Aim To compare the effects of continuous regional perfusion methods for infant aortic arch repair on the incidence of acute renal dysfunction and mortality in the early postoperative period. Methods A total of 121 infants who underwent aortic arch reconstruction in the period from June 2007 to December 2017 were included in the study. Patients were 1:1 propensity score matched using the nearest-neighbor methodology. Sixty-two patients (median age 14 (interquartile range (IQR) [8; 23]) days) were selected for the retrospective analysis and divided in two groups: those who underwent repair with selective antegrade cerebral perfusion (SACP) (SACP group, 31 patients) at 23–26°C and those who received whole brain perfusion and additional lower body perfusion (double arterial cannulation (DAC) group, 31 patients) at 28–32°C. Results In-hospital mortality was 3.2% in the DAC group (3.2%) and 12.8% in the SACP group, respectively (p = 0.03). More patients from the SACP group required an open chest after operation (p = 0.013). Patients from the DAC group had shorter open chest duration (p = 0.002) and shorter length of stay in the intensive care unit (ICU) (p = 0.035). There were no differences in the need for renal replacement therapy (p = 0.20) and rate of creatinine level progression during the first three postoperative days between the groups (p = 0.53). The body mass of less than 2 kilos predisposes patients to the onset of acute renal dysfunction (p = 0.013), which was found to be a predictor of early mortality (p = 0.038). Conclusion Lower body perfusion reported similar results to SACP in terms of the onset of acute renal dysfunction, but was superior in terms of lower mortality and shorter lengths of stay in the ICU.

Aim. To evaluate the results of vacuum therapy and closed irrigation drainage (CID) technique for the treatment of postoperative sternomediastinitis in infants Methods. This single-institution retrospective study included 69 patients diagnosed with sternomediastinitis from 2008 to 2018. Patients were divided into two groups: those treated using vacuum-assisted closure therapy (VAC; n = 29) and those treated using CID (n = 40). After propensity score matching, a total of 25 infants were included in each group. Results. Age, gender, weight, body surface area, Risk Adjustment for Congenital Heart Surgery score, cardiopulmonary bypass time and the frequency of open chest management were comparable between the two groups after propensity score matching. During hospital stay, no deaths were noted in the VAC group, whereas eight patients died in the CID group (32%; P = 0.004). The median durations of mechanical ventilation were 79 (28; 176) and 154 (24; 356) hours in the VAC and CID groups, respectively (P = 0.38). Moreover, eight patients in the VAC group (32%) were extubated early (P = 0.028). Re-mediastinitis occurred in 1 (4%) and 8 (32%) patients from the VAC and CID groups, respectively (P = 0.01). The multivariable regression analysis revealed that the CID technique was the only risk factor for re-mediastinitis (odds ratio, 13.9; 95% confidence interval, 1.2–152.5; P = 0.031). The median durations of hospital stay were 14 (10; 30) and 23 (18; 33) days in the VAC and CID groups, respectively (P = 0.045). Conclusion. VAC therapy in patients with mediastinitis showed better outcomes than CID technique such as lower hospital mortality and re-mediastinitis rates. Received 14 August 2019. Revised 8 December 2019. Accepted 10 December 2019. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

Pulmonary artery agenesis combined with tetralogy of Fallot is the most rarely seen congenital heart disease. Children with this anomaly are an especially problematic category of patients undergoing staged surgical repair. The postoperative period quite often is complicated with shunt thrombosis while a redo open surgery is associated with a very high risk; therefore, endovascular repair is a preferred procedure. We describe a case of right ventricular outflow tract stenting in a 8 month old girl with tetralogy of Fallot and right pulmonary artery agenesis. The patient was admitted at 3 month after performing of a left-sided modified Blalock-Taussig shunt with severe signs of heart failure and desaturation caused by shunt thrombosis. Assessments performed at 2 months after stenting of the outflow tract demonstrated good oxygen saturation in arterial blood (80% and above) and improvement of heart failure symptoms to NYHA II class.

