Вклад авторов Концепция и дизайн: Д.У. Малаев, А.Р. Таркова, А.А. Прохорихин, А.А. Бойков Написание статьи: Д.У. Малаев, А.А. Прохорихин, А.А. Бойков Исправление статьи: Д.Л. Мерсон, А.Ю. Виноградов, В.И. Байструков, Е.И. Кретов Утверждение окончательной версии: все авторы ORCID ID Д.У. Малаев, https://orcid.org/0000-0001-6032-788X А.Р. Таркова, https://orcid.org/0000-0002-4291-6047 А.А. Прохорихин, https://orcid. org/0000-0002-3247-8290 Д.Л. Мерсон, https://orcid.org/0000-0001-5006-4115 А.Ю. Виноградов, https://orcid. org/0000-0001-9585-2801 В.И. Байструков, https://orcid. org/0000-0003-2883-6574 А.А. Бойков, https://orcid.org/0000-0002-3129-5572

Aim. The article compares long-term outcomes after Ross procedure in patients with combined coronary arteries lesion depending on a myocardial revascularization technique: coronary angioplasty or coronary artery bypass graft surgery (CABG). Methods. This prospective randomized one-center trial included 105 patients with aortic valve stenosis and combined arteriosclerotic involvement of coronary arteries. All patients received Ross procedure and myocardial revascularization. Aortic valve stenosis combined with hemodynamically significant lesion of the coronary bed served as the criteria of entry in the trial. A comparative analysis of the results in the immediate postoperative period and during 1-year follow-up was carried out. Results. The study revealed statistically significant differences in the survival rate (p = 0.024). In the CABG + Ross procedure group, the 1-year survival rate was 77 % [66; 89], which was considerably lower than that in the group with transluminal coronary angioplasty and Ross procedure – 92 % [85; 99]. Mortality in the groups under study predominantly occurred during the 1st postoperative month. In the CABG + Ross procedure group mortality was mostly recorded during the intervention and at 13th postoperative day. In the group with transluminal coronary angioplasty and Ross procedure fatal cases tended to happen at the 6th to 18th day after the intervention. Conclusion. The study was the first to show the advantage of 1-year lethality results in the percutaneous transluminal coronary angioplasty + Ross procedure group as compared to the CABG + Ross procedure group. Nevertheless, it should be noted that one-stage aortic stenosis repair and CABG is a conventional option. In this case, a multimodality approach could be recommended for taking an optimal decision. Received 1 March 2017. Accepted 31 March 2017.Financing: The study did not have sponsorship.Conflict of interest: Kretov E.I. served as executive editor of “Endovascular surgery” section. All other authors declare no conflict of interest.Author contributionsData collection and analysis: Zubarev D.D., Demin I.I., Naydenov R.A., Prohorihin A.A., Baystrukov V.I.Critical revision: Kretov E.I., Pokushalov E.A., Karaskov A.M.

