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.

Highlights. The main approaches to the aortic root valve-sparing surgery of are reimplantation and remodeling;The literature review demonstrates either the relative identity of the reimplantation and remodeling clinical outcomes, or the advantage of reimplantation in relation to long-term results.Abstract. In recent decades, valve-sparring methods of aortic root replacement, including reimplantation and remodeling, as well as their modifications, have been developed and put into widespread practice. The effectiveness and durability of these two approaches is the subject of discussions in the modern cardiac surgery community. The global experience in performing remodeling and reimplantation procedures allows for a comprehensive literature review to compare the results of these approaches. The presented review is devoted to the comparison of surgical aspects and clinical outcomes of reimplantation and remodeling techniques, the analysis of the feasibility of restoring the physiological architectonics of the aortic root in valve-sparring operations using Valsalva grafts, as well as the assessment of risk factors for residual aortic insufficiency after such interventions. The search strategy included the analysis of international (PubMed, Scopus, Embase) databases for the following keywords: “reimplantation versus remodeling for aortic root valve-sparring procedures”, “David procedure versus Yacoub procedure”, “Valsalva graft for aortic root valve-sparring procedures”, “Valve-sparing aortic root repair with an anatomically shaped sinus prosthesis”. Literature analysis demonstrates either the relative identity of early and long-term results of reimplantation and remodeling procedures, or the advantage of reimplantation in terms of freedom from late mortality and residual aortic insufficiency. Preservation of the physiology of the aortic root by implantation of Valsalva grafts or remodeling provides better hemodynamics and reduces stress on the leaflets, however, these postulates run counter to the data of clinical studies analyzing postoperative outcomes and demonstrating the lack of advantages of Valsalva grafts over linear prostheses in terms of freedom from aortic valve surgery. Residual postoperative regurgitation of a mild degree, a decrease in the effective height below 9 mm and additional interventions on the leaflets are reliable factors of significant aortic insufficiency in the long-term period after valve-sparring operations on the aortic root.

INTRODUCTION AND IMPORTANCE:Bekhterev's disease, or ankylosing spondylitis (AS), is a chronic inflammatory rheumatic disease closely related to the human leukocyte antigen (HLA)-B27. Cardiac damage in AS occurs in 2-10 % of patients more commonly as aortic insufficiency, aortitis, mitral valve fibrosis, or cardiac conduction abnormalities. CASE PRESENTATION:In this article we present a clinical case of a 52-year-old female patient with Bekhterev's disease, who underwent aortic valve reconstruction with autopericardium and mitral homograft implantation in mitral position. CLINICAL DISCUSSION:The use of homografts and reconstructive surgeries using autologous materials allow not only avoiding lifelong intake of anticoagulants, but also maintaining hemodynamic profile comparable to that of native valves. CONCLUSION:This clinical case shows that treatment of patients with rheumatic diseases is a complex treatment problem that requires a personalized approach.

The purpose — to assess the acute coronary syndrome (ACS) clinical aspects in patients with aortic stenosis. Material and methods. This is a retrospective single-center study that included comparison of hospital and midterm outcomes of ACS and aortic stenosis (n = 95, divided into the following groups: group 1 — severe aortic stenosis + ACS (n = 39); group 2 — moderate aortic stenosis + ACS (n = 28); group 3 — ACS without aortic stenosis (the control group selected using «Propensity matching» method) (n = 28)). Results. Hospital mortality did not differ statistically between the groups. In group 1, there was a tendency to worse survival within 1 year. In groups with aortic malformation, ACS with ST segment elevation was less common — p = 0.0002 and p = 0.001, respectively. In group 1, 23.1% of patients had intact coronary arteries. Conclusions. Severe aortic valve stenosis in some cases «mimics» acute coronary syndrome, which is indicated by significantly more frequent detection of intact coronary arteries in this cohort. Aortic stenosis of varying degrees does not lead to an increase in the frequency of early postoperative complications and 30-day mortality after PCI.

