Цель. Сравнительный анализ непосредственных и среднеотдаленных результатов протезирования трикуспидального клапана с использованием митрального гомографта и каркасных биологических протезов.

Introduction . Surgical treatment of infective and prosthetic endocarditis using homografts shows good results. Aortic homograft implantation is a common technique, whereas tricuspid and mitral valve replacement with mitral homograft is rare. Multiple valve malformations in infective endocarditis pose a surgical challenge because these patients are usually critically ill and surgical outcomes are often unsatisfactory. In this article, we describe our experience with successful surgical treatment of patients who underwent implantation of cryopreserved homografts Aim : To study the long-term results of cryopreserved homograft implantation, freedom from reoperation, long-term survival, and to demonstrate new technical aspects of homograft implantation. Material and Methods . This is a retrospective analysis of 24 patients operated in our clinic (UKB No. 1 of Sechenov University) between 2015 and 2021. Aortic homograft (AH) in orthotopic position was implanted in 6 patients with active IE. Pulmonary homograft (PH) was implanted in 13 patients: in orthotopic position (n = 10) and in heterotopic position (in the aortic root) (n = 3). Mitral homograft was implanted in 4 patients, with only 1 of them in the orthotopic position, whereas 3 were implanted in the TC position (Table 1). In 1 patient with AK and MC IE extended to the mitral-aortic contact, the use of an aorto-mitral monobloc was requested. Results . In the midterm period, we had available data from all surviving patients. The mean gradient on AC after implantation of aortic homograft and pulmonary homograft in the position of the aortic root was 4.6 ± 1.96 mm Hg, significant regurgitation was absent in all patients, and no cases of reoperation were noted. After orthotopic implantation of pulmonary homografts, the mean gradient was 3.2 ± 1.4 mm Hg, significant regurgitation was absent in all cases. After MG implantation in TC position according to ECHO data all patients have 0–1 degree of regurgitation on the prosthesis, mean pressure gradient was 2,5 ± 0,6 mm Hg. MG was implanted in orthopic position in one case – a 52 years old woman with Bechterew’s disease, mean gradient on IC was 4 mm Hg, regurgitation 0–1 degree. Conclusion . Valve homografts may have more advanced indications than IE. Techniques such as implantation of MG in tricuspidal or orthotopic position and the use of combined homografts show promising results, but require further clinical recruitment and evaluation of the distant period.

Today, the issue of atrial fibrillation recurrence after ablation is increasingly discussed in the literature. Many authors analyze the factors predicting success or failure of cryo-maze procedure. This review is devoted to predictors of atrial fibrillation recurrence in long-term period after biatrial cryo-maze procedure. Primary screening identified 48 studies. There were 27 articles after removing duplicate articles, case reports and articles with unavailable full-text versions. Two independent researchers reviewed the full-text articles and enrolled 11 and 14 articles, respectively. After collegial discussion and involving the third researcher, we selected 13 articles for final analysis. It was established that atrial enlargement and duration of atrial fibrillation are the main independent predictors of recurrence in long-term period.

The trend towards minimally invasive and excellent cosmetic effect has affected the most difficult section of cardiac surgery – the aortic root. To date, there are various minimally invasive approach for the correction of aortic root pathol ogy, which are used in single clinics in the world. The objective of this literature review was to study the current state of minimally invasive aortic root surgery and critically evaluate methods of correcting its pathology from different types of minimally invasive approach. The minimally invasive approach to these operations is presented in this review of the literature. A mutual comparison of minimally invasive approaches was carried out, their advantages over the traditional approach were determined. Despite the attractiveness of the technique, there are serious limitations of its wide appli cation, such as a long learning curve, an extremely low number of long-term results and the absence of multicenter, randomized comparison studies with traditional approach.

