*Correspondence: Alexey Nesmachnyy, Department of the Aorta and Coronary Arteries Surgery, Siberian Biomedical Research Center Ministry of Health Russian Federation, 15 Rechkunovskaya St., Novosibirskaya Region, Novosibirsk, Russia, 630055, Tel: +79137631266; E-mail: Alexey_Nesmachnyy@Mail.Ru Received Date: 01 Aug 2017 Accepted Date: 26 Aug 2017 Published Date: 28 Aug 2017 Citation: Nesmachnyy A, Chernyavskiy A, Kareva J, Sirota D, Tarkova A. Surgical Treatment for Chronic-Contained Rupture of Thoracic Aortic Aneurysm Complicated with Vertebral Erosion: Case Report. Ann Clin Case Rep. 2017; 2: 1425. ISSN: 2474-1655 Copyright © 2017 Alexey Nesmachnyy. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Case Report Published: 28 Aug, 2017

Аутологичные костномозговые стволовые клетки являются альтернативным способом терапии пациентов с сердечной недостаточностью. Цель работы - изучение фенотипа и функциональных свойств костномозговых мононуклеарных клеток (КМ-МНК) больных хронической сердечной недостаточностью (ХСН) до и после кратковременной экспозиции с эритропоэтином in vitro . Методика. КМ-МНК выделяли на градиенте плотности фиколл/верографин (r = 1,077 г/л). Фенотип КМ-МНК, клеточный цикл и апоптоз CD34+ клеток определяли до и после экспозиции с эритропоэтином на проточном цитометре. Пролиферативный потенциал КМ-МНК до и после экспозиции с эритропоэтином оценивали в спонтанном и стимулирующем тесте. Пролиферацию, миграцию и ангиогенный потенциал клеток EA.hy 929 изучали в тесте «раневого дефекта» монослоя клеток и на матригеле под влиянием 30% кондиционных сред от КМ-МНК. Результаты. Показано, что КМ-МНК представляют собой смесь гемопоэтических стволовых клеток (ГСК), эндотелиальных прогениторных клеток (ЭПК) на разных этапах созревания и дифференцировки, и мезенхимных стволовых клеток (МСК). Под действием эритропоэтина увеличивается количество CD34+ клеток в G0G1 фазе клеточного цикла, CD45+/EpoR+, CD31-/CD184+, CD31+/CD184+ и CD34+/CD184-, и уменьшается количество CD34+/CD133+, CD34+/EpoR-. Кондиционная среда от КМ-МНК способствует пролиферации, миграции и формированию сосудисто-подобных структур клетками EA.hy 929. Заключение. Полученные результаты свидетельствуют, что кратковременная экспозиция КМ-МНК больных ХСН задерживает CD34+ клетки в стадии покоя, увеличивает пул ЭПК, экспрессирующих «хоуминг» рецептор, а кондиционная среда от КМ-МНК стимулирует пролиферацию, миграцию и ангиогенный потенциал EA.hy 929, что следует учитывать при выборе методов усиления «приживаемости» клеточного трансплантата. Autologous bone marrow stem cells are an alternative therapy for patients with heart failure. The aim of this work was to study the phenotype and functional properties of bone marrow mononuclear cells (BM-MNCs) from patients with chronic heart failure (CHF) before and after a short-term in vitro exposure to erythropoietin. Methods. BM-MNCs were isolated using density gradient. The BM-MNC phenotype, cell cycle, and apoptosis of CD34+ cells were evaluated before and after exposure to erythropoietin with a flow cytometer. Proliferation of BM-MNCs before and after the erythropoietin exposure was evaluated in a spontaneous and stimulating test. Proliferation, migration, and angiogenic potential of EA.hy 929 cells were studied in the wound closure test and in the tubule formation test under the influence of 30% conditioned medium from BM-MNCs. Results. BM-MNCs represented a mixture of hematopoietic stem cells (HSCs), endothelial progenitor cells (EPCs) at different stages of maturation and differentiation, and mesenchymal stem cells (MSCs). Erythropoietin increased the number of CD34+ cells in the G0/G1 cell cycle phase, CD45+/EpoR+, CD31-/CD184+, CD31+/CD184+, and CD34+/CD184-, and decreased the number of CD34+/CD133+ and CD34+/EpoR. The erythropoietin exposure of BM-MNCs reduced their proliferative capacity. The BM-MNCs-conditioned medium promoted EA.hy 929 cell proliferation, migration, and formation of vascular-like structures. Conclusion. A short-term exposure of BM-MNCs delayed the resting stage of CD34+ cells, increased the pool of EPCs expressing the homing receptor while the BM-MNC conditioned medium stimulated EA.hy 929 proliferation, migration and tubule formation, which should be taken into account when selecting methods to enhance survival of cellular grafts.