Introduction . One of surgical methods for treatment of aortic valve (AV) pathology is Aortic Valve Neocuspidalization Ozaki procedure (AVNeo). Thus, according to the latest systematic review, freedom from reoperation within one, three, five years after AVNeo was 98%, 97% and 96%. Available references provide few descriptions of reoperations after AVNeo. Aim . To analyze the immediate results of AV reinterventions after AVNeo. Materials and methods . In the medium term, reinterventions after AVNeo were necessary for 11 patients (4.3%). The age of patients ranged from 26 to 69 years. 11 patients who underwent surgery included 6 males and 5 females. Four patients had class III-IV CHF, according to NYHA classification. Three patients had previously been operated on for infective endocarditis (IE), and five patients had bicuspid aortic valve. The duration of follow-up, from AVNeo surgery to reinterventions, ranged from 3 to 43 months. Results and discussion . All patients underwent an isolated AV intervention. The main causes of dysfunction were IE (six patients) and leaflet rupture in the commissural area (five patients). Seven patients underwent aortic valve replacement with mechanical valves, one patient — with aortic homograft valve, one patient — with tissue valve and two patients underwent valve repair. In the early postoperative period, one patient had bleeding with the development of cardiac tamponade and one patient had a haemorrhagic stroke. No patients had ARF, perioperative myocardial damage, sternal infection or permanent pacemaker implantation. Two patients died during the hospital period. Conclusions . AV reinterventions are associated with a high incidence of complications and deaths. Therefore, prevention of IE and commissure enhancement should reduce the frequency of repeated interventions, which is to be confirmed by prospective studies in large cohorts of patients.

Objective. Assessment of organizational and clinical aspects of acute coronary syndrome combined with a new coronavirus infection (SARS- CoV-2). Materials and methods. This is a retrospective study where 60 patients were divided into the following groups: group 1 patients with acute coronary syndrome (ACS) and a new coronavirus infection hospitalized in the «red» zone after infection was detected at the prehospital stage (n=29); group 2 - uninfected coronavirus infection patients with ACS (n=31). The primary points were mortality in the hospital and the average time (up to 2 months) after ACS, the incidence of acute heart failure, the incidence of ACS with ST segment elevation, the frequency of acute coronary artery occlusions. Results. The analysis of hospital mortality revealed its higher level in the ACS group and COVID-19 (group 1) (p=0.009). Mortality within 2 months was also higher in group 1 (p=0.017). The groups did not differ in the number of patients with ACS and ST segment elevation and acute coronary artery occlusions. Analysis of the incidence of OSN at admission revealed a statistically significant difference (p=0.05) in group 2 (n=12, 38.7%) compared with group 1 (n=5, 17.2%). Conclusions. Patients with ACS and COVID-19 are characterized by a higher initial severity, a tendency to develop ACS with ST segment elevation, high rates of hospital and 60-day mortality. Separating the flows of infected and uninfected patients makes it possible to improve the epidemiological situation in non-infectious hospitals, however, it leads to a delay in hospitalization of patients with ACS and COVID-19, which potentially increases the risk of fatal complications in this cohort.

With the development of cardiac surgery, more and more women with congenital heart disease undergo cardiac interventions and reach reproductive age. Therefore, the number of pregnant patients with significant cardiac pathology is increasing. This article presents a clinical case of successful surgical treatment of aortic stenosis (the Ozaki procedure) in a 31-year-old woman who subsequently became pregnant and delivered a child. Conclusion. Despite the debate among cardiac surgeons, the Ozaki procedure can be considered as a viable option for aortic valve replacement in women with the prospect of pregnancy and childbirth. However, a larger study in this population is needed. Key words: aortic valve, aortic stenosis, aortic valve neocuspidization with autologous pericardium, aortic valve replacement, Ozaki procedure, pregnancy

За последние 30 лет минимально инвазивная кардиохирургия из единичных демонстраций операций доступом через торакотомию и различных вариантов частичных стернотомий превратилась в использование мини-доступов «на потоке», а также выполнение полностью торакоскопических и роботизированных операций. В хирургию аортального клапана минимально инвазивные технологии внедрены наиболее широко. Цель данного обзора — описание современных подходов к минимально инвазивной хирургии аортального клапана, включая критерии отбора пациентов, эволюцию и описание основных операционных доступов. Стратегия поиска включила анализ международных баз данных PubMed, Scopus, Embase, Web of Science. Поиск осуществляли по ключевым словам minimally invasive surgery of aortic valve, alternative surgical approaches in aortic valve surgery, minimally invasive autologous pericardium neocuspidization. Отбор пациентов для минимально инвазивных аортальных вмешательств должен учитывать как анатомические особенности средостения и корня аорты, так и коморбидность пациента и сопутствующую кардиальную патологию. К минимально инвазивным доступам в хирургии аортального клапана относят торакотомии, частичные стернотомии и методики эндоскопической хирургии. Особый интерес представляет минимально инвазивная неокуспидизация клапана аутологичным перикардом. Используют частичные стернотомии наиболее рутинно в хирургии аортального клапана, а накопленные результаты позволяют провести крупные метаанализы для сравнения эффективности и безопасности с классическим стернотомным доступом. В минимально инвазивной аутоперикардиальной неокуспидизации и эндоскопических вмешательствах на аортальном клапане требуется дальнейшее накопление хирургического опыта и клинического материала. Поступила в редакцию 17 января 2022 г. Исправлена 6 апреля 2022 г. Принята к печати 8 апреля 2022 г. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: Р.Н. Комаров, С.В. Чернявский, А.Н. Дзюндзя Написание статьи: О.О. Огнев, М.В. Ленковец Исправление статьи: А.М. Исмаилбаев Утверждение окончательного варианта статьи: все авторы