Cardiac surgery research shows that isolated aortic valve (AV) procedures account for 9% of all cardiac surgeries, with a surgery mortality rate of 2.3% and the predominance of bioprosthese use. Despite the widespread use of these methods, there is a high rate of patient-prosthesis mismatch affecting long-term survival. In this context, new technologies are emerging, such as Tiara bioprostheses and Ozaki neocuspidization of AV, but their comparative analysis is currently lacking. Aim : to compare short-term outcomes of the Tiara bioprosthesis implantation and the Ozaki procedure. Methodology and Research Methods . Retrospective analysis of 387 patients who underwent Ozaki procedure or the Tiara bioprosthesis implantation was performed. Inclusion criteria are patient age 18 years or older, Ozaki procedure performed or the Tiara bioprosthesis implantation. Exclusion criteria are use of a mini-access, the presence of infective endocarditis and repeated cardiac surgery. Ultimately, 352 patients were selected. Given the statistically significant differences in clinical and demographic characteristics between the groups, a propensity score matching was used in a 1 : 1 ratio. As a result two balanced groups of 58 patients each were formed. Results . In the group, where the Tiara bioprosthesis was implanted, the average age was 69 ± 5 years. In the group, where the Ozaki procedure was performed, the average age was 68 ± 6 years (p = 0.3). There were 14 men and 44 women in the Tiara group and 21 men and 37 women in the Ozaki group (p = 0.1). The median diameter of the annulus in the Tiara group was 20 (20–22) mm, while in the Ozaki group it was 21 (20–22) mm (p = 0.2). Statistically significant differences were noted in the duration of the surgery, cardiopulmonary bypass and cross-clamp time, which were statistically less in the Tiara group compared to the Ozaki group: surgery duration – 160 (145–199) minutes versus 250 (220–295) minutes (p < 0.001 ), cardiopulmonary bypass time – 72 (60–97) minutes versus 112 (92–133) minutes (p < 0.001), cross-clamp time – 55 (46–70) minutes versus 81 (71–100) minutes (p < 0.001). There was no statistically significant difference between the groups in terms of postoperative complications and hospital mortality. In-hospital mortality was 0% versus 2 (3.4%) cases (p = 0.4). Resternotomy due to bleeding was performed in 1 patient (1.7%) in the Tiara group and in 4 patients (6.9%) in the Ozaki group (p = 0.3). Pacemaker implantation was required in 2 patients (3.4%) in the Tiara group, whereas such a need did not arise in the Ozaki group (p = 0.4). Stroke occurred in 4 patients (6.9%) in the Tiara group and in 1 patient (1.7%) in the Ozaki group (p = 0.3). Acute kidney injury was recorded only in 1 patient in the Ozaki group (1.7%) (p = 1). Both groups had similar rates of patient-prosthesis mismatch; moderate discrepancy was noted in only one patient (1.7%) in the Tiara group; no such cases were recorded in the Ozaki group. However, significant differences were found in peak and mean gradients on AV. In the Tiara group, the peak gradient was 32 ± 12 mmHg, and the average was 17 (11–20) mmHg. In comparison, in the Ozaki group the average values were significantly lower: peak gradient – 11 ± 5 mmHg, average – 5 (3–8) mmHg. (p < 0.001 for both comparisons). Conclusion . The study showed that the surgery duration, cardiopulmonary bypass, and myocardial ischemia period was statistically significantly shorter in the Tiara group compared with the Ozaki group. Despite this, transvalvular gradients on the AV were smaller in the Ozaki group.

Aim. To assess the effect of intermittent hypoxic-hyperoxic exposures (IHHE) on the outcomes of on-pump cardiac surgery.Material and methods. This prospective, single-center, randomized, controlled study was conducted in 110 patients with heart valve defects and/or aortic pathology from the cardiac surgery clinic of the I. M. Sechenov First Moscow State Medical University. The total sample was randomly divided into a group of patients who underwent IHHE (n=66) and a control group of patients who underwent placebo procedures with ambient air (n=44). The frequency and structure of intra-and postoperative complications were analyzed within 30 days after surgery. The presence of cognitive impairment, as well as serum troponin I and lactate concentrations were analyzed before and after surgery.Results. Peri- and early postoperative complications such as cardiac death, non-fatal infarction and acute heart failure occurred significantly less frequently in patients treated with IHHE compared with placebo group (1,6% vs 16,7%, p=0,009; 1,6% vs 16,7%, p=0,009; 6,3% vs 33,3%, p<0,001, respectively). The median troponin I values 24 hours after surgery were 1,068 ng/ml (0,388-1,397 ng/ml) in the IHHE group and were significantly lower compared to the control group (1,980 ng/ml (1,068-3,239 ng/ml)). The serum lactate level after surgery was 1,8±0,7 mmol/l in the IHHE group and was significantly lower compared to the control group — 2,4±1,2 (p=0,05). Cognitive function, assessed by MOCA and MMSE tests, turned out to be significantly higher in patients who underwent a preoperative IHHE. No significant complications or serious adverse events were observed during the IHHE procedures.Conclusion. The use of individually adapted hypoxic preconditioning procedures reduces the incidence of peri- and postoperative complications, which is accompanied by a lower ischemia-reperfusion myocardial injury during artificial circulation with preservation of cognitive functions. IHHE procedures ramp up prehabilitation of patients referred for on-pump surgery of heart defects and aortic pathology.