Цель. Оценить эффективность и безопасность транскатетерной эмболизации тканевым клеем гистоакрилом в лечении перфорации коронарных артерий.Методы. Как только перфорация коронарной артерии была подтверждена, готовили композицию тканевого клея гистоакрила с рентгеноконтрастным средством липиодолом. Перфорированный сосуд эмболизировали композицией, введенной с помощью микрокатетера. Транскатетерную эмболизацию тканевым клеем гистоакрилом для лечения перфорации коронарных артерий при чрескожном коронарном вмешательстве провели 11 пациентам с марта 2013 г. по февраль 2016 г. Клинические данные этих пациентов собраны и проанализированы ретроспективно.Результаты. Рассматривали морфологические повреждения коронарных артерий, основываясь на классификации рабочей группы Американского колледжа кардиологов/Американской ассоциации сердца. У 4 пациентов было поражение типа В2, а у 7 — поражение типа С (у 4 пациентов с хронической окклюзией коронарной артерии). В соответствии с классификацией перфораций коронарных артерий по Эллис С.Г., у 5 пациентов была перфорация типа II, у 6 — пациентов перфорация типа III. Причиной перфорации в 10 случаях послужил коронарный проводник, в 1 случае — предилатация баллонным катетером. У 8 пациентов выполнили пункцию перикарда. Всем пациентам с перфорацией коронарной артерии провели транскатетерную эмболизацию композицией тканевым клеем и липиодолом. Коронарография подтвердила успешное выполнение эмболизации. Серьезных осложнений после процедуры не было.Выводы. Транскатетерная эмболизация клеем гистоакрилом является эффективным, безопасным, недорогим и легким в выполнении методом лечения перфораций небольших сосудов, включая перфорации при чрескожном коронарном вмешательстве.Поступила в редакцию 14 сентября 2016 г. Принята к печати 2 февраля 2017 г.ФинансированиеИсследование не имело финансовой поддержки.Конфликт интересовКретов Е.И. — ответственный редактор рубрики «Эндоваскулярная хирургия». Остальные авторы заявляют об отсутствии конфликта интересов.Вклад авторовСбор и обработка материала: Шермук А.А., Нарышкин И.А., Гранкин Д.С., Зубарев Д.Д., Ибрагимов Р.У., Байструков В.И.Написание текста: Шермук А.А., Хелимский Д.А., Крестьянинов О.В.Редактирование: Шермук А.А., Хелимский Д.А., Крестьянинов О.В., Кретов Е.И.

Aim. The article looks at the effect of the program "Confidence" to increase the proportion of patients’ therapy in patients with coronary heart disease for two years after successful revascularization using thrombolytic or stenting of the coronary arteries on the myocardial infarction.Methods. This is a prospective, randomized, controlled, parallel-group trial including 4.000 patients. They will be divided into two groups: patients receiving standard outpatient observation (n=2000) and those enrolled for the program "Confidence" (n=2000). The total duration is 24 months. The trial will take place in two stages. In the first stage (0-12 months) the impact of the program "Confidence" on therapy adherence and outcomes of cardiovascular diseases will be assessed. In the second stage (after the change of groups in 12 months, 12-24 months) the effect of changing the way to remind patients of therapy adherence will be evaluated.Conclusion. The trial was designed in such a way as to show that the proposed program "Confidence" increases the proportion of patients who adhere to therapy in the cohort of those with coronary heart disease for two years after successful revascularization by using thrombolytic or stenting of the coronary arteries against the background of myocardial infarction.Received 13 February 2017. Accepted 9 March 2017.Financing: KRKA company’s grant. Sponsorship had no effect on data acquisition, analysis and interpretation.Conflict of interest: Kretov E.I. served as executive editor of “Endovascular surgery” section. All other authors declare no conflict of interest.Author contributionsStudy conception and design: Kretov E.I., Grazhdankin I.O., Baystrukov V.I., Zubarev D.D. Statistical data processing: Krestyaninov O.V., Kozyr K.V., Obedinskiy A.A., Prokhorikhin A.A.Drafting the article: Tarkova A.R., Anisimova V.D.Critical revision: Tarkova A.R., Anisimova V.D., Kretov E.I.

Aim. This study is aimed at evaluating the efficacy and safety of sirolimus-eluting coronary stent “Calypso” in comparison with everolimus-eluting coronary stent “Xience Prime” in patients with ischemic heart disease. Methods. This is a prospective, randomized, single-blind multicenter clinical trial in patients undergoing coronary revascularization with coronary stenting. Seven clinical sites in Russia will enroll 610 patients with coronary artery disease. Patients suitable for coronary stenting will be randomized in group 1 (n=406) to receive coronary stent “Calypso” (“Angioline”, and group 2 (n=204) to receive coronary stent Xience Prime (Abbott). Clinical follow-up will continue for 1 year. By the end of follow-up, a quantitative coronary angiography will be performed in 122 patients (20 %). Conclusion. A randomized trial “PATRIOT” is designed to prove the efficacy and safety of sirolimus-eluting coronary stent “Calypso” in comparison with everolimus-eluting coronary stent “Xience Prime” in patients with ischemic heart disease.Received 5 October 2016. Accepted 6 December 2016.Funding: This study was funded by “Angioline Interventional Devices”, 630090, 18 Inzhenernaya Street, Novosibirsk, Russian Federation. Conflict of interest: The authors declare no conflict of interest.