Aim: The paper focuses on assessment of the late results and causes of complications when repairing coarctation with distal aortic arch hypoplasia.Methods: This prospective randomized study included 54 patients who underwent repair of coarctation of the aorta. All patients were divided in 2 groups depending on the correction type: reconstruction using the modified reverse left subclavian artery flap plasty (Group I, 27 pts) or extended end-to-end anastomosis (Group II, 27 pts).Results: A postoperative follow-up period was 26 (21;31) months. Recoarctation of the aorta during long-term follow-up was found in 1 patient (3.84%) in Group I and in 2 patients (7.7%) in Group II (p=0.5). Two patients in the Group I (7.7%) and 8 patients in the Group II (30.8%) had arterial hypertension (p=0.03).Conclusion: With modern types of surgical correction used, the anastomotic area tended to proportionally grow in different segments of the aortic arch and did not influence the postoperative complications rate. Endocardial fibroelastosis and ascending aortic wall rigidity could be considered as predictors of arterial hypertension in the late period after coarctation repair in infants. Low body weight before surgery is a factor of aortic recoarctation development in the late postoperative period. Arterial hypertension persistence depends on the correction type. One-stage reconstruction of the distal aortic arch allows for reducing the rate of arterial hypertension from 30.8% to 7.7%. Despite a range of complications in the late postoperative period, the infants’ quality of life was not affected and was high in both groups.

Клапаносодержащий кондуит Contegra (Medtronic) с 1999 г. используют для реконструкции выводного отдела правого желудочка в хирургии врожденных пороков сердца. В литературе противоречивы и малочисленны сведения об иммунных воспалениях ксеновены. Мы представляем клинический случай выраженной клеточной иммунной реакции на ксенокондуит Contegra.

AIMTo evaluate long-term results and the causes of complications in congenital obstructive pathology of the aortic arch.MATERIAL AND METHODSRetrospective study enrolled 62 patients aged 55 ± 14 days who underwent aortic arch surgery under cardiopulmonary bypass. It was compared two methods of aortic archplasty: use of xenopericardial material in group 1 and Rajasinghe's autoplastic method in group 2.RESULTSFollow-up was 42 ± 14 months. In the long-term recoarctation occurred in 7 (13.7%) cases including 6 (18.75%) patients in group 1 and one (3.3%) patient in group 2. Residual hypertension was observed in 12 (23.5%) cases including 10 (37%) patients in group 1 and 2 (8.3%) patients in group 2. Six (50%) patients receive antihypertensive therapy, 5 (41.6%) patients who receive antihypertensive drugs have persistent increase of blood pressure without evidence of anatomic aortic obstruction. Hypertensive response to functional tests was observed in one patient.CONCLUSIONSAortic arch reconstruction using autoplasty is associated with lower risk of recoarctationand residual hypertension compared with xenopericardial patch application.

The Ross procedure has emerged as an attractive option for aortic valve replacement in children and young adults. This work represents immediate postoperative period results and long term outcome after Ross procedure among the pediatric population in the single center experience. The main part of a material is submitted by the statistical analysis of risk factors in the early postoperative period within more than 5 years postoperative analysis of long term condition.

Transventricular (perventricular) VSD closure is a promising minimally invasive procedure in congenital heart disease surgery. This report looks at the attitude of the leading Russian, Chinese, German and Hungarian pediatric cardiac surgery schools towards the procedure of transventricular VSD closure.

