume and method of intervention.

[Hypertrophic cardiomyopathy: current state of the problem]. / Gipertroficheskaia kardiomiopatiia: sovremennoe sostoianie problemy.

The main aspects of epidemiology, pathophysiology, medication and surgical treatment of hypertrophic cardiomyopathy (HCM) are reviewed in the article. The authors emphasize that surgical treatment is still the method of choice for HCM and can guarantee excellent immediate and long-term results with minimal risk.

[Conservative treatment of thrombosis of aortic valve bioprosthesis]. / Konservativnoe lechenie tromboza biologicheskogo proteza aortal'nogo klapana.

Case report of successful conservative treatment of patient with thrombosis of aortic valve bioprosthesis after 8 months postoperatively is presented.

[Endoscopic harvesting of internal mammary artery for coronary artery bypass grafting]. / Éndoskopicheskoe vydelenie vnutrennei grudnoi arterii iz mini-torakotomii pri mammarno-koronarnom shuntirovanii.

Endoscopic harvesting of internal mammary artery for minimally invasive coronary artery bypass surgery seems to be highly justified and expedient. Technical features of this procedure are reviewed in the article. There are certain advantages of this method including ligation of proximal branches, reduced surgical trauma, better cosmetic results and enhanced postoperative rehabilitation.