This review is devoted to a topical problem of modern cardiology – techniques of diagnosing vasospastic angina. The results of retrospective and prospective studies on the efficacy and safety of vasospastic angina diagnostics are reviewed. The literature on the prevalence, progression and treatment of this pathology is discussed.Received 13 January 2017. Accepted 6 February 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

This article provides an overview of existing studies on percutaneous intervention in the affected left main coronary artery. The present state of the problem, outlines the latest recommendations for endovascular coronary revascularization in patients with lesions of the left main coronary artery.

Цель. Оценить возможность и безопасность транскатетерного закрытия постинфарктных дефектов межжелудочковой перегородки в различные сроки после острого инфаркта миокарда. Материал и методы. С 2010 по 2015 г. в Новосибирском научно-исследовательском институте патологии кровообращения имени академика Е.Н. Мешалкина транскатетерное закрытие постинфарктного дефекта межжелудочковой перегородки проводилось у 15 пациентов (11 женщин и 4 мужчин). Время от возникновения инфаркта миокарда до вмешательства составило от 1 дня до 6 мес. (в среднем 10,9 нед.). Три пациента подвергались вмешательству в острой фазе инфаркта миокарда (2 нед. и менее). Размеры дефекта по данным эхокардиографии составили 7–24 мм (в среднем 13,5 мм), размеры устройства от 12 до 34 мм (в среднем 22,8 мм). Время процедуры и флюороскопии составило 65–170 (в среднем 115,3) и 14–78 (32,5) мин. Результаты. Успешная имплантация окклюдера наблюдалась в 14 случаях из 15. У одного пациента произошла дислокация окклюдера. В дальнейшем пациент подвергся успешной хирургической коррекции дефекта. Имплантация окклюдера не улучшила клинический статус пациентов в критическом состоянии. В обоих случаях прогрессировала полиорганная недостаточность, в итоге первый пациент умер на 2-е сутки после операции, а второй на 9-е. Выводы. Эндоваскулярное закрытие может служить альтернативой и позволяет избежать открытой операции у пациентов с выраженной сопутствующей патологией и подходящей анатомией. Однако внутрибольничная летальность остается высокой, даже после успешной имплантации окклюдера.

Aim. The aim of this randomized study was to evaluate the safety and efficacy of septal myectomy (SM) and alcohol septal ablation (ASA) in patients with an obstructive form of hypertrophic cardiomyopathy. Methods. The study included 76 patients eligible for ASA and Morrow myectomy. The patients were divided into two equal groups: one for ASA (n = 38), the other for SM. The primary endpoint (combined) was to assess the safety, which included 30-day complications after surgery (mortality, bleeding, tamponade, stroke, development of VT / VF) and the frequency of pacemaker/ICD implantation. Secondary endpoints focused on the evaluation of pressure gradient (efficiency), repeated operations, clinical and functional indicators, volume and mass of the ablation zone and dissected infarction. Control observation period was 12 months. Results. By the end of control observations, it was found out that SM is a safer technique as compared to ASA, the complication rate was 13 % and 47 % respectively (log-rank test p = 0.0021; Cox: HR 11.4 95% CI [1.52 -11.1] p = 0.005). No significant differences in early (30 days) postoperative complications were found (log-rank test p = 0.24; Cox: HR 2.52, 95% CI [0.48-12.9] p = 0.27). Rhythm disturbances requiring pacemaker implantation / ICD (log-rank test p = 0.0029; Cox: HR 95% CI 4.92 [1.06-22.74] p = 0.042) were the most common complication. In both groups, there was a significant reduction of the LVOT gradient, p <0.01. However, the residual gradient in the ASA group was significantly higher than that in the SM group, p <0.01. Clinical data of both groups were comparable in the long term. A significant correlation was observed between the dissected infarction volume and the degree of reduction in the LVOT gradient of the SM group, p = 0.01. No significant dependency of the ablation zone volume on the degree of reduction in the LVOT gradient was observed, p = 0.7. Conclusion. Septal myectomy is a safe treatment for hypertrophic cardiomyopathy as compared to ASA. Alcohol septal ablation and SM are comparable in the effectiveness of LVOT gradient reduction. There is a dependence of the excised myocardium volume and the degree of reduction in the LVOT gradient during long-term follow-up of patients who underwent Morrow SM. Received 5 August 2016. Accepted 2 September 2016. Funding: The study had no sponsorship. Conflict of interest: The authors declare no conflict of interest.