The incidence of coronary artery aneurysms in patients with multifocal atherosclerosis is very rare. The literature describes isolated cases of correction of this pathology. The authors present a case of successful surgical treatment of a giant left anterior descending coronary artery aneurysm in a 52-year-old patient with coronary artery disease.

Aim: The study was to determine the feasibility and safety of truly stentless aortic valve replacement with bovine pericardium sutured directly onto the aortic wall by using a holding device.Methods: Seven patients with pronounced aortic stenosis and coronary artery disease who underwent aortic valve leaflets plasty with a xenopericardial patch by means of a holding device combined with CABG were recruited. Results: The aortic valve was successfully re-paired in 7 patients. A normal function of the valve was confirmed by echocardiographic data obtained in all patients. No complications were observed during follow-up. Mean hospital stay was 17 (13; 35) days. No reoperation for the aortic valve was performed during follow-up. Hospital mortality was 0%. Mean follow-up was 759 days. Long-term survival rate was 86%. Freedom from structural valve deterioration, thromboembolism, endocarditis and reoperation ran to 100%. The peak gradient across the aortic valve in the late period was 30 (26; 42) mm Hg, peak speed amounted to 3 (2.8; 3.2), mean aortic regurgitation grade was 1±0.1 degree.Conclusion: Truly stentless xenopericardial aortic valve replacement is a good alternative to standard aortic valve replacement. This method is safe with regard to freedom from reoperations, degenerative valve changes, thromboembolism, endocarditis in the early and late postoperative periods.

Aim: The study was to determine the feasibility and safety of truly stentless aortic valve replacement with bovine pericardium sutured directly onto the aortic wall by using a holding device. Methods: Seven patients with pronounced aortic stenosis and coronary artery disease who underwent aortic valve leaflets plasty with a xenopericardial patch by means of a holding device combined with CABG were recruited. Results: The aortic valve was successfully re-paired in 7 patients. A normal function of the valve was confirmed by echocardiographic data obtained in all patients. No complications were observed during follow-up. Mean hospital stay was 17 (13; 35) days. No reoperation for the aortic valve was performed during follow-up. Hospital mortality was 0%. Mean follow-up was 759 days. Long-term survival rate was 86%. Freedom from structural valve deterioration, thromboembolism, endocarditis and reoperation ran to 100%. The peak gradient across the aortic valve in the late period was 30 (26; 42) mm Hg, peak speed amounted to 3 (2.8; 3.2), mean aortic regurgitation grade was 1±0.1 degree. Conclusion: Truly stentless xenopericardial aortic valve replacement is a good alternative to standard aortic valve replacement. This method is safe with regard to freedom from reoperations, degenerative valve changes, thromboembolism, endocarditis in the early and late postoperative periods.

Objective. The purpose of this prospective, randomized, single-center, uncontrolled, open study was to assess the efficiency of surgical treatment of the most common worldwide disease of the cardiovascular system – coronary heart disease (CHD) in combination with atrial fibrillation (AF). Methods. Different techniques of AF ablation in patients with coronary artery disease during coronary bypass surgery were analyzed. 98 patients with longstanding persistent AF were randomized into three groups: PVI+CABG (n = 31) group underwent isolation of the pulmonary veins, the CABG+MM group (n = 37) received a modified mini-MAZE procedure (isolation of pulmonary veins in combination with left isthmus ablation and formation of an ablation line on the roof of the left atrium) and CABG with anatomical ablation of ganglionated plexi zones was performed for the CABG+GP group patients (n = 30). Results. It was found out that in patients with coronary artery disease and longstanding persistent AF, only radiofrequency fragmentation of the left atrium performed during CABG surgery can yield satisfactory results in the long term, with efficiency running up to 48.65%. Predictors of AF return in the patients with longstanding persistent AF are: the size of the left atrium exceeding 6.5 cm (OR 1.18, CI 1.01–1.75; p = 0.043) and a long (over 10 years) AF history (OR 1.07, CI 0.23–5.03; p = 0.038). Conclusion. Ganglionated plexi ablation performed simultaneously with CABG in patients with long standing persistent AF has a low efficiency in the long term (33.3%) and cannot be an independent method of treatment of this form of AF.