Background: Congenital aortic valve (AV) disease is viewed in 2% of the population and in 20 out of 1000 neonates are presented with bicuspid configuration. Treatment of the congenital AV diseases requires multiple interventions. The ultimate goal is to provide adequate close to physiological left ventricle outflow and minimization of regurgitation. The optimal operative management of AV disease in children and young adults remains controversial. AV neocuspidization with glutaraldehyde-treated autologous pericardium may be a satisfactory alternative in pediatric cardiac surgery.Objectives: The data of the AVNeo procedure results enable a comparative analysis of various AV reconstructive approaches in the pediatric cohort. In this article, we present the comparative study of various techniques in pediatric AV surgery, including the immediate and midterm outcomes of AVNeo, commissurotomy with aortic leaflet augmentation using pericardial patch ("free style" technique), and Ross procedure.Study Design: We conducted a retrospective analysis of the early and midterm results of surgical AV disease treatment of 44 children in 5 cardiac surgery centers from 2014 to 2022. The patients were divided into 3 groups: group I: glutaraldehyde-treated autologous pericardium AVNeo (n = 12), group II: "free style" technique (n = 10), and group III: Ross procedure (n = 22). We described the immediate and midterm outcomes. The study design was approved by the ethics committees of the participating centers.Results: A total of 44 children after surgical treatment of the AV disease in 5 cardiac surgery centers were included in the study and were grouped as group I: AVNeo (n = 12), group II: "free style" technique (n = 10), and group III: Ross procedure (n = 22). The median follow-up period was 57 +/- 23.8 months. In-hospital mortality was 4.5% (n = 2). In the midterm follow-up, the peak pressure gradient was 18.45 +/- 4.63 mmHg for group I and 8.9 +/- 1.6 mmHg for group III (p=0.00001), respectively. The cumulative freedom from reoperations was 100%, 30%, and 95.2% for 40 months of follow-up and 100%, 30%, and 83.4% for 70 months of follow-up in I, II, and III groups, respectively. No cases of midterm mortality were detected in all groups.Conclusion: The AV neocuspidization with glutaraldehyde-treated autologous pericardium has an enormous advantage in pediatric AV surgery, significantly surpassing the freedom from resurgery of repair procedures and having comparable results with the Ross procedure in the midterm follow-up.

Introduction . Aortic root surgery continues to improve. Both linear valve-containing and anatomic (so-called Valsalva grafts) conduits are used for aortic root replacement. However, there is no clear opinion about the importance of using anatomical valve-containing conduits. The answer to this question can be obtained by comparing the transvalvular hemodynamics of a linear conduit with the transvalvular hemodynamics of the native aortic root. Research in this area will help to find the characteristics that a new valve-containing conduit should possess to provide optimal hemodynamics. Objective . To demonstrate the method of aortic root structures prosthetics with imitation of its natural geometry, to report on the advantages of such intervention from the position of transvalvular hemodynamics. Material and Methods . An experimental study of transvalvular hemodynamics in the prosthesis “Russian Conduit I” of linear design with autopericardial flaps sewn into it was performed. The results were compared with the reference hemodynamics in the native aortic root with sewn-in flaps of the same shape as in the studied conduit. The results of the study showed that the natural geometry of the aortic root significantly affects transvalvular hemodynamics, which is expressed in smaller transvalvular gradients, lower energy losses at the opening and closing of the flaps, and larger opening area. Results . We extrapolated the experimental data to the clinical results of similar operations in comparable groups. We studied the results of the operation with the use of the Russian Conduit prosthesis. The operation with the aortic root preservation was symmetrical neocuspidization. According to the results of the study it was demonstrated that preservation of native aortic root gives better transvalvular hemodynamics, which significantly affects the reverse remodeling of the left ventricle in the mid-term period. With this in mind, it is concluded that it is necessary to preserve the geometry of the aortic root during interventions for its prosthesis with a valve-containing conduit. This paper presents a clinical case of a new aortic root prosthesis “Russian Conduit II”. It was used for aortic root reconstruction with restoration of the locking function of the native aortic valve. The description of the surgical technique, immediate results, and the possibilities of similar surgical intervention are described in detail. Conclusion . There are reasons to believe that the use of the developed prosthesis in aortic root surgeries can give hemodynamic results comparable with native valve, and the operation itself has a potential for high reproducibility and standardization of surgical technique, which will expand its application.

