Purpose of the study. To analyze the long-term results from various strategies of endovascular treatment for coronary artery disease (CAD) in patients concomitant with cancer.Patients and methods. 74 patients with both CAD disease and cancer were treated in A. V. Vishnevskiy National Medical Research Center of Surgery from 01/01/2018 to 12/31/2022. By a multidisciplinary council, patients were divided into three groups: group 1 (n = 39) – staged treatment: percutaneous coronary intervention (PCI) is the first stage, the second is surgical treatment of cancer; group 2 (n = 14) – staged treatment: the first stage was surgical treatment of cancer, and the second stage was PCI; group 3 (n = 21) – PCI and open surgery were performed on the same day.Results. In the immediate period, 3 (4.0 %) deaths were observed: 2 (5.1 %) in group 1, 1 (4.8 %) in group 3, the cause of which was complications arising after oncological surgical interventions. One (2.6 %) patient from group 1 had acute myocardial infarction (AMI) due to acute stent thrombosis in the left anterior descending artery (LAD). The patient underwent successful emergency PCI. In the long-term period, 15 (25.4 %) patients died, out of which 11 (18.7 %) from progression of cancer, and 4 (6.7 %) from other causes. Among the major cardiovascular complications, the following were observed: 1 (3.2 %) AMI in group 1 and 1 (7.1 %) in group 2.Conclusion. In the long-term follow-up period, the leading cause of death (73,3 %) was progression of cancer. There were no detected from deaths AMI, which confirms the importance and feasibility of myocardial revascularization in this severe group of patients. PCI in patients with coronary artery disease in combination with cancer allows for effective and safe surgical treatment of malignant pathology without cardiac mortality both in the immediate and long-term follow-up periods.

first method of coronary revascularization (CR), became possible in the 1960s due to advanced achievements in clinical medicine (2) .PCI, as an alternative method, emerged in 1978 (3) and quickly gained a dominant position because of its low invasiveness, irreplaceability in acute CA disease (CAD), and good reproducibility (4) .Nowadays, treatment of patients with myocardial infarction (MI) is directed toward reducing symptoms,In the present review, we have discussed the fundamental issues of coronary revascularization in stable coronary artery disease and shown the pivotal differences between percutaneous coronary intervention and coronary artery bypass grafting regarding the long-term prognosis and clinical profiles.The analysis of the latest publications has demonstrated the advantages of open heart surgery due to the long-term survival and prevention of adverse events in specific groups of patients.

Highlights The feasibility and safety of stereotactic radioablation of arrhythmias have been actively investigated over the last few years. Stereotactic radioablation is an innovative approach for the noninvasive treatment of sustained arrhythmias in high-risk patients. A comprehensive analysis of the advantages and disadvantages of this STAR in relation to AF will allow us to assess the future prospects for the development of this area. Abstract Atrial fibrillation is the most common tachyarrhythmia. The prevalence of this arrhythmia continues to increase steadily due to the rapid demographic ageing of the population. In addition, patients with concomitant cancer are often affected by AF. Despite the relatively benign course of AF, this arrhythmia is a risk factor for the development of a number of life-threatening and disabling complications, which significantly reduces the quality of life and increases the costs to the health care system. For a long time, non-invasive methods of AF treatment were represented exclusively by antiarrhythmic therapy. It is important to note that in elderly and oncological patients, even paroxysmal AF is difficult to treat with medication, and catheter ablation and surgery are associated with high risks of procedural and early postoperative complications. All this served to search for noninvasive methods of ablation of arrhythmogenic substrates of AF. For the first time, stereotactic radioablation was used in clinical practice to eliminate sustained ventricular tachyarrhythmias. Having accumulated sufficient experience, the scientists decided to consider the application of this non-invasive therapy in patients with AF. Currently, there are sporadic papers and clinical case series highlighting the efficacy and safety of stereotactic radioablation in the treatment of AF. The main aim of the presented literature review was to highlight recent data on the capabilities and limitations of non-invasive radiotoxic stereoablation in patients with AF.