The incidence of coronary artery aneurysms in patients with multifocal atherosclerosis is very rare. The literature describes isolated cases of correction of this pathology. The authors present a case of successful surgical treatment of a giant left anterior descending coronary artery aneurysm in a 52-year-old patient with coronary artery disease.

Objective. The purpose of this prospective, randomized, single-center, uncontrolled, open study was to assess the efficiency of surgical treatment of the most common worldwide disease of the cardiovascular system – coronary heart disease (CHD) in combination with atrial fibrillation (AF). Methods. Different techniques of AF ablation in patients with coronary artery disease during coronary bypass surgery were analyzed. 98 patients with longstanding persistent AF were randomized into three groups: PVI+CABG (n = 31) group underwent isolation of the pulmonary veins, the CABG+MM group (n = 37) received a modified mini-MAZE procedure (isolation of pulmonary veins in combination with left isthmus ablation and formation of an ablation line on the roof of the left atrium) and CABG with anatomical ablation of ganglionated plexi zones was performed for the CABG+GP group patients (n = 30). Results. It was found out that in patients with coronary artery disease and longstanding persistent AF, only radiofrequency fragmentation of the left atrium performed during CABG surgery can yield satisfactory results in the long term, with efficiency running up to 48.65%. Predictors of AF return in the patients with longstanding persistent AF are: the size of the left atrium exceeding 6.5 cm (OR 1.18, CI 1.01–1.75; p = 0.043) and a long (over 10 years) AF history (OR 1.07, CI 0.23–5.03; p = 0.038). Conclusion. Ganglionated plexi ablation performed simultaneously with CABG in patients with long standing persistent AF has a low efficiency in the long term (33.3%) and cannot be an independent method of treatment of this form of AF.

Проведен анализ результатов эпикардиальной радиочастотной аблации (РЧА) анатомических зон ганглионарных сплетений (ГС) левого предсердия во время аортокоронарного шунтирования (АКШ) у больных ишемической болезнью сердца (ИБС) с различными формами фибрилляции предсердий (ФП). С 2009 по 2012 г. процедура РЧА выполнена 92 пациентам с ФП и ИБС. В зависимости от формы ФП пациенты были разделены на три группы. Средний срок наблюдения составил 14,49,6 мес. Радиочастотная аблация анатомических зон ГС в сочетании с АКШ позволяет сохранить синусовый ритм у 78,6% пациентов с пароксизмальной ФП, у 42,5% пациентов с персистирующей ФП и у 39% пациентов с длительно персистирующей ФП в отдаленном периоде.

A case of successful treatment of a rare form of postinfarction ventricular septal defect presented as dissection and ventricular septal aneurysm in a 47-year female during 9-week follow-up is described.

AIM:To estimate the results of sternomediastinitis management using vacuum-therapy compared with conventional treatment of such wounds.MATERIAL AND METHODS:We have retrospectively analyzed data for the period from January 2007 to October 2014. The study enrolled 79 patients with infectious complication after cardiac surgery. All patients underwent coronary artery bypass grafting. The first group included 40 patients who received conventional therapy. The second group enrolled 39 patients in whom vacuum-therapy was applied. Patients were comparable in main characteristics.RESULTS:Mortality rate was significantly lower in vacuum-therapy group (2.5% vs. 15%, p=0.05). Similarly duration of hospital-stay in the 2nd group was 29±10 days, in the 1st group - 47±11 days (p<0.01). Incidence of sepsis and other complications was significantly higher in group of conventional treatment.CONCLUSION:Vacuum-therapy for infectious complications after cardiac surgery provided good results including decrease of hospital-stay duration and mortality rate in comparison with conventional management of wounds.