Aim. The aim of this randomized study was to evaluate the safety and efficacy of septal myectomy (SM) and alcohol septal ablation (ASA) in patients with an obstructive form of hypertrophic cardiomyopathy.Methods. The study included 76 patients eligible for ASA and Morrow myectomy. The patients were divided into two equal groups: one for ASA (n = 38), the other for SM.The primary endpoint (combined) was to assess the safety, which included 30-day complications after surgery (mortality, bleeding, tamponade, stroke, development of VT / VF) and the frequency of pacemaker/ICD implantation.Secondary endpoints focused on the evaluation of pressure gradient (efficiency), repeated operations, clinical and functional indicators, volume and mass of the ablation zone and dissected infarction. Control observation period was 12 months.Results. By the end of control observations, it was found out that SM is a safer technique as compared to ASA, the complication rate was 13 % and 47 % respectively (log-rank test p = 0.0021; Cox: HR 11.4 95% CI [1.52 -11.1] p = 0.005). No significant differences in early (30 days) postoperative complications were found (log-rank test p = 0.24; Cox: HR 2.52, 95% CI [0.48-12.9] p = 0.27). Rhythm disturbances requiring pacemaker implantation / ICD (log-rank test p = 0.0029; Cox: HR 95% CI 4.92 [1.06-22.74] p = 0.042) were the most common complication. In both groups, there was a significant reduction of the LVOT gradient, p <0.01. However, the residual gradient in the ASA group was significantly higher than that in the SM group, p <0.01. Clinical data of both groups were comparable in the long term. A significant correlation was observed between the dissected infarction volume and the degree of reduction in the LVOT gradient of the SM group, p = 0.01. No significant dependency of the ablation zone volume on the degree of reduction in the LVOT gradient was observed, p = 0.7.Conclusion. Septal myectomy is a safe treatment for hypertrophic cardiomyopathy as compared to ASA. Alcohol septal ablation and SM are comparable in the effectiveness of LVOT gradient reduction. There is a dependence of the excised myocardium volume and the degree of reduction in the LVOT gradient during long-term follow-up of patients who underwent Morrow SM.Received 5 August 2016. Accepted 2 September 2016.Funding: The study had no sponsorship. Conflict of interest: The authors declare no conflict of interest.

Calcific aortic stenosis is an aortic valve disease of atherosclerotic origin occurring in 2-4 % of persons older than 65 years, for whom open surgery is contraindicated. Models of self-expanding aortic valves available today have a number of significant drawbacks. The authors have developed a prototype of a new aortic valve and present its first successful implantation in the experiment.Received 17 October 2016. Accepted 22 November 2016.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.

The article presents analytical review of literature data on the problem of combined lesions of the aortic valve and coronary arteries. It outlines the current views on the assessment approach to the selection of methods and volume of surgical intervention and reflects the current state of the problem of endovascular treatment of patients with concomitant coronary artery in patients with severe aortic stenosis in the era of transcatheter aortic valve implantation.