OBJECTIVE:To analyze the comprehensive program for prevention of thromboembolic complications in orthopedic patients.MATERIAL AND METHODS:We have analyzed thromboembolic complications in orthopedic patients after surgeries on large joints over the past 5 years (2018-2022).CONCLUSION:A comprehensive approach to prevention and treatment of thromboembolic complications including ultrasound, early surgical prevention of pulmonary embolism can significantly improve postoperative outcomes after joint replacement surgery. Vacuum aspiration retrograde thrombectomy is effective, feasible and safe for acute ilio-femoral venous thrombosis reducing hospital-stay (p=0.0124) and restoring vein patency. Widespread thromboembolic complications, especially for pulmonary embolism in 2022, are likely due to a new coronavirus infection and require careful screening of patients with risk factors with appropriate preventive antithrombotic therapy.

Lipid metabolism disorders are an important part in the pathogenesis of cardiovascular diseases. There are genetic forms of dyslipidemia, so-called familial hypercholesterolemia. In this condition, the risk of morbidity and mortality from cardiovascular pathology increases many times. In 2021, an active work was begun in the Chuvash Republic to create a regional (Republican) register accumulating information about patients with lipid metabolism disorders. The authors were the first to attempt to identify individuals with a high probability of familial hypercholesterolemia among them, an analysis of clinical manifestations and ongoing therapy was carried out. The purpose of this work was to study the prevalence and clinical features of familial lipid metabolism disorders among residents of the Chuvash Republic. Materials and methods. For the purposes of the study out of 7838 persons with dyslipidemia documented during 2021, 100 persons aged 40 to 86 years were selected, the average age was 63.29±9.24 years, there were 26% men and 74% women with cholesterol levels of more than 7 mmol/l and/or triglycerides of more than 10 mmol/l, which was regarded as a probable hereditary familial hypercholesterolemia. Anthropometric data, anamnestic data, results of laboratory and instrumental studies were taken into account. For further analysis, the patients were divided into two groups based on their gender. Results. No differences were revealed between the groups in most of the analyzed clinical, laboratory and instrumental indicators. In women with probable familial hypercholesterolemia, obesity is twice more common than in men. Obese women were more likely to have a history of COVID-19 infection (Q = 0.53). Correlation and regression analysis showed that statins intake and coronary arterial stenosis are closely correlated – more than 50% (correlation coefficient Q = 0.55), however, the fact of lipid-lowering therapy has no strong connection with documented atherosclerosis of the lower extremities (Q = 0.06) and the carotid arteries (Q = 0.29). Conclusions. According to the Regional Register of the Chuvash Republic, women significantly predominate among people with suspected familial hypercholesterolemia, and they are older than men. Men are more likely than women to have a mixed type of hyperlipidemia and, consequently, a higher level of triglycerides. The conducted lipid-lowering therapy is insufficient in 86%, which is confirmed by the absence of a significant difference in the level of atherogenic lipids between patients receiving statins and patients not receiving them.

Aim. Pathological accumulation of contrast-paramagnetic by the aortic wall interrelated with volume of ischemic myocardial infarction damage and left ventricular ejection fraction (EFLV) were studied in patients with acute myocardial infarction (AMI). Materials and Methods. By contrast-enhanced MRI (CE-MRI) and quantitative methods of image processing left ventricular mass (ММLV) and mass of myocardial damage (МDAMI) were calculated. 25 patients having AMI within 2–4,5 weeks (19 male, 6 female, age 60.6±3.8 years), 12 patients with stable angina without AMI (7 male, 5 female, age 57.6±3.3 years) and 11 practically healthy people without heart disease (6 male, 5 female, age 63.1±3.2 years) were studied. Results. Paramagnetic contrast enhancement of the aortic wall was found to be significantly correlated with severity of infarction damage (the index (МDAMI/ММLV))). Enhancement index T1-WI of the aortic wall less than 1.18–1.20 means that only 2 of 10 patients had myocardial damage higher 20 % (i. e., (МDAMI/ММLV)>0.2); the index greater than 1.20 means 10 of 15 patients had the damage (p<0.02). Furthermore, the proportion of the damaged myocard (МDAMI/ММLV) was found to be related with left ventricular ejection fraction (EFLV). When (МDAMI/ММLV) ranged in 0.2–0.25, the EFLV per normal value was slightly decreased; when higher the upper limit EFLV sharply decreased and achieved 20–35 % when LV myocardium had more than third of damage. Conclusion. Mechanisms of the damage of aortic wall and functioning of the ascending aorta faced to risk of myocardial infarction should be studied along with coronary and myocardial pathology.><0.02). Furthermore, the proportion of the damaged myocard (МDAMI/ММLV) was found to be related with left ventricular ejection fraction (EFLV). When (МDAMI/ММLV) ranged in 0.2–0.25, the EFLV per normal value was slightly decreased; when higher the upper limit EFLV sharply decreased and achieved 20–35 % when LV myocardium had more than third of damage. Conclusion. Mechanisms of the damage of aortic wall and functioning of the ascending aorta faced to risk of myocardial infarction should be studied along with coronary and myocardial pathology.

ЦЕЛЬ ИССЛЕДОВАНИЯ Описать случаи COVID-19-ассоциированного миокардиального повреждения, проанализировать его патогенез, подходы к диагностике и лечению. МАТЕРИАЛ И МЕТОДЫ Все пациенты в приведенных клинических примерах миокардита при новой коронавирусной инфекции имели жизнеугрожающие нарушения ритма, в том числе в виде фибрилляции желудочков с клинической смертью и последующими реанимационными мероприятиями, синкопальных состояний на фоне брадиаритмии в двух случаях, а также фибрилляции предсердий с тромбозом ушка правого предсердия. РЕЗУЛЬТАТЫ Во всех случаях специализированная медицинская помощь позволила спасти жизнь пациентам, а соответствующее медикаментозное лечение — восстановить синусовый ритм и компенсировать явления сердечной недостаточности. Стоит указать, что нарушения ритма у представленных пациентов имели преходящий характер и полностью нивелировались при контрольном осмотре через 3 мес. Специфическую медикаментозную терапию проводили согласно общепринятым подходам, и лишь в 1 случае было принято решение об имплантации кардиовертера-дефибриллятора — пациентке с внезапно развившейся фибрилляцией желудочков — с последующими успешными реанимационными мероприятиями. ВЫВОД Миокардит при новой коронавирусной инфекции может сопровождаться жизнеугрожающими нарушениями ритма с возможным летальным исходом в отсутствие соответствующей медицинской помощи. Особенностями миокардита, ассоциированного с инфекцией SARS-CoV-2