The demographic shift towards an increasing number of older and oldest-old individuals is a global phenomenon. This trend has been accompanied by a rise in surgical interventions targeting individuals aged 65 years and above.However, the traditional clinical approach to treating single diseases often proves insufficient for geriatric patients due to multiple factors, such as the presence of multiple chronic conditions, the use of multiple medications, physical frailty, malnutrition, cognitive impairments, and diminished physiological function. With age, metabolic processes tend to slow down, leading to reduced efficiency and diminished ability to cope with stressors.These factors, coupled with the increasing frequency of surgical interventions, pose a significant risk of postoperative complications and even mortality. Consequently, a comprehensive approach is essential for geriatric surgical patients. This approach encompasses preoperative assessment, meticulous surgical planning, and complex postoperative care. A multidisciplinary team of medical professionals is indispensable for providing comprehensive care throughout the treatment course.

Aim. To identify the predictors of atrial fibrillation (AF) recurrence after simultaneous Maze V procedure in combination with coronary artery bypass grafting.Methods. Medical records of 102 patients with coronary artery disease and concomitant AF were retrospectively reviewed. All patients underwent coronary artery bypass grafting and the combined Maze V procedure. The patients were divided into 2 groups: 51 patients with paroxysmal AF (group I), and 51 patients with non-paroxysmal AF (group II). In group I, 6 cases of AF recurrence were detected (subgroup IA), while 45 patients (subgroup IB) maintained sinus rhythm for the entire follow-up period. Accordingly, in group II, the return of AF was noted in 9 patients (subgroup IIA), sinus rhythm - in 42 patients (subgroup IIB). The follow-up period was 36 months. Clinical and echocardiographic parameters were studied as predictors of AF recurrence.Results. A significant predictor in patients with paroxysmal AF was a recurrence of AF at the hospital stage (odd ratio (OR) 10,25; 95% confidence interval (CI) 1,53-68,20; р=0.032). The duration of the AF history was the main predictor in patients with non-paroxysmal AF (OR 8,8; 95% CI 1,01-76,1; р=0.04). ROC analysis revealed a significant effect on the AF recurrence of left atrium (LA) dimension >48.5 mm, LA volume index >44.4 ml/m2 for patients with paroxysmal AF, and left ventriclular end-diastolic volume > 150 ml for patients with non-paroxysmal AFConclusion. A recurrence of AF at the hospital stage, LA dimension, LA volume index were significant predictors of AF recurrence after coronary artery bypass grafting + Maze V procedure in patients with paroxysmal AF. А long AF history and left ventriclular end-diastolic volume played the role of predictors for patients with non-paroxysmal AF.

The number of elderly and senile patients who are in need of surgical care delivery is growing steadily year over year. This category of patients is characterized by comorbidity, polypragmasy and high prevalence of geriatric syndromes including loss of autonomy, malnutrition and cognitive impairments that increase the risk of developing perioperative complications. Management of these patients at all stages requires a comprehensive multidisciplinary approach. Nevertheless, there is no uniform understanding of solution of this problem at present. Determination of consensus on certain issues using the Delphi method will allow to gather and unite expert opinions. In this regard, the working group formulated the main points of management of elderly and senile patients before, during and after surgical treatment and conducted a cross-sectional analysis of experts' opinions.

OBJECTIVE:To analyze potentially preventable causes of mortality from acute calculous cholecystitis (ACC) at the population level. MATERIAL AND METHODS:A retrospective study of causes of ACC-related mortality was conducted. We used online survey of state hospitals and estimated fatal outcomes following ACC considering appropriate annual e-database. RESULTS:There were 1.500 deaths among 142.975 patients aged ≥18 years with acute cholecystitis. We received responses to the proposed questionnaire about 1154 deaths (76.9%). Analysis included 648 cases of ACC (K80.0). Mean age of patients was 76.0 years (31-100). There were 256 (39.5%) men and 392 (60.5%) women. ACC severity was assessed according to the Tokyo guidelines (2018). Mild (I) degree was noted in 24 (3.7%) cases, moderate (II) - 270 (41.7%), severe (III) - 354 (54.6%) patients. Cardiovascular diseases and complications caused death in mild ACC regardless of treatment method in 16 (66.7%) cases, in moderate ACC - 106 (39.3%), in severe ACC - 97 (27.4%) cases. ACC caused death in 3 (12.5%) patients with mild disease, 111 (41.1%) with moderate disease and 200 (56.5%) ones with severe disease. Postoperative complications caused death in 4 (16.7%) patients with mild disease, 29 (10.7%) ones with moderate disease and 30 (8.5%) patients with severe disease. Other causes comprised 4.1% (n=1), 8.9% (n=24) and 7.6% (n=27), respectively. Potentially preventable causes of death were identified in 33.0% of cases. CONCLUSION:ACC-related mortality is mainly associated with comorbidity in elderly and senile patients, late presentation and complicated course of disease. Delayed surgical treatment due to diagnostic and tactical problems, as well as technical intraoperative errors is potentially preventable causes of death.