ВведениеИсследована проблема хирургического лечения наиболее распространенных заболеваний сердечно-сосудистой системы – ишемической болезни сердца в сочетании с длительно персистирующей формой фибрилляции предсердий.ЦельИзучить эффективность различных способов аблации фибрилляции предсердий при аортокоронарном шунтировании (АКШ), динамику клинико-функционального состояния пациентов и качество их жизни в отдаленном послеоперационном периоде.Материал и методыВ исследование включено 98 пациентов с длительно персистирующей фибрилляцией предсердий. Больные рандомизированы на три группы: АКШ в сочетании с изоляцией устьев легочных вен (n = 31) – I группа, АКШ с модифицированной процедурой mini Maze, или фрагментацией левого предсердия (n = 37), – II группа и в сочетании с аблацией анатомических зон ганглионарных сплетений (n = 30) – III группа. Оценивалось течение раннего послеоперационного периода, данные ЭхоКГ и показатели качества жизни исходно и через 4 года после операции, а также свобода от фибрилляции предсердий в отдаленном периоде.РезультатыПо характеру выполненных вмешательств и количеству послеоперационных осложнений группы между собой не различались. Выживаемость в течение 3 лет в I группе составила 96,8%, во II группе – 100%, в III – 96,7%. Свобода от фибрилляции предсердий к 4-му году после операции в I группе составила 38,7 %, во II – 48,6%, в III группе – 33,3%. По данным ЭхоКГ, статистически значимого улучшения линейных и объемных размеров левого предсердия и левого желудочка в отдаленном периоде не выявлено. Улучшение качества жизни по всем показателям в отдаленном периоде во всех группах статистически незначимо.ЗаключениеИсследование демонстрирует безопасность и эффективность аблации фибрилляции предсердий при АКШ у пациентов с длительно персистирующей фибрилляцией предсердий и ишемической болезнью сердца. Предикторы возврата аритмии в отдаленном периоде – размер левого предсердия >6,5 см и длительный (более 10 лет) стаж аритмии.

AIM:comparative assessment of endoscopic and open exposure of the great saphenous vein during the operation of coronary artery bypass grafting.MATERIAL AND METHODS:a total of 228 patients with endured coronary artery bypass graft operation were randomized depending on the method of exposing the great saphenous vein (GSV) - an open method of vein exposure (OVE) - 115 patients and endoscopic vein exposure (EVE) - 113 patients. The evaluated parameters included healing of the postoperative wounds, postoperative oedema, pain intensity, and neuropathies in the early postoperative period. We performed lymphoscintigraphy of the lower limbs, as well as morphological examination of the venous wall by means of light and electron scanning microscopy.RESULTS:the duration of vein exposure was less in the EVE group than in the OVE group, amounting to 31.8 ± 6.2 min and 40.3 ± 15.8 min, respectively (p<0.01). Complications after GSV isolation were encountered considerably less often in the EVE group (11.5%) as compared to 44.4% in the OVE (p=0.001). According to the results of the multivariate analysis, diabetes mellitus was the only risk factor for postoperative complications in OVE. According the findings of lymphoscintigraphy the EVE group had no significant impairments of lymph outflow after the operation, whereas during OVE, accumulation of radiopaque material in the lymph nodes decreased twofold (p ≤ 0.001). Histological assessment of the sampled vein specimens showed no considerable lesions of the venous wall in the examined groups.CONCLUSION:the obtained findings confirm high efficacy of using EVE during operations of CABG, lower traumaticity of this method with a conduit of good quality, which was proven based on electron microscopy of the vein fragments.

There are analyses the results of surgical treatment of patients with atrial fibrillation and coronary artery disease. Eighty patients were undergone CABG combined with epicardial radiofrequency ablation of anatomic zones ganglionic plexi of the left atrium using Cardioblate system. Combined procedure CABG and epicardial radiofrequency ablation anatomic zones ganglion plexi of the left atrium provides high frequency restore of sinus rhythm in patients with coronary artery disease with atrial fibrillation during the postoperative period.

Atrial fibrillation (AF) is a challenging medical problem accounting for the development of stroke, thromboembolism, and cardiac failure. Disbalance in the autonomous nervous system (ANS) is a leading cause of AF. There is definitive evidence of the relationship between vegetative innervations, initiation and maintenance of AF, the main contributors being hyperactivity of ANS and uncontrolled release of neurotransmitters that shorten atrial refractoriness. The neurotransmitters make up the triggering mechanism of AF. The present review focuses on the role and mechanism of AF in ANS disbalance.