Background. Atrial septal defects closure nowadays is a relatively low-risk procedure; therefore, a cosmetic outcome of intervention is a very important factor. A midline scar after full sternotomy is cosmetically unsatisfactory for some patients. Different types of lateral thoracotomies (anterolateral, posterolateral) might result in asymmetry of the chest and mammary glands in women. An alternative surgical approach, such as midaxillary lateral minithoracotomy can be used for better cosmetic results without increasing operative risks.Methods. We performed a retrospective analysis of 100 patients operated at Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology over a period from July 2012 to December 2013 by using midaxillary lateral minithoracotomy. There were 96 cases of isolated secundum ASD unsuitable for transcatheter closure and 4 cases of ASD with partial anomalous pulmonary venous connection (PAPVC). Direct aortic and caval cannulation was performed in all cases; induced ventricular fibrillation was used during intracardiac repair instead of aortic cross-clamping and cardioplegia.Results. No mortality was observed. Neither was there a need in access conversion. Mean age amounted to 45.9±41.3 months (from 11 months to 17 years). Average weight was 16.0±10.3 kg (from 6.7 to 76 kg). Mean CPB ran to 29.5±9.9 min (from 12 to 57 min), mean duration of ventricular fibrillation was 12.9±5.6 min (from 5 to 27 min). Conclusion. Midaxillary lateral minithoracotomy is a safe and convenient approach for isolated ASD closure or in cases with PAPVC, providing excellent cosmetic results and can be used in patients with almost any weight and of any age.

Гигантская псевдоаневризма аорты, осложненная аорто-бронхиальным свищем, редкое, но зачастую фатальное осложнение баллонной ангиопластики рекоарктации аорты. Представлен клинический случай успешной одномоментной коррекции гигантской псевдоаневризмы дуги аорты и аорто-бронхиального свища у ребенка 6 лет после протезирования дуги аорты, развившихся в результате отрыва синтетического протеза от стенки сосуда после попытки баллонной ангиопластики суженного участка аорты.

The Ross procedure is thought of as an attractive option for aortic valve replacement in children and adolescents. We reviewed the basic and latest surgical criteria for graft selection in pediatric population who underwent the Ross procedure. Some positive and negative sides of various grafts in the aortic and lung positions are described. The tendencies and follow-up results of homograft growth proportional to somatic growth of patients are also analyzed.

The article presents the analysis of available literature data regarding the diagnosis and treatment of truncus arteriosus. Data on incidence, anatomy, and pathogenesis of this congenital heart disease were analyzed. The methods of surgical treatment of truncus arteriosus were reviewed taking into consideration the individual anatomical abnormalities, the most important of which was the truncus arteriosus valve dysfunction. The article reviews the milestones in the development of the approaches to the truncus arteriosus treatment including the correction of valvular disease. The authors concluded that the expanding diagnostic capabilities and advances in surgical treatment of truncus arteriosus lead to increase in a number of patients who require the followups in the postoperative period. This observation suggests that there is a high demand for further studies of longterm outcomes in patients with truncus arteriosus.

The article presents immediate and long-term results of mitral valve replacement in a pediatric group. The obtained data suggest that hospital mortality does not depend on the degree of preservation of subvalvular apparatus. Factors associated with mortality were young age and low weight, as well as higher NYHA functional class of chronic heart failure before surgery. Neither of groups showed significant advantages in the immediate postoperative period. However, the group with subvalvular apparatus required lower cumulative doses of inotropic drugs. Remote mortality rate was higher in the group with complete excision of subvalvular apparatus.

The article presents the results of the life quality assessment of 49 who underwent mitral valve replacement in the age from 1 to 15 years. Life quality was estimated using the Nottingham Health Profile questionnaire. The obtained data suggests that quality of life is lower in with mitral valve prosthesis it depends on the type of performed operation, functional classes of cardiac decompensation, exercise tolerance. In addition, it is directly correlated with BNP level, and also is related to heart size and left ventricular ejection fraction. It was revealed that mitral valve replacement with preservation of subvalvular apparatus contributes to improving of patients life quality.

The aim of this work was to evaluate immediate and long term results of tricuspid valve replacement with various types of prostheses in children. One hundred and twelve (112) children underwent tricuspid valve replacement with various types of prostheses in Novosibirsk Research Institute of Circulation Pathology in the period from 1994 to 2008. Mechanical prostheses were initially used in 42 patients (37.5%), and biological prostheses in 70 (62.5%). Overall hospital mortality was 7.1%. Re&operations occurred in 17 (43.6%) patients with mechanical prostheses and 34 (52.3%) patients with biological prostheses. Mean follow&up period in the mechanical prostheses patients group was 6.5±3.7 years and 4.3±1.7 years in biological prostheses group of patients.