The issue of ascending aortic repair with concomitant aortic valve replacement in pa-tients with ascending aortic aneurysm (AscAA) and aortic valve stenosis is still debatable.Aim. To analyze the dimension changes of the preserved aortic root after simultaneous ascending aorta repair and aortic valve replacement.Material and methods. This retrospective study included 102 patients who, from December 2012 to May 2022, underwent simultaneous aortic valve replacement and ascending aorta repair with hemiarch replacement. Patients were divided into 2 following groups based on the aortic valve morphology: group 1 — patients with bicuspid aortic valve (BAV) and AscAA (n=75), group 2 — patients with tricuspid aortic valve (TAV) and AscAA (n=27). Depending on the presence of aortic root dilatation (maximum diameter (d) >40 mm), each of the groups was additionally stratified into 2 more subgroups as follows: patients without aortic root dilatation (d≤40 mm) and patients with its dilatation (d>40 mm). The dynamics of the aortic root diameter was assessed by computed tomography angiography.Results. The mean follow-up period for patients was 36,2±14,6 months. Survival rate in the BAV+AscAA and TAV+AscAA groups was 96% and 100%, respectively (p=0,380). Freedom from aortic root resurgery was 100% in both study groups. In patients with dilated and non-dilated aortic root of the BAV+AscAA group, an increase in aortic root dimension was noted at a rate of 0,65±0,51 mm/year and 0,32±0,27 mm/year, respectively. In patients of the TAV+AscAA group, a regression in dilated and non-dilated aortic root diameter was observed as follows: 0,93±0,48 mm/year and 0,56±0,43 mm/year, respectively.Conclusion. In patients with AscAA in combination with BAV stenosis after a singlestep surgical intervention, a weak negative dynamics of non-dilated and dilated aortic root is observed in the mid-term follow-up period. In patients with AscAA and TAV, there is involutive alterations of the aortic root dimension during 3-year follow-up.

The article presents our own experience of organoprotection during thoracic aortic surgery under circulatory arrest and off ers our own concept for perfusion of organs during surgical interventions for aortic dissection and thoracic aortic aneurysms.

Introduction. According to recent data, thoracic aortic surgery have reduced morbidity and mortality, however, women are at increased postoperative risk of adverse outcomes. Our aim was to evaluate and compare early outcomes in male and female patients undergoing ascending aortic replacement.Methods. A total of 88 patients, consisting of 54 men (61.4%) and 34 women (38.6%) underwent ascending aortic surgery for non-syndromic aneurysms from January 2013 to December 2021. We analyzed clinical outcomes between males and females.Results. According to computed tomographic angiography, preoperative normalized aortic diameters were significantly larger in females (2.9 [2.7; 3.2] cm/m2) vs. (2.5 [2.3; 2.6] cm/m2, p < 0.001) in males, without differences in absolute values (51 [49; 53] mm vs. 52 [50; 53] mm, p = 0.356). There were no significant differences in neurological, cardiac, pulmonary, and renal complications in both groups in the early postoperative period. In-hospital mortality was 1.9% and 5.9% (p = 0.307) in male and female patients, respectively.Conclusions. Ascending aortic surgery for aneurysms below 5.5 cm threshold has tolerable early outcomes both in men and women.

Introduction. Ascending aortic aneurysms with bicuspid and tricuspid aortic valves have completely diff erent nature of origin. There is a large number of studies focusing on the negative effect of bicuspid aortic valve on the prognosis of this disease. However, studies regarding the impact of tricuspid aortic valve on ascending aortic aneurysms are extremely rare. In this regard, the purpose of our work was. Aim: To analyze the early results of simultaneous surgical treatment. Material and Methods. The retrospective study included 73 patients with aortic valve stenosis in combination with ascending aortic aneurysm. Patients were divided into two groups: group 1 comprised patients with bicuspid aortic valve and aortic aneurysm; group 2 comprised patients with tricuspid aortic valve and aortic aneurysm. All the examined patients underwent prosthetics of the aortic valve with simultaneous prosthetics of the ascending aorta as planned. Echocardiographic parameters and multispiral computed aortography were evaluated before and after surgery. Results. The patients were comparable in baseline characteristics. The incidence rates of acute cerebrovascular accident, respiratory failure requiring prolonged respiratory support, acute kidney injury, and bleeding requiring re-operation were 3.7 vs. 0% ( p = 0.918), 1.9 vs. 0% ( p = 0.492), 1.9% vs. 0% ( p = 0.492), and 0% vs. 5.3% ( p = 0.128) in groups 1 and 2, respectively. There was no hospital mortality in any of study groups. There was no aortic valve prosthesis dysfunction in the early postoperative period. Conclusion. Reconstructive surgeries for ascending aortic aneurysm with simultaneous prosthetics of the tricuspid aortic valve were characterized by satisfactory immediate clinical results comparable to patients with a bicuspid aortic valve.

