The rising number of people with heart failure is leading to a corresponding increase in heart failure-related deaths. End-of-life care for these patients involves supplementing standard treatments with therapies aimed at managing symptoms that don’t respond to guideline-directed medical care. The INCOR, a lightweight (200 g), implantable, magnetically levitated axial flow pump (providing non-pulsatile flow), is designed for long-term left ventricular support. This video tutorial details the initial single-centre clinical experience with this device.

The Berlin Heart EXCOR Adult biventricular assist device (BiVAD) is an approved option for mechanical circulatory support in patients experiencing end-stage biventricular heart failure. In this video tutorial we demonstrate a clinical case of BiVAD EXCOR implantation in an adult.

Objective: The aim of this study was to evaluate the outcomes of autoarterial revascularization involving Y-composite grafts and in situ conduits out of the internal thoracic arteries (ITAs) at the hospital period and after a year follow-up.Methods: The study included 200 patients with coronary artery disease who underwent coronary bypass surgery over the period from March 2018 to March 2021. Patients were randomized using the envelope method into 2 groups: in the first group, autoarterial conduits out of the ITAs were used according to the in situ method (n = 100); in the second group, autoarterial conduits with the formation of a Y-composite grafts out of ITAs (n = 100) were put into practice. The primary endpoints of the study were the incidence of repeat revascularization and amount of major adverse cardiac and cerebrovascular events (MACCE).Results: There was no significant difference between the two groups in the level of freedom from MACCE; in the in situ and Y-composite groups the indicators were 97.9% (95% CI 92.1-99.5) and 94.8% (95% CI 88.1‑97.8; P = 0.24), respectively. In a year follow-up, freedom from repeated revascularization amounted to 97.9% in the in situ group (95% CI 92-99.4), and 97.9% in the Y-composite group (95% CI 91.9-99.4; P = 0.97). A significant difference was registered in the surgery duration, which in the in situ group lasted 235 [197.5; 252.5] minutes versus 252.5 [225; 290] minutes in the Y-composite group, P < 0.002. In the Y-composite group, the rate of infectious complications on the breast bone was significantly more frequent than in the in situ group (P < 0.023).Conclusion: Despite the hypothetical advantages of bimammar coronary bypass surgery over the Y-configuration one, this study did not reveal significant differences in outcomes between the in situ and Y-composite groups. Received 7 November 2023. Revised 10 June 2024. Accepted 24 June 2024. FundingThe study did not have sponsorship. Conflict of interestThe authors declare no conflict of interest. Contribution of the authorsConception and study design: A.K. Sabetov, D.S. Khvan, M.O. ZhulkovData collection and analysis: A.K. SabetovStatistical analysis: A.A. Shadanov, A.K. SabetovDrafting the article: A.K. SabetovCritical revision of the article: D.A. Sirota, D.S. Khvan, A.M. ChernyavskiyFinal approval of the version to be published: A.K. Sabetov, D.A. Sirota, D.S. Khvan, M.O. Zhulkov, A.A. Shadanov, A.M. Chernyavskiy

Цель. Изучить результаты аутоартериальной реваскуляризации с использованием Y-композитных и in situ кондуитов внутренних грудных артерий в госпитальном периоде и через 1 год. Методы. В исследование включили 200 пациентов с ишемической болезнью сердца, которым выполнили коронарное шунтирование с марта 2018 г. по март 2021 г. Пациентов рандомизировали при помощи метода конвертов на 2 группы: в первой использовали аутоартериальные кондуиты из внутренних грудных артерий по методике in situ (n = 100); во второй — с формированием Y-композитных конструкций (n = 100). За первичную конечную точку исследования принимали повторную реваскуляризацию и количество больших неблагоприятных сердечно-сосудистых событий (англ. Major Adverse Cardiac and Cerebrovascular Events, MACCE). Результаты. В уровне свободы от основных неблагоприятных сердечных и мозговых событий достоверной разницы не получили: 97,9 % (95% доверительный интервал 92,1–99,5) для группы in situ и 94,8 % (95% доверительный интервал 88,1–97,8) для группы Y-композитных конструкций, p = 0,24. Через 1 год свобода от повторной реваскуляризации составила для группы in situ 97,9 (95% доверительный интервал 92,0–99,4), для группы Y-композитных конструкций 97,9 % (95% доверительный интервал 91,9–99,4), p = 0,97. Достоверно значимую разницу получили в продолжительности операции, которая в группе in situ составила 235 [197,5; 252,5] против 252,5 [225; 290] мин в группе Y-композитных конструкций, p < 0,002. В группе Y-композитных конструкций инфекционные осложнения на грудине были достоверно значимо чаще, чем в группе in situ, p < 0,023. Заключение. Несмотря на гипотетические преимущества бимаммарного коронарного шунтирования с Y-образной конфигурацией, в результатах между группами in situ и Y-композитных конструкций нет существенных различий. Поступила в редакцию 7 ноября 2023 г. Исправлена 10 июня 2024 г. Принята к печати 24 июня 2024 г. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: А.К. Сабетов, Д.С. Хван, М.О. Жульков Сбор и анализ данных: А.К. Сабетов Статистическая обработка данных: А.А. Шаданов, А.К. Сабетов Написание статьи: А.К. Сабетов Исправление статьи: Д,А. Сирота, Д.С. Хван, А.М. Чернявский Утверждение окончательного варианта статьи: все авторы