To study effectiveness of radiofrequency ablation (RFA) of atrial fibrillation (AF) in patients with coronary artery disease (CAD) during the aortocoronary bypass grafting surgery (ACBG), to assess freedom from arrhythmia in the late post-operation period, pro-arrhythmic effects, and quality of life of patients after the surgery, 95 patients (74 men; 78%), aged 62.8±8.8 years were examined and surgically treated. Group I included 31 patients, in whom radiofrequency ostial pulmonary vein isolation (ROPVI) was performed. The radiofrequency procedure Cox-Maze was performed in 30 patients of Group II. In 34 patients of Group III, only the ABCG surgery was performed. According to the echocardiography data, ejection fraction lower than 35% was found in 8 patients, moderate mitral insufficiency, in 22 patients, and the left ventricular aneurysm, in 9 subjects. ROPVI included application of ablation lines on common collectors of pulmonary vein ostia. The radiofrequency procedure Cox-Maze included the ostial pulmonary vein isolation, resection of the left auricle, as well as application of ablation lines from the resected left auricle towards the left upper and lower pulmonary veins, as well as the fibrous ring of the mitral valve, and on the left atrial roof. For persistent long-term ECG monitoring in the late post-operation period, implantable devices Reveal XT were used. The ACBG surgery in combination with different types of AF ablation took place in the study subjects without technical issues. During the application of ablative lines, no issues related to the branch positioning were noted. All patients after AF ablation received antiarrhythmic and anticoagulant therapy in early post-operation period to prevent iatrogenic arrhythmias. No significant difference was observed in the duration of stay in ICU in all three groups; no differences between both study and control group in the clinical course of the post-operation period and incidence of complications developed in the early post-operation period were revealed, as well. At the discharge from hospital, the sinus rhythm was documented in all patients from Group I and control group excluding one patient from both above groups apiece who had the pacemaker rhythm after the planned pacemaker implantations occurred during the surgery. In the late post-operation period, the sinus rhythm was detected in 26 patients of 30 (86.7%). In Group II, 28 patients of 29 (96.5%) had the sinus rhythm one year after the operation. In the control group after one year of follow-up, only 18 patients of 34 had the sinus rhythm, i.e. the freedom from arrhythmia was 53%. Thus, RFA of persistent AF during the ACBG procedure is a highly effective and safe method of treatment of AF. Radiofrequency isolation of pulmonary vein ostia during the ACBG surgery permits one to restore the sinus rhythm in 100% of patients and radiofrequency procedure Cox-Maze, in 96.7% of patients. The radiofrequency procedure Cox-Maze is associated with a less pro-arrhythmic effect than the radiofrequency isolation of pulmonary vein ostia. The effective AF elimination during the ACBG surgery improves the quality of life of the patients according to all scales of the SF 36 questionnaire. Insertable cardiac monitors are highly effective in detection of AF paroxysms and permit one to correct or discontinue antiarrhythmic and/or anticoagulant therapy in proper time. Radiofrequency isolation of pulmonary vein ostia during the ACBG surgery maintains the sinus rhythm in the late post-operation period in 80% of patients with persistent AF, the radiofrequency procedure Cox- Maze, in 86.2% of patients, and the ACBG surgery alone, in 44.1% of subjects.

Atrial fibrillation (AF) is known to be as the most widespread cardiac rhythm disorder which results in morbidity and mortality increase. Material and methods. This paper presents the results of one stage surgical procedure for IHD and AF in 157 patients. All the patients had intraoperative radiofrequency ablation of atrial fibrillation. Clinical assessment of AF ablation efficiency, analysis of the invasive electrophysiological test results and implantable devices for long-term rhythm monitoring were carried out. Follow-up period was 6-24 months. Results. Radiofrequency isolation of pulmonary veins orifice associated with initial paroxismal AF is efficient in 95.2% patients in the late period. Radiofrequency modified mini-maze procedure removes AF in 62.5% patients with initial constant AF. Sinus rhythm persists in 72% patients with persistent AF following isolation of pulmonary veins orifice and in 73.4% following radiofrequency modified mini-maze procedure. Continuous heart rate monitoring with Reveal system makes it possible to give anbiased assessment of AF ablation effect in combination with direct myocardial revascularization. Electrophysiological test with CARTO XP system in patients after AF radiofrequency ablation in combination with CABG procedure allows us to confirm ablation lines transmurality as well as reveal the portions of myocardial auricles which could initiate and maintain arrhythmia. Conclusion. One-stage operation CABG in combination with AF radiofrequency ablation provides high frequency of sinus rate restoration, is easy-to-operate and virtually does not extend duration of operation.