In aortic valve (AV) replacement surgery in patients with a narrow annulus fibrosus (AF), the likelihood of prosthesis-patient mismatch (PPM) is high. PPM, in turn, significantly affects the hemodynamic and functional capabilities of AV, morbidity and mortality in the postoperative period. The “gold standard” for the treatment of AV diseases is prosthetics with mechanical and biological prostheses. However, there are alternative methods, such as neocuspidalization of AV according to the S. Ozaki (AVNeo) method.Aim: To compare the immediate and medium-term results of AV prosthetics using the S. Ozaki (AVNeo) technique and AV prosthetics with a biological prosthesis in patients with a small aortic annulus.Material and Methods: A retrospective multicenter study of 309 patients with a narrow fibrous ring of the aortic valve (FR AV) who underwent surgery between February 2010 and December 2021 was conducted. Inclusion criteria: prosthetics of AV, FR AV = 21 mm, age 18 years and older. Exclusion criteria: left ventricle ejection fraction ≤ 40%, repeated interventions, mini-stop. 153 patients underwent Aveo and 156 patients underwent AV prosthetics using biological prostheses. After “pseudorandomization” (propensity score matching), 92 patients were selected: 46 patients in the AVNeo group and 46 patients in the biological prosthesis group. The primary endpoint was hospital mortality. Postoperative complications, transvalvular gradients, and medium-term outcomes (three-year overall survival and freedom from surgery on AV) were evaluated as secondary endpoints.Results. There was no statistically significant difference in the duration of surgery (275.9 ± 34.2 min in the AVNeo group and 285.8 ± 37 min in the bioprosthesis group, p < 0.4), artificial circulation (98 min in the AVNeo group and 115 min in the bioprosthesis group, p < 0.3), aortic compression (80 min in the AVNeo group and 93 min in the bioprosthesis group, p < 0.7). Hospital mortality among the studied patients did not differ: in the AVNeo group – 2 (4.3%) and 1 (2.2%) in the bioprosthesis group, p = 1.0. There were no significant differences in postoperative complications: wound surface infection (3 (6.5%) in the AVNeo group and 1 (2.2%) in the bioprosthesis group, p = 0.617), acute kidney injury (1 (2.2%) in the AVNeo group and 0 in the bioprosthesis group, p = 1.0), stroke ( 1 (2.2%) in the AVNeo group and 2 (4.3%) in the bioprosthesis group, p = 1.0), resternotomy for bleeding (0 in the AVNeo group and 2 (4.3%) in the bioprosthesis group, p = 0.495). Permanent pacemaker implantation was not required by any patient. There was also no statistically significant difference in the three-year overall survival and re–operation, in the AVNeo group it was 83% and 92.5% in the bioprosthesis group, p = 0.23; three-year freedom from re-operation was 96.4% in the AVNeo group and 97.1% in the bioprosthesis group, p = 0.27. However, peak and average gradients were statistically less after AVNeo surgery. The peak and average gradients after AVNeo were 12 and 6 mmHg, after prosthetics 32 and 20 mmHg, p < 0.001.Conclusions: There was no statistically significant difference in hospital mortality, postoperative complications, and three-year survival and re-operation. The values of the peak and average pressure gradient at discharge differed statistically significantly in favor of the AVNeo group.