СЕРДЕЧНАЯ И СОСУДИСТАЯ ХИРУРГИЯ ■ РезюмеХирургическое лечение обструктивной гипертрофической кардиомиопатии остается наиболее сложной проблемой современной кардиохирургии.Наряду с классическим трансаортальным доступом из срединной продольной стернотомии развитие получил и трансмитральный хирургический подход из правосторонней мини-торакотомии с применением эндовидеохирургической ассистенции

Prosthetic heart valves are widely used biomedical devices. The need for these prostheses is increasing due to the increasing life expectancy of the general population and the consequent incidence of age-related degenerative valvular defects. However, even though mechanical prosthetic valves have been significantly modernized over the last decades, they are still associated with several life-threatening complications, the main one being thrombosis. Addressing this problem is challenging and requires collaboration between bioengineering and cardiothoracic surgery. Thus, the problem of creating the most adapted model of prosthetic heart valve (PHV) turns out to be at the confluence of sciences – medicine, biology, applied mechanics, mathematical modeling, etc. Today, it seems clear that the engineering ideas for hemodynamic adaptation of PHV models have been fully developed. However, research in the field of materials science, as well as a search for surface modification methods, remain a pressing bioengineering challenge.

A 74-year-old male entered the hospital with a medical history of an aortic arch and a descending thoracic aneurysm. To prevent arm ischaemia after the frozen elephant trunk procedure, a left subclavian artery to left common carotid artery anastomosis was performed. The postoperative period was complicated by sepsissternal infection and mediastinitis. We decided to perform a combined total aortic root and aortic arch replacement with 3 cryopreserved homografts. In addition, the "reverse arch technique" was applied to adapt the distal anastomosis. The operation is associated with a high risk of mortality in the postoperative period.

Цель. Провести сравнительный анализ отдаленных результатов применения голометаллических стентов и гибридных протезов при лечении расслоения аорты I типа.

В статье представлен обзор истории развития малоинвазивной коронарной хирургии. Акцентируется внимание на ключевых проблемах, описаны рекомендуемые критерии отбора пациентов для коронарного шунтирования (КШ) из переднебоковой миниторакотомии. Проанализированы преимущества и недостатки малоинвазивного КШ в сравнении с классическим КШ и гибридным подходом. Подробно разобраны текущие вопросы развития малоинвазивного КШ и способы их решения. Приведены выводы, согласно которым при соответствующем отборе пациентов, наличии определенного оснащения и достаточного опыта у хирурга малоинвазивное КШ выполнимо и может сделать многососудистую миниинвазивную коронарную хирургию безопасной, эффективной и широкодоступной.

Objective: comparative analysis of long-term outcomes following heart transplantation (HT) with prolonged and short cold ischemia. Materials and methods. We analyzed the data of 29 orthotopic HT with > 4 hours of cold ischemia. The transplant surgery was performed at Meshalkin National Medical Research Center between 2013 and the present time. Organs were obtained from donors from other regions. The control group consisted of 29 HTs with cold ischemia < 4 hours, performed in the same period. The minimum distance between the transplant center and the donor base was about 250 km (Barnaul); the maximum distance was about 850 km (Krasnoyarsk). Recipient survival and postoperative peculiarities were analyzed. Results. In-hospital survival in the prolonged cold ischemia group was 89.7% (n = 26) with 3 deaths (10.3%). In the second group (< 240 min), in-hospital survival was 79.3% (n = 23) with 6 (20.7%) deaths. The Kaplan-Meier survival analysis showed no difference between the groups (Log-Rank Test, P 1/4 0.59). In addition, cold ischemia time did not increase the risk of graft rejection and the risk of transplant coronary artery disease (TCAD). Conclusion. HT with cold ischemia > 4 hours did not have worse outcomes than in short graft ischemia. This provides grounds for further accumulation of experience in the use of heart donors from remote locations.