The BioBentall procedure has many options, but the optimal approach is still not determined. Alternative options for aortic root surgery include Ross procedure and modification of the Bentall – De Bono procedure using autologous pericardium leaflets. This literature review showed topical issues of surgical technique and the results of various modifications of the BioBentall operation, as well as methods of the aortic root repair using autologous materials. The search strategy included the analysis of international (PubMed, Scopus, Embase) and Russian’s databases (Russian Science Citation Index). The BioBentall procedure demonstrates satisfactory early and long-term results comparable to both the classic Bentall – De Bono procedure and valve-sparing techniques. Composite grafts containing frameless bioprostheses seem to be more promising and durable in comparison with stent-grafts, however, given the minimal amount of publications directly comparing these techniques, further study of this hypothesis is necessary. Total xenopericardial conduits have demonstrated higher rates of degradation and are currently not recommended for use, as demonstrated in most foreign studies. Modified Ross procedure shows excellent hemodynamic outcomes in the long-term follow-up, however, the literature data regarding its applicability in a cohort of patients with proximal aortic aneurysms are limited. The combination of the Bentall – De Bono procedure and autopericardial neocuspidization seems to be a promising and cost-effective method, however, this approach requires a clinical assessment, which results have not been yet published. Received 26 February 2022. Revised 20 April 2022. Accepted 21 April 2022. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: R.N. Komarov, A.M. IsmailbaevDrafting the article: A.N. Dzyundzya, A.O. Danachev, O.O. Ognev, M.V. LencovetsCritical revision of the article: S.V. CherniavskiiFinal approval of the version to be published: R.N. Komarov, A.M. Ismailbaev, S.V. Cherniavskii, A.N. Dzyundzya, A.O. Danachev, O.O. Ognev, M.V. Lencovets

Модификация операции Бенталла – Де Боно с использованием биологических протезов имеет множество разновидностей, однако оптимальный подход по-прежнему не определен. К альтернативным вариантам хирургии корня аорты относят операцию Росса и модификацию процедуры Бенталла – Де Боно с применением створок из аутологичного перикарда. В обзоре литературы рассмотрены хирургическая техника и результаты различных модификаций операции БиоБенталл, а также методик протезирования корня аорты с использованием аутологичных материалов. Стратегия поиска включила анализ международных (PubMed, Scopus, Embase) и отечественных баз (Российский индекс научного цитирования). Процедура БиоБенталл демонстрирует удовлетворительные ранние и отдаленные результаты, сопоставимые как с классической операцией Бенталла – Де Боно, так и с клапано­сохраняющими методиками. Композитные графты, содержащие бескаркасные биопротезы, представляются более перспективными и долговечными в сравнении с каркасными, однако с учетом минимального количества работ, напрямую сопоставляющих эти методики, необходимо дальнейшее изучение данной гипотезы. Тотальные ксеноперикардиальные кондуиты продемонстрировали высокий потенциал к деградации и не рекомендуются к использованию. Модификация операции Росса с помещением легочного ауто­графта в сосудистый протез показывает превосходные гемодинамические исходы в отдаленном периоде наблюдения, но данные литературы о ее применимости в когорте больных с проксимальными аневризмами аорты ограничены. Комбинация процедуры Бенталла – Де Боно и аутоперикардиальной неокуспидизации представляется перспективной и экономически выгодной, но требует оценки клинических результатов, которые в настоящий момент не опубликованы. Поступила в редакцию 26 февраля 2022 г. Исправлена 20 апреля 2022 г. Принята к печати 21 апреля 2022 г. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: Р.Н. Комаров, А.М. Исмаилбаев Написание статьи: А.Н. Дзюндзя, А.О. Даначев, О.О. Огнев, М.В. Ленковец Исправление статьи: С.В. Чернявский Утверждение окончательного варианта статьи: все авторы