Objective. The aim of this study was to identify predictors of adverse events after ascending aortic replacement for the aortic aneurysms in the early postoperative period.Material and Methods. The analysis included 151 patients with ascending aortic aneurysm who underwent non-hemiarch or hemiarch repair. The following adverse outcomes were selected: postoperative delirium, respiratory failure, bleeding, multiple organ dysfunction syndrome, and in-hospital mortality. Predictors of adverse clinical events were identified by constructing uni- and multivariate logistic regression.Results. Significant predictors of early outcomes and mortality after ascending aortic replacement were as follows: female gender, atrial fibrillation, low glomerular filtration rate, chronic obstructive pulmonary disease, aortic root repair, multiple organ dysfunction, duration of cardiac arrest, operation time, and reoperation for bleeding.Conclusions. The risk factors of adverse outcomes after ascending aortic replacement were decreased kidney function, atrial fibrillation, female gender, aortic root repair, and increased duration of cardiac arrest and operation time.

The objective was to evaluate the efficacy of sternal closure using the «double twist» technique.Methods and materials. The study included 37 patients with risk factors for sternal dehiscence (obesity, diabetes, chronic obstructive pulmonary disease). The patients were divided into 2 groups. In the first group (n=12), «double twist» technique was used. In patients of the second group (n=25), osteosynthesis was performed using standard technique (single wire ligatures). The efficacy of the «double twist» sternal closure was evaluated on the basis of clinical examination and multispiral computed tomography of the chest.Results. In the early postoperative period, the sternal dehiscence, which required re-operation was detected in 12 % after standard sternal closure. Sternum was stable in all of the patients of «double twist» group (p=0.211). No deep sternal infection was observed in both groups. In the follow-up (up to 6 months), there were no clinical and tomographic sings of delayed sternal dehiscence or infection in «double twist» group.Conclusions. Sternal closure using the «double twist» technique provides reliable fixation of the sternum in patients with the risk of its dehiscence.

The aim of this study was to develop and test a technique for scintigraphic examination of the thoracic aorta, which allows for visualizing foci of inflammation.Materials and Methods:The study included 15 patients (median age - 61 [47; 73] years) with aortic dilatation more than 45 mm and thoracic aortic aneurysm who were candidates for surgical treatment. All patients underwent a chest scintigraphy with 99mTc-pyrophosphate 48 h before surgery to identify foci of inflammation in the aortic wall. The new technique included intravenous administration of 370 MBq of a radiopharmaceutical (RP), registration of scintigrams at 3 and 6 h after injection of RP in a tomographic mode combined with X-ray computed tomography. After the image reconstruction, subtraction of the later scintigrams from the early ones was performed, followed by analysis of the final images. The results of scintigraphy were compared with the histological data obtained from intraoperative samples of resected aorta.Results:According to the results of this novel scintigraphic technique, artifacts from the radioactivity of the vascular blood pool were eliminated and pathological RP uptake was identified in 5 (33.3±1.5%) out of 15 examined patients. The "focus/vessel lumen" ratio averaged at 1.47 [1.30; 1.48]. Histological examination of resected aorta samples confirmed the presence of chronic inflammation in 4 (26.7±1.3%) out of 15 patients. Parameters of diagnostic efficiency were: sensitivity - 100%, specificity - 91%, diagnostic accuracy - 93%.Conclusion:The method of scintigraphic diagnostics of inflammatory processes in the aorta using 99mTc-pyrophosphate, supplemented by subtraction of the late from the early images, makes it possible to eliminate artifacts from the radioactivity of the aortic blood pool and to reveal the pathological RP accumulation indicating the areas of inflammation in the aortic wall.