ТРАНСПЛАНТОЛОГИЯ И ИСКУССТВЕННЫЕ ОРГАНЫ ■Хроническая дисфункция пересаженных легких остается одной из главных причин смерти реципиентов в отдаленные сроки после трансплантации.Одним из возможных путей решения данной проблемы может быть полное анатомическое соединение всех структур пересаживаемого легкого

Medical management of end-stage chronic heart failure (HF) has evolved significantly over the past few decades. With a better understanding of the pathophysiology of HF, new pharmacological agents have been synthesized. However, survival in this cohort of patients with medical treatment remains extremely low. This has stimulated the development of surgical methods of treatment. Recent technological advances in the development of mechanical circulatory assist devices have made possible a single-stage implantation of two centrifugal pumps as an alternative to a total artificial heart. Today ventricular assist devices can be implanted to provide both univentricular and biventricular support depending on the severity of hemodynamic disorders, target organ damage, likelihood of recovery and heart transplantation.

The aim of the study is to analyze predictors of lethality, false lumen thrombosis, enlargement of aortic diameter, and frequency of aorta-related events in the early and remote postoperative periods for various types of proximal aortic dissection surgery using the logistic regression method. Materials and Methods:A retrospective observational comparison of the results of surgical treatment of 213 patients with the diagnosis of "DeBakey type I aortic dissection" has been carried out. The participants were divided into three groups: group 1 underwent classic aortic arch reconstruction using hemiarch technique or total reconstruction of the aortic arch with a multiple-branch prosthesis (n=121); group 2 was subjected to the hemiarch technique and implantation of bare-metal (uncoated) stents (n=55); in group 3, the "frozen elephant trunk" correction technique was used (n=37). The diagnosis of all patients included into the study was preoperatively confirmed by ultrasound and tomographic examination. Predictors of negative events have been identified by building the models of logistic regressions. Results:The multivariate model of logistic regression has revealed multiplicative significant predictors of lethality: postoperative neurological complications increased the probability of lethality by 3.39 (1.24-9.18) times and presence of a patent false lumen by 4.17 (1.49-13.68) times.Among the predictors of aorta-related events, the most important were connective tissue diseases (the probability increased by 6.68 (2.98-15.62) times), presence of partial thrombosis of the false lumen (the probability of event development increased by 2.39 (1.07-5.44) times), and aortic valve repair (the probability aorta-event occurrence increased by 2.84 (1.13-7.17) times).Hybrid prosthesis implantation appeared to be the most significant predictor of false lumen thrombosis increasing its probability by 4.19 (1.90-9.44) times among aortic repair methods, while a bare-metal stent implantation in contrast reduced the likelihood of false lumen thrombosis by 0.17 (0.03-0.62) times. Eventually, the type of repair had not any significant impact on the aorta-related events and lethality in the long-term period.

Aim To study the dynamics of right ventricular function and pulmonary hemodynamics in patients with pulmonary hypertension during mechanical circulatory support of the heart. Material and methods A retrospective analysis was performed for 25 implantations of left ventricular assist device performed in the Meshalkin National Medical Research Center from 2006 through 2021. Mechanical assist devices were implanted in 21 men and 4 women (median age, 37.5 [29; 48] years). All patients had severe, NYHA functional class III-IV chronic heart failure refractory to the optimal drug therapy. Invasive measurements showed that mean pulmonary arterial pressure (MPAP) was 50 [44.5; 60] mm Hg, transpulmonary pressure gradient (TPG) was 16 [14; 19] mm Hg, and calculated pulmonary vascular resistance was 5.4 [4.9; 9] Wood units, which is an absolute contraindication (TPG >15 mm Hg or pulmonary vascular resistance >5 Wood units) for heart transplantation (HT). Results Duration of left ventricular support was from 17 to 948 days. For 12 (48 %) patients, the HT was performed at 180-948 days following the implantation of left ventricular assist device; 3 patients are presently waiting for HT; 10 patients died from various complications, 6 of them died during the hospital stage. Already during the early stage after the implantation of the mechanical assist device, pulmonary hemodynamics significantly improved. Thus, in one week, MPAP decreased from 50 [44.5; 60] mm Hg to 36 [33; 38] mm Hg (р=0.012) whereas pulmonary vascular resistance decreased from 5.4 [4.9; 9] to 2.9 [2.4; 3.6] Wood units (р=0.008). Follow-up showed further improvement of pulmonary hemodynamics; at 1 month, MPAP was 29 [27; 30] mm Hg and by the time of HT, MPAP was 2.0 [24.8; 26.3] mm Hg (р=0.01), i.e., reached a normal level, which made it possible to perform HT. Similar dynamics was observed for other variables that reflected pulmonary hemodynamics. Conclusion Mechanical support of the heart is able to alleviate manifestations of pulmonary hypertension in most patients with end-stage heart failure. It is necessary to develop an algorithm for identifying the category of patients with a high risk of progression of right ventricular failure.