OBJECTIVE:To determine the current status and main factors influencing the level of emergency laparoscopic surgery in the Russian Federation. MATERIAL AND METHODS:A retrospective nationwide analysis included patients ≥18 years old undergoing surgery for acute cholecystitis (AC), acute appendicitis (AA), perforated ulcer (PU) and ileus. The database of the chief surgeon of the Russian Ministry of Health for 2018 - 2022 was used. To investigate possible reasons influencing the level of emergency laparoscopic surgeries, we performed online survey of medical organizations connected to the electronic reporting system. RESULTS:Over five years, the incidence of laparoscopic surgeries for AC increased from 52.6% to 70.5% (p<0.001), for AA from 25.1% to 41.0% (p<0.001), for PU from 9.4% to 13.2% (p<0.001) and for ileus from 5.9% to 8.5% (p<0.001). The percentage of emergency laparoscopic surgeries in rural hospitals (level I) was 14.8%, level II hospitals - 40.2%, level III - 67.7% (p<0.001). We obtained responses from 1.982 (84.9%) out of 2.335 hospitals included in the database. Significant differences were revealed in equipment of hospitals of different levels with laparoscopic surgical systems and proportion of surgeons proficient in laparoscopic techniques (p<0.001). The same factors influence laparoscopy in different federal districts to a greater extent than their geographic and demographic characteristics. CONCLUSION:Laparoscopic emergency procedures became more widespread, but vary widely between regions, urban and rural. Availability of laparoscopic surgery is influenced by availability of equipment and trained surgeons, geographic distance and population density, level of hospital and ability to maintain acquired skills and increase experience in appropriate surgeries.

Cardiovascular diseases (CVDs) are one of the most common causes of death in the developed as well as in the developing world. Despite improvements in primary prevention, the prevalence of CVD has continued to rise in recent years. Thus, the issues of molecular pathophysiology of CVD and search for new biomarkers related to early and reliable prevention and diagnosis of these diseases still hold relevance today. New genomic techniques provide innovative tools to solve this problem. A research of the current scientific literature clearly indicates that among transcriptomic biomarkers, micro-ribonucleic acids (miRNAs) are the most promising. The microRNAs (miRNAs) are small (~22 nucleotides) non-coding RNAs which regulate gene expression at the post-transcriptional level via inhibition of the translation of messenger RNA (mRNA) or by inducing the degradation of specific miRNAs. The lack of consensus regarding methodologies used for miRNA quantification is one of the main limiting factors in the application of these transcripts. Various studies have proposed the use of circulating miRNAs as biological markers of the acute coronary syndrome, coronary artery disease, heart failure, arrhythmias, myocardial infarction, etc. MiRNAs are involved in many cellular processes such as proliferation, vasculogenesis, apoptosis, cell growth and differentiation, and tumorigenesis.This review considers the most fully studied and clinically significant miRNAs, which physiological role makes them potential biomarkers for various CVDs.

A clinical case of cryoballon ablation of pulmonary veins in a patient with atrial fibrillation with congenital heart disease: persistent left superior vena cava, atresia of the superior vena cava. The methods of investigation at the preoperative stage are described, which allow to plan the operation in advance, taking into account the peculiarities of the confluence of the main veins into the heart, and also some technical features of cryoballon ablation surgery are emphasized.