Пандемия новой коронавирусной инфекции (COVID-19) – это глобальная проблема института здравоохранения, характеризующаяся высокими показателями заболеваемости и смертности. Тема острого коронарного синдрома (ОКС) осложнилась целым рядом клинически значимых вопросов, таких как ковид-индуцированные повреждения миокарда, неопределенность в отношении курации этого неотложного состояния, необходимость четкой оптимизации диагностических и терапевтических мероприятий, а также обеспечение максимальной защиты медицинского персонала. Кроме того, во всем мире отмечается снижение количества госпитализаций по поводу ОКС, что связано с нежеланием пациентов обращаться за врачебной помощью и перенаправлением медицинских ресурсов в пользу борьбы с пандемией. Учитывая, что первостепенным патофизиологическим механизмом COVID-19 является значимый сдвиг в показателях коагуляции крови, необходимо установить наличие взаимосвязи между данной инфекцией и повышением риска острого коронарного поражения. Высокий риск развития ОКС, ассоциированный с COVID-19, может быть связан с разрывом атеросклеротической бляшки, вызванным повреждением эндотелиальных клеток, цитокиновым штормом и воспалительным статусом пациента. В данном обзоре будут освещены мировые и отечественные данные, посвященные влиянию пандемии COVID-19 на диагностику и клиническое течение ОКС, а также представлены результаты лечения ОКС в новых эпидемиологических условиях.

Highlights . A retrospective analysis of the patients’ data after Ozaki operation in four Russian Medical Centers was carried out. A comparative gender assessment of the immediate and medium-term results of Ozaki operation was performed. Aim. Gender assessment of Ozaki operation immediate and mid-term results in patients with aortic valve (AV) pathology. Methods. A retrospective multicenter study enrolled 251 patients (135 women, median age 66 (60–70) years old) who underwent Ozaki operation (2017–2020) was carried out in four centers in Russia. After propensity score matching, 92 patients were selected (mean age 65.8±10.8 years old). Two groups were formed in the gender structure: 46 females (average age 67.8±6.3 years old), 46 males (average age 63.8±15.4 years old). The main cause of AV dysfunction was severe aortic stenosis – in 86 (93.5%) cases. Chronic heart failure of III–IV functional class according to NYHA was observed in 26 (28.3%) patients. A bicuspid AV was in 24 cases (26.1%). The primary endpoint was hospital mortality. Postoperative complications and mid-term results (three-year overall survival and freedom from reoperation on AV) were assessed as secondary endpoints; the median follow-up period was 23 (18–33) months. Results. There was no statistically significant difference between the groups in the duration of surgery (275 minutes for females and 285 minutes for males, p = 0.4), cardiopulmonary bypass (98 minutes for females and 115 minutes for males, p = 0.3), aortic clamping (80 minutes for females and 93 minutes for males, p = 0.7). Hospital mortality among the studied patients did not differ: in the female group – 2.2% (1 case) and 0 in the male one, p = 0.9. There were no significant differences in postoperative complications: sepsis (2.2% in women and 0 in men, p = 0.9), superficial wound infection (8.7% in women and 6.5% in men, p = 0.9). Acute kidney injury, stroke, pacemaker implantation, resternotomy for bleeding were not observed in any patient. Three-year overall survival was 91.8% in females and 91.6% in males, p = 0.8; three-year freedom from reoperation – 94.4% for females and 100% for males, p = 0.1. Conclusion. Ozaki operation is equally reproducible with the same hospital mortality, postoperative complications, and medium-term outcomes in both females and males.

ЦЕЛЬ ИССЛЕДОВАНИЯ Оценка частоты и определение факторов риска инфекционного эндокардита (ИЭ) после неокуспидализации аортального клапана. МАТЕРИАЛ И МЕТОДЫ В исследование был включен 251 пациент (116 мужчин и 135 женщин) с патологией аортального клапана, которым выполняли неокуспидализацию аортального клапана в период с 2016 по 2019 г. в четырех российских центрах. Медиана периода наблюдения составила 24 [17; 32] мес. РЕЗУЛЬТАТЫ ИЭ после операции развился у 7 (2,8%) пациентов. По результатам построения кривых Каплана—Мейера ИЭ отсутствовал после неокуспидализации аортального клапана в течение 3 лет в 96,6% случаев, повторные операции в течение 3 лет отсутствовали в 94,6% случаев, а 3-летняя общая выживаемость составила 90,6%. Факторы риска ИЭ включали операцию по поводу активного ИЭ (относительный риск 16,5; 95% ДИ 2,85—95,54; p=0,002) и ишемическую болезнь сердца с чрескожным коронарным вмешательством в анамнезе (относительный риск 11,6; 95% ДИ 2,24—60,14; p=0,003). ВЫВОД Потенциально операция неокуспидализации аортального клапана может снизить количество инфекционных осложнений в определенных группах больных. Необходимы дальнейшие проспективные многоцентровые исследования для подтверждения данной гипотезы.