Cardiac injury remains one of the most complex conditions in emergency surgery. Only 6% of patients with penetrating heart wounds manage to be delivered to the operating room for surgery, and the mortality rate is still extremely high. Unfortunately, such emergency interventions are often performed in institutions lacking the ability to provide the full range of reconstructive techniques, resulting in suboptimal correction and a high risk of developing postoperative complications. This paper describes a clinical case of successful repair of multiple stab wounds to the heart with concomitant anterior descending artery injury followed by severe heart failure requiring biventricular mechanical circulatory support.

The aim of the study is to evaluate the efficacy of various types of hybrid technology in compare to the classical repair of the aortic arch of type I aortic dissection treatment in the in-hospital period.Materials and Methods. A retrospective observational study has been conducted, the results of surgical treatment of 213 patients with DeBakey type I aortic dissection operated on within the period from 2001 to 2017 were compared. Patients were divided into three groups: in group 1, patients undergone a hemiarch type of aortic repair or the total arch replacement (n=121); in group 2, a hemiarch aortic reconstruction and implantation of bare metal stent was performed (n=55); in group 3, a frozen elephant trunk technique was used (n=37). Taking into consideration the retrospective character of the investigation and nonequivalence of the groups by separate characteristics, they were equalized to improve the reliability of the results using the PSM (propensity score matching) pseudorandomization method. As a result, three groups of comparison were formed which were equalized by the PSM method and called PSM 1, 2, and 3. The mortality and complication rate in the in-hospital period, as well as the frequency of false lumen thrombosis development depending on the treatment method, have been analyzed.Results. The mortality rate in the PSM 1 group was 15 patients: group 1 (standard technique) - 10 patients (9%), group 2 (uncoated stents) - 5 patients (11%). A significant difference was found in the number of major bleedings (group 1 - 8%, group 2 - 21%, p=0.031) and cases of bowel ischemia (group 1 - 1%, group 2 - 9%, p=0.028). Complete false lumen thrombosis of the thoracic aorta was observed significantly more often in group 1 than in group 2 (22% vs 5%, p=0.015).In the examined group PSM 2, hospital mortality rate was 4 patients: group 1 - 3 patients (12%), group 3 - 1 patient (3%). No differences between the groups were found in the number of complications. In group 3, complete false lumen thrombosis of the thoracic aorta was observed in 59% of cases, whereas in group 1 it was found only in 4% of patients (p<0.001).In comparison group PSM 3, the mortality was 8 patients: group 2 - 5 patients (11%), group 3 - 3 patients (9%). The number of neurological complications differed significantly: in group 2 - 27%, in group 3 - 6% (p=0.019). Besides, 3% of cases of complete false lumen thrombosis were found in group 2, while there appeared 55% (p<0.001) of such patients in group 3.Conclusion. The comparative analysis showed that the use of bare metal stents and hybrid prostheses demonstrated a comparable low level of in-hospital mortality compared to the standard surgical technique of aortic arch reconstruction. At the same time, the use of the bare metal stents is associated with a higher rate of perioperative complications (bleeding, postoperative bowel ischemia, neurological complications) compared to the standard treatment and repair of the aortic dissection using hybrid prostheses. Complete thrombosis of the false lumen occurred significantly less commonly in case of using bare metal stents than with standard treatment and hybrid prostheses.