Background: As the severity of comorbid diseases increases, risks of cardiopulmonary bypass (CPB) complications significantly increase. A complex of the procedure’s damaging factors provokes a systemic inflammatory response that in some cases is accompanied by the damage to target organs, transitioning from chronic organ dysfunctions into acute ones. Some studies on the use of minimal invasive extracorporeal circulation (MiECC) systems show their advantage over conventional extracorporeal circulation (CECC); however, the diversity of MiECC systems, patients, and outcomes precludes us from confidently extrapolating these data to older comorbid patients.Objective: To compare the severity of systemic inflammation and treatment outcomes in comorbid patients who underwent cardiac surgery with CECC and MiECC.Methods: We conducted a retrospective cohort study of 760 patients who consecutively underwent elective cardiac operations in 2019-2022. Inclusion criteria: comorbid status (age-adjusted Charlson Comorbidity Index score of ≥6); CPB time ≥90 min. Exclusion criteria: emergency surgery, refusal to participate in the study. A total of 68 patients met the inclusion criteria. We formed 2 study groups based on the extracorporeal circulation method: CECC group (n = 51) and MiECC group (n = 17). Control points: before CPB and 24 hours after the surgery (lactate; creatinine; oxygenation index, hemolysis level). For systemic inflammatory response markers: 1 hour after the CPB start and 24 hours after the CPB end (interleukin 6; interleukin 10; procalcitonin; C-reactive protein; soluble Triggering Receptor Expressed on Myeloid Cells-1 [sTREM-1]). We evaluated respiratory and renal complications, drainage-related hemorrhages, hemostatic disorders, the need for sympathomimetic drugs, and the length of stay in an intensive care unit and inpatient hospital.Results: Between the groups there were no statistically significant differences in gender and anthropometric characteristics, surgery types, and main perfusion parameters. In the CECC group, we observed significantly higher doses of vasoconstrictors (norepinephrine) as well as a decrease in urine output and lung injury and an increase in lactate and hemolysis. The systemic inflammatory response markers were also significantly higher.Conclusion: Compared with CECC, MiECC does not significantly affect the frequency of organ dysfunctions; however, it reduces the severity of the systemic inflammatory response and immune suppression that are trigger mechanisms for multiple organ dysfunction syndrome. It is particularly important for patients with chronic organ dysfunctions. A range of indications for MiECC systems should be defined given its high cost and off-target effect on pleiotropic factors of systemic inflammatory response development. Received 6 April 2023. Revised 17 August 2023. Accepted 18 August 2023. Funding: The study was conducted within the framework of the research project "Development of minimally invasive and hybrid technologies for surgical treatment of heart diseases". Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.Sh. Revishvili, G.P. Plotnikov, V.A. PopovData collection and analysis: R.A. Kornelyuk, L.B. Berikashvili, I.P. Komkov, E.S. Malyshenko, V.M. ZemskovStatistical analysis: L.B. BerikashviliDrafting the article: R.A. Kornelyuk, G.P. Plotnikov, L.B. Berikashvili Critical revision of the article: G.P. PlotnikovFinal approval of the version to be published: A.Sh. Revishvili, R.A. Kornelyuk, G.P. Plotnikov, L.B. Berikashvili, I.P. Komkov, E.S. Malyshenko, V.M. Zemskov, V.A. Popov

AIM: to establish the consensus on controversial issues of the surgery for Сrohn’s disease by Delphi method. METHODS: a cross-sectional study was conducted by the Delphi method. 62 experts voted intramural and anonymous (31.03.23). 5 statements from the current edition of clinical guidelines were selected for correction by working group and further voting [2]. Based on the practical experience of the working group and literature data, 3 new statements were created also. Statements that do not reach the required level of agreement (80% or more) will be subjected to Round 2 of the Delphi method. RESULTS: all experts took part in the anonymous voting. The panel of experts is represented by 8 different areas of practical medicine and the median of the professional experience of the respondents was 30 (12–49) years. Of the 8 statements submitted for voting, consensus (80% or more) was reached on 6 out of 8. 2 statements have been revised by working group for the distance 2nd round of the Delphi study. Consensus (more than 80%) was reached on both. CONCLUSION: a cross-sectional study by the Delphi method provided the opinions of a panel of experts on controversial issues in the surgical treatment of Crohn’s disease. Statements that reach consensus will be included by the working group in a new edition of clinical guidelines of Crohn’s disease.