Over the past 30 years, minimally invasive cardiac surgery has progressed from single case reports of operations via thoracotomy and various procedures of partial sternotomy to routine use of mini-accesses as well as fully thoracoscopic and robotic techniques. It is aortic valve surgery that implemented minimally invasive technologies most widely. The objective of this systematic review is to present state-of-the-art approaches to minimally invasive aortic valve surgery including patient selection criteria as well as evolution and state-of-the-art of the main surgical approaches. The search strategy covered international databases, such as PubMed, Scopus, Embase, and Web of Science. We used following queries: ‘minimally invasive surgery of the aortic valve’, ‘alternative surgical approaches in aortic valve surgery’, ‘minimally invasive autologous pericardium neocuspidization’. Selection of patients for minimally invasive aortic interventions should consider both the anatomy of the mediastinum and the aortic root as well as cardiac and other comorbidities. Minimally invasive approaches in aortic valve surgery include thoracotomy, partial sternotomy, and endoscopic techniques. Of particular interest is minimally invasive neocuspidization with autologous pericardium. Partial sternotomies are the most routinely used approaches in aortic valve surgery. Their cumulative outcomes allow to compare their efficacy and safety with those of classic sternotomy access within large meta-analyses. Minimally invasive autopericardial neocuspidization and endoscopic interventions on the aortic valve require further surgical experience and clinical outcomes. Received 17 January 2022. Revised 6 April 2022. Accepted 8 April 2022. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: R.N. Komarov, S.V. Cherniavskii, A.N. DzyundzyaDrafting the article: O.O. Ognev, M.V. LenkovetsCritical revision of the article: A.M. IsmailbaevFinal approval of the version to be published: R.N. Komarov, O.O. Ognev, A.M. Ismailbaev, S.V. Cherniavskii, A.N. Dzyundzya, M.V. Lenkovets

Various types of autologous materials are used in heart valve surgery, particularly the aortic valve, and this article describes their historical development. The evolution of the use of various autogenous tissues, such as the aortic wall, fascia lata of the thigh, pericardium and others is described and discussed in detail. This paper presents the results of experimental and clinical publications devoted to the surgical techniques and the outcomes of heart valve reconstruction using such materials. The negative aspects of the use of a wide range of autografts are discussed, including the short service life and low strength, which led to declining interest in this group of reconstructive interventions. The method for treating the autopericardium with glutaraldehyde, proposed in 1986 by C.S. Love, J.W. Love and colleagues, raised the use of autologous materials in the reconstruction of heart valves to a new level, allowing surgeons to strengthen the autopericardial flaps and increase resistance to hemodynamic stress. Many surgeons, their interest in such treatment methods increased by this discovery, then reported their observations and further developed ways of using the treated autopericardium in aortic valve surgery. Particularly, the method of neocuspidisation of the aortic valve, introduced into wide practice by M.G. Duran and S. Ozaki, has become the quintessential reconstructive valve surgery involving the use of autologous materials.Received 14 March 2021. Revised 26 April 2021. Accepted 27 April 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflicts of interests.Contribution of the authorsConception and study design: A.O. Simonyan, A.M. IsmailbaevDrafting the article: A.O. Simonyan, A.M. Ismailbaev, N.O. Kurasov, M.I. TcheglovCritical revision of the article: R.N. Komarov, V.V. Dalinin, I.A. BorisovFinal approval of the version to be published: R.N. Komarov, A.O. Simonyan, I.A. Borisov, V.V. Dalinin, A.M. Ismailbaev, N.O. Kurasov, M.I. Tcheglov

Neocuspidisation of the aortic valve with autopericardial leaflets has been actively introduced into widespread cardiac surgery practice within the last decade. Most practicing surgeons associate this technique with scientists such as Carlos Duran and Shigeyuki Ozaki. The accumulated experience of the N. N. Burdenko Faculty of Surgery Clinic of Sechenov First Moscow State Medical University allows us to optimize approaches to autopericardial neocuspidisation of the aortic valve in order to increase the availability of procedures. The article describes in detail the technique of neocuspidisation of the aortic valve, as well as reveals some technical features and improvements regarding the quality of this procedure.Received 23 September 2020. Revised 17 November 2020. Accepted 18 November 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.