An analysis of the level of relative expression of the β1 adrenergic receptor ADRB1 gene in the myocardium of 78 patients with chronic heart failure against the background of the combined development of ischemic heart disease and arterial hypertension was carried out. A significant decrease in the level of ADRB1 gene expression was revealed in patients with left ventricular hypertrophy. In the considered cohort, the expression level of the ADRB1 gene did not depend on the functional class of heart failure. The ADRB1 relative expression was higher in patients taking acetylsalicylic acid preparations, but did not show a significant association with the use of β blockers or ACE inhibitors.

Objective . To analyze the early clinical results of frozen elephant trunk repair using the domestic hybrid stent-graft MedEng (Penza, Russia). Material and Methods. From September, 2019 to September, 2020, a total of 12 patients underwent surgical reconstruction of the thoracic aorta with an implantation of the MedEng hybrid stent-graft. All interventions were performed under conditions of moderate hypothermia (25–28 °C) and antegrade unilateral cerebral perfusion through the brachiocephalic trunk. Results. The technical success of the operation was achieved in 100% of cases. In the early postoperative period, there were no cases of acute cerebrovascular accidents, episodes of delirium, and paraplegia. There was no need for a resternotomy for bleeding. The extended respiratory support was required in two cases (16.7%). One patient (8.3%) required renal replacement therapy for acute renal injury. Hospital mortality rate reached 16.7%. Conclusion. Surgical reconstruction of the thoracic aorta using the MedEng hybrid stent-graft was characterized by satisfactory clinical results in the early postoperative period.

Nitric oxide (NO) is a universal biological mediator that has a multifaceted effect on physiological and pathological processes in various organs and systems of the body. It is known that NO-therapy is a powerful stimulator of a positive effect on the course of the wound process, especially in complicated wounds.Objective: to evaluate the use of the combined effect of NO-containing air-plasma flows on the parameters of the blood system in the treatment of infectious wound complications in cardiac surgery patients.Materials and methods. A total of 60 patients were included in the study: 31 (52%) men and 29 (48%) women aged 29 to 79 years (mean 63.67 ± 7.6 years). All patients were divided into two groups: Group I – 30 patients who received treatment for sternomediastinitis using a combined exposure to air-plasma flow and exogenous nitric oxide; Group II – 30 patients who were treated for sternomediastinitis according to the clinical guidelines for the surgical treatment of patients with postoperative mediastinitis and osteomyelitis of the sternum and ribs.Results. The use of the combined effect of NO-containing air-plasma flows for the treatment of sternomediastinitis is accompanied by a decrease in the level of acute phase proteins already by 3 days, normalization of leukocytes and neutrophils by 10 days after the start of therapy, and prevents hyperaggregation and spontaneous aggregation of platelets.Conclusion. The use of the combined method of low-temperature plasma and exogenous nitrogen monoxide in the local treatment of infectious wound complications after cardiac surgery is justified and effective. No reliable confirmation of the cytotoxic effect of exogenous nitric oxide in the applied dosage on the elements of red blood was found in this study

Aim. To compare the shortand medium-term outcomes of hemiarch and nonhemiarch replacement for ascending aortic aneurysm (AAA).Material and methods. The study included 151 patients with non-syndromic AAA who underwent an elective replacement. Patients were divided into two groups: group 1 (non-hemiarch, n=40) — standard ascending aortic replacement; group 2 (hemiarch, n=111) — ascending aortic replacement with the hemiarch anastomosis in conditions of moderate hypothermia and circulatory arrest with unilateral antegrade cerebral perfusion. To eliminate systematic differences between the compared groups, the propensity score matching (PSM) method was used.Results. Before PSM, there were no significant intergroup differences in the incidence of neurological complications, myocardial infarction, prolonged ventilation, or acute kidney injury. Bleeding-related reoperation rates and hospital mortality significantly differed between groups. After pseudo-randomization between the non-hemiarch and hemiarch groups, there were no significant differences in the incidence of neurological events, myocardial infarction, prolonged ventilation, reoperations for bleeding, acute renal injury, and hospital mortality. Median-term survival and freedom from aortic reoperations also did not show significant intergroup differences.Conclusion. Hemiarch replacement for AAA does not lead to an increase in the incidence of postoperative complications, as well as the risk of shortand mediumterm mortality compared with non-hemiarch.