Highlights. Stroke prevention in patients with atrial fibrillation is extremely important and difficult. Lifelong anticoagulant therapy is not always an effective way of preventing thrombosis in the left atrial appendage in this group of patients. In this regard, one of the most urgent problems of modern surgical arrhythmology and cardiac surgery is the search for new open and minimally invasive surgical methods of excluding the left atrial appendage from the blood flow. Aim. To investigate the safety and efficacy of using the left atrial appendage stapler for video-guided thoracoscopic ablation (TSA) of non-valvular atrial fibrillation (AF). Methods. The retrospective, single-center study included 100 patients with non-valvular AF who underwent video-guided thoracoscopic ablation of AF with single-stage left atrial appendage exclusion using an Endo GIA stapler (Medtronic, Minneapolis, Minnesota, USA). Results. The mean age of the patients was 56,2±8,8 years, the majority of the patients (73 patients, 73%) were male. Patients with persistent 50 (50%) AF and longstanding AF 50 (50%) were included in the study. The duration of atrial fibrillation was 4 (1,7–7) years. The median CHA2DS2-VASc and HAS-BLED scores were 2 (1–1,5) and 1 (0-1), respectively. The mean anticoagulation therapy-to-ablation time was 4,2±1,9 years. Thirty-eight (38%) patients were prescribed warfarin preoperatively. The completeness of left atrial appendage (LAA) exclusion was confirmed by intraoperative transesophageal echocardiography. The average length of the staple lines was 48 (35–75). A single left atrial appendage exclusion was performed using a 60 mm staples. In 12 (12%) patients, stapler exclusions were performed using two 45 mm staples due to insufficient staple length. None of the patients had ruptures, punctures along the staple lines or rupture of the surrounding epicardial tissue. Anticoagulant therapy was discontinued 6 months after TSA in 70 (70%) patients with sustained sinus rhythm observed on 24-h Holter Monitoring, satisfactory CHA2DS2-VASc scores and after confirmation of absence of left atrial thrombus by transesophageal echocardiography and contrast-enhanced MSCT. No strokes were reported within 1,2±0,7 years after discontinuing anticoagulation therapy. Conclusion. Exclusion of LAA using a stapler for TSA is a highly effective and safe technique for patients with non-valvular atrial fibrillation compared to alternative methods of excluding the LAA from the systemic blood flow.

Background: The outcomes of ventricular tachycardia (VT) ablation in patients with structural heart disease (SHD) are not ideal. High-power radiofrequency ablation (RFA) may have a long-term beneficial effect in this patient cohort.Objective: To evaluate the safety, early and long-term efficacy of high-power RFA for VT and concomitant SHD in a multicenter prospective registry.Methods: Our study included a total of 63 patients (66,7% of them were men; median age was 61.0 [51.0-66.5] years) with ischemic heart disease and drug-resistant VT who were scheduled for RFA (50 W). Non-fluoroscopic 3D mapping systems were used for bipolar and activation mapping with standard settings. The safety end point included perioperative complications, such as death, hemopericardium, stroke, myocardial infarction, electrical storm, and vascular complications. The efficacy end points included VT non-inducibility at the end of ablation and freedom from VT at 12 months of the follow-up. The secondary end points were changes in implantable cardioverter-defibrillator (ICD) therapy, sonographic findings, and number of hospital admissions.Results: All patients underwent VT ablation under general sedation. One clinical VT was induced in 96.8% of the patients before ablation. After ablation no clinical VTs were induced (P < .0001 vs baseline). No perioperative complications were observed. Freedom from VT without antiarrhythmic drugs was 82.6% at 12 months of the follow-up. The number of ICD therapies significantly decreased at 12 months of the follow-up compared with baseline (3.2% vs 31.7%, respectively; P = .0001). The left ventricular ejection fraction increased from 48.7% ± 14.7% at baseline to 50.3% ± 11.9% at 12 months of the follow-up (P = .038). There was a statistically significant decrease in hospital admission rate before and after ablation (from 2 [range: 0-12] to 0 [range: 0-3], P < .0001).Conclusion: High-power RFA for VT in patients with ischemia demonstrated its safety and high perioperative and long-term efficacy, which were linked to clinical improvement. Further randomized studies will help introduce this VT ablation approach into routine clinical practice. Received 5 September 2022. Revised 16 February 2023. Accepted 31 May 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: S.V. Korolev, A.Sh. Revishvili, A.B. Romanov Data collection and analysis: S.V. Korolev, E.A. Artyukhina, V.V. Shabanov, O.V. Sapelnikov, A.V. Tsyganov, A.Sh. Revishvili, A.B. RomanovStatistical analysis: S.V. Korolev Drafting the article: S.V. Korolev Critical revision of the article: A.B. Romanov, A.Sh. Revishvili Final approval of the version to be published: S.V. Korolev, E.A. Artyukhina, V.V. Shabanov, O.V. Sapelnikov, A.V. Tsyganov, A.Sh. Revishvili, A.B. Romanov