Aim. Comparative assessment of long-term results of bare metal stents and frozen elephant trunk prosthesis using in aortic dissection I DeBakey type.Methods. The retrospective comparative evaluation of different surgery results (2001–2017) in 213 patients with DeBakey type I aortic dissection was performed. Patients was divided in to 3 groups: Group 1 — standard treatment (hemiarch or total arch replacement) (n = 121), Group 2 — arch reconstruction with bare metal stent (n = 55), Group 3 — arch reconstruction with frozen elephant trunk prosthesis (n = 37). For groups equation we used propensity score matching analysis (PSM).Results. A pairwise comparison with the formation of three groups equated by the PSM method was performed. Long-term mortality in PSM 1 was 88 [82; 96] % (Group 1) и 89 [79; 100] % — (Group 2) respectively (p = 0.893). Long-term mortality in PSM 2 was 85 [71; 100] % in Group 1 and 94 [84; 100] % — Group 3 respectively (p = 0.342). Long-term mortality in PSM 3 was 88 [77; 100] % in Group 2 и 80 [64; 100] % — Group 3 respectively (p = 0.457). Freedom from aortic and mortality events (surrogate end point) in PSM 1 was 68% and 75% (p>0.999), PSM 2 was 50% and 100% (p = 0.006), PSM 3 was 73% and 89% (p = 0.22).Conclusion. There were no any statistical differences in long-term mortality and in surrogate end point (aortic events and mortality) between groups, but there was a trend to better results in Group 3.

Цель. Провести сравнительный анализ отдаленных результатов применения голометаллических стентов и гибридных протезов при лечении расслоения аорты I типа. Методы. Выполнено ретроспективное обсервационное сравнение результатов хирургического лечения 213 пациентов с диагнозом расслоение аорты I типа в период с 2001 по 2017 г. Пациентов разделили на три группы лечения: группа 1 — реконструкция дуги аорты по типу hemiarch или полное протезирование дуги аорты многобраншевым протезом (n = 121); группа 2 — реконструкция дуги аорты по типу hemiarch и имплантация непокрытого металлического стента (n = 55); группа 3 — вмешательство по типу «замороженного хобота слона» (n = 37). Для выравнивания групп использовали метод псевдорандомизации (англ. propensity score matching, PSM). Результаты. Выполнили попарное сравнение с формированием трех выравненных методом PSM групп. Отдаленная выживаемость в исследуемой группе PSM 1 составила 88 [82; 96] % в группе 1 и 89 [79; 100] % в группе 2 соответственно (p = 0,893). При сравнении группы 1 с группой 3 (группа сравнения PSM 2) выживаемость составила 85 [71; 100] и 94 [84; 100] % соответственно (p = 0,342). При оценке результатов в группах 2 и 3 (группа сравнения PSM 3) выживаемость составила 88 [77; 100] и 80 [64; 100] % (p = 0,457). Кумулятивная свобода от аортосвязанных событий и летальности в группе PSM 1 составила 68 и 75 % (p > 0,999), в группе PSM 2 — 50 и 100 % (p = 0,006), в группе сравнения PSM 3 — 73 и 89 % (p = 0,22). Заключение. Анализ отдаленных результатов демонстрирует отсутствие статистически значимых различий в отдаленной выживаемости между исследуемыми группами. При оценке количества аортосвязанных осложнений и летальности между группами непокрытых стентов и гибридных протезов достоверного различия не обнаружили, однако отметили тенденцию к улучшению в группе гибридных протезов.

For a number of centuries, the problem of bleeding arrest from damaged vessels remains the major issue of surgery (alongside with infectious complications and fight against the pain syndrome). The development of vascular surgery began exactly when bleeding from a damaged vessel was arrested by tying it, and the introduction of reconstructive vascular surgery, being one of the most outstanding achievements of the 20th century, was the peak of creation. With the advent and development of this relatively young branch of clinical surgery, it became possible to effectively help patients with various vascular pathologies, previously considered incurable and doomed to death. However, the development of each industry is necessarily associated with the development of technical support. The lack of high-quality suture material and instruments has restrained the development of reconstructive vascular surgery for a long time; this fact forced researchers and surgeons to develop techniques for the seamless connection of blood vessels. Despite the widespread use of manual surgical suture, it is not always possible to use this option due to altered vascular walls. Development of technology for manufacturing synthetic materials allowed for techniques providing fast and high-quality connection of blood vessels, significantly reducing the time required for reconstruction and, as a result, reducing the incidence of complications.