Objective: To analyze the results of biatrial (BA) Cox-Maze IV cryoablation during combined heart surgeries Methods: The study involved 88 patients who underwent BA cryoablation and concomitant cardiac surgery. The inclusion criteria were patients who underwent BA cryoablation and concomitant cardiac surgery between 2019 and 2021. The types of atrial fibrillation (AF) observed were as follows: persistent – 39 (44.3%) and long-term persistent – 49 (55.7%) cases Results: The following procedures were performed: coronary artery bypass grafting (CABG) in 5 cases (5.7%), isolated valve repair in 67 cases (76.1%), and valve repair combined with CABG in 16 cases (18.2%). The aortic cross-clamping (ACC) time was 143 minutes [range: 120.5-161.5], and the cardiopulmonary bypass time was 193.5 minutes [range: 168.5-210]. BA Cox-Maze IV cryoablation was performed in all cases. The hospital mortality rate was 1.1%. Sinus rhythm was restored at the time of discharge in 81 patients (92%). Two patients (2.3%) received a permanent pacemaker. The survival rates at 1, 2, 3, and 4 years were 88.9%, 88.9%, 82.2%, and 73.5%, respectively. The rates of remaining free from AF at 1, 2, 3, and 4 years were 87.5%, 80.7%, 68.3%, and 38.6%, respectively. Conclusion: Cryoablation using the maze procedure as a concomitant step during cardiac surgery is a safe procedure with a high likelihood of restoring sinus rhythm.

Aim. To evaluate the aortic valve (AV) hemodynamic characteristics after the Ozaki procedure according to echocardiography.Material and methods. The retrospective multicenter study included 277 patients with AV defects who were operated on from January 2017 to June 2022 in five centers in Russia. After the Ozaki procedure, the following endpoints were assessed: immediate echocardiographic results (peak AV gradient, mean AV gradient, AV effective orifice area, aortic regurgitation grade), mid-term clinical (three-year survival rate, three-year freedom from reoperation, three-year freedom from grade ≤2 aortic regurgitation) and echocardiographic results (peak and mean AV gradient, AV effective orifice area, aortic regurgitation grade, AV calcification severity). The median follow-up period was 23 (13-32) months. The mean echocardiography follow-up period was 21±10 months.Results. During the treatment, a decrease in the peak AV gradient was observed from 74±30 mm Hg before surgery up to 12 (8-16) mm Hg one week after surgery, which remained in the mid-term period — 12 (9-15) mm Hg. There was also a decrease in the mean gradient from 40 (27-53) mm Hg before surgery up to 6 (4-8) mm Hg one week after surgery. By the mid-term period, the mean gradient was 6 (4-8) mm Hg. The AV effective orifice area increased from 1 (1-1) cm2 to 2 (2-2) cm2 in the mid-term follow-up period. Three-year survival rate was 90,2%, freedom from reoperation was 95%, freedom from grade ³2 aortic regurgitation was 88%, and no patient had AV calcification.Conclusion. The Ozaki procedure in patients with AV defects has good immediate and mid-term hemodynamic parameters according to echocardiography. However, there remains a need for large randomized controlled trials comparing Ozaki procedure with biological AV replacement.

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.

Ischemic cardiovascular events (ischemic stroke, myocardial infarction) are the most common complications of cardiovascular diseases. One of the leading mechanisms of these complications is atherosclerosis. Lipids play an important role in plaque development. Recently, the lipidome has been of greatest interest, since it may have a prognostic value in atherosclerosis development. With an increase in the circulation of proatherogenic lipidomic biomarkers, the risk of atheroscle­rosis destabilization and ischemic complications increases.The conducted studies made it possible to create additional risk stratification scales, for example, Cardiovascular Event Risk Test (CERT) 1 and 2. They make it possible to estimate the residual risk in patients taking statins. The lipidome examination in extracranial artery atherosclerosis can identify those plaques that have signs of instability, and therefore are dangerous for ischemic stroke development.The review describes the features of plasma lipidome in various cardiovascular diseases associated with atherosclerosis.

The unique clinical and surgical experience with cardiac valve allografts is presented in the study. Cutting-edge approach with regard to clinical course of the disease, particular diagnostic findings, patient’s preference, and allograft accessibility is highlighted in case series. State-of-the-art techniques, initial and mid-term results are summarized with a specific focus on allograft tissue application in cardiovascular surgery. Four patients underwent surgery during the period between February 2020 and February 2023 with inferior vena cava tumor involvement, destructive double valve endocarditis, rheumatic aortic and mitral insufficiency, and severe tricuspid regurgitation in patients with large ostium secundum and atrial fibrillation. All patients demonstrated an uneventful postoperative course.