Purpose : To compare the reproducibility of texture features during segmentation of CT and MR images of hepatocellular cancer (HCC) by two radiologists. Evaluate the possibility of images pre-processing to improve the reproducibility of texture features. Material and methods . We included 66 patients with preoperative CT and MR images, followed by surgical liver resection for HCC, indicating the tumor histologic grade. Two radiologists with 3 and 6 years of abdominal imaging experience independently segmented the entire tumor volume on CT and MR images. The calculation of texture features was performed without the use of images pre-processing and using a spatial resampling with fixed voxel size of 1 mm 3 (RES), a Laplace Gaussian filter, and for CT images, also with a density threshold from 0 to 300 HU (0–300 HU). The agreement between measurements of radiologists in relation to texture features was carried out using the type 2 intra-class correlation coefficient (ICC). Results . The highest percentage of reproducible texture features with the use of image preprocessing was observed with CT in the arterial phase (0–300 HU + RES) (89.1%), and with MRI in the hepatobiliary phase (RES) (86.6%). At the same time, spatial resampling with fixed voxel size of 1 mm 3 increased the percentage of reproducible texture features in the native, arterial, and delayed phases in CT, as well as in T2-WI, DWI, and in the hepatobiliary phase for MRI. Conclusion . Thus, both techniques, CT and MRI, make it possible to extract reproducible texture features, especially with the use of spatial resampling with fixed voxel size. In this case, preference should be given to a postcontrast images, including the hepatobiliary phase. In CT, it is also advisable to use a density threshold from 0 to 300 HU for the selected area of interest, which will avoid affecting the texture features of adjacent organs and adipose tissue and increase the reproducibility of textural features.

According to global statistics, 25% of deaths every year are cases of sudden cardiac death. Implantation of cardioverter-defibrillators is currently used as its prevention. In the coming years, the world is projected to see an increase in the number of implantations of cardioverter-defibrillators in high-income countries, as well as an expansion of the range of medical devices offered, including subcutaneous cardioverter-defibrillators, which are currently being considered as a promising alternative. We systematized the literature data presented in various international studies evaluating the efficacy and safety of the use of subcutaneous cardioverter-defibrillators. Areview of the medical literature published in the period from 2015 to 2022 was carried out using the information and analytical systems MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar and Web of Science. The review was performed in accordance with the checklist of preferred reporting items for systematic reviews and meta-analyses. 398original publications were selected, of which 50original scientific articles on the research topic were included in the analysis. Modern international studies have demonstrated the efficacy and safety of the use of subcutaneous implantable cardioverter defibrillators. An improvement in the performance of unmotivated discharges over time was noted, which was associated with the improvement of implantable cardioverter-defibrillators. The operating time for implantation of subcutaneous cardioverter-defibrillators was significantly less compared to transvenous cardioverter-defibrillators. Subcutaneous cardioverter-defibrillators were associated with a lower incidence of perioperative complications and high efficacy of shock therapy. Subcutaneous cardioverter-defibrillators were as effective as transvenous implantable cardioverter-defibrillators and did not have the risk of complications associated with implantation of endocardial electrodes. The main limitations of the technique were the impossibility of pacing and the absence of antitachycardic stimulation.