Aim. To compare the effectiveness and safety of ascending aortic hemiarch replacement performed during hypothermic circulatory arrest with different temperature regimens.Material and methods. The study included 104 patients with ascending aortic aneurysm, who underwent ascending aortic hemiarch replacement under hypothermic circulatory arrest and antegrade cerebral perfusion. Depending on the temperature regimen, all patients were divided into two comparable groups: group 1 (n=28) — patients operated on under mild hypothermia (29-31oС), group 2 (n=76) — patients operated on under moderate hypothermia (25-28oC).Results. Comparative analysis of intraoperative data between groups of patients with mild and moderate hypothermia revealed a significant difference in the duration of cardiopulmonary bypass (111 [97; 135] min vs 125 [108.5; 170] min, p=0,031) and surgery (240 [210; 270 ] min vs 275 [240; 330] min, p=0,003). In the early postoperative period, the best results were also obtained in patients of mild hypothermia group. In these patients, compared with moderate hypothermia group, there was a lower frequency of reoperation due to bleeding (3,5% vs 5,2%, p=0,572), a decrease in transfused fresh frozen plasma volume (2 [2; 4] vs 4 [2; 4], p=0,03), a decrease in the ventilatory support duration (10 [7; 16] hours vs 18 [10; 24] hours, p=0,002), as well as a bed-day decrease in intensive care unit (2 [2; 3] and 3 [2; 4] days, p=0,005). No neurologic deficit was found in any of the patients. In-hospital mortality had no significant intergroup differences (p=0,541).Conclusion. An increase in the temperature regimen during the ascending aortic hemiarch replacement performed under hypothermic circulatory arrest is relatively safe in relation to early postoperative complications. Mild hypothermia does not increase early postoperative surgical risks compared to moderate hypothermia.

The study was aimed at analysing the immediate results of various surgical approaches to prosthetic repair of ascending aortic aneurysms. We analysed the data of 113 patients operated on for an ascending aortic aneurysm from 2008 to 2017. All patients were divided into two comparable groups. Group One patients (n=43) underwent prosthetic repair of the ascending portion of the aorta with formation of a distal anastomosis proximal to the level of the brachiocephalic trunk, Group Two patients (n=70) were subjected to reconstruction of the ascending aorta with aortic arch plasty ('hemiarch'). In the early postoperative period in Group One and Group Two patients, the frequency of adverse cardiac events amounted to 3 (7.0%) and 1 (1.5%) cases (p=0.339), with prolonged mechanical ventilation required in 12 (18.6%) and 6 (8.6%) cases and resternotomy required in 8 (18.6%) and 4 (5.7%) cases, respectively. The postoperative 30-day mortality in the group of isolated prosthetic repair of the ascending aorta amounted to 11.6% (5 cases) and in the group of patients with the hemiarch reconstruction to 3.0% (2 cases). No neurological complications were observed. Hemiarch prosthetic repair of the aorta is an effective and safe surgical method of treatment. This approach does not increase the risks for cardiac, neurological, pulmonary, haemorrhagic complications in the immediate postoperative period as compared with prosthetic repair of only the ascending portion of the aorta.

A case of successful surgical treatment for peripheral lung cancer with concurrent coronary artery bypass for ischemic heart disease has been presented.

The article presents a clinical case of successful simultaneous surgery for coronary artery disease and newly diagnosed apex lung tumor without postoperative complications.

A case of successful surgical treatment for peripheral lung cancer with concurrent coronary artery bypass for ischemic heart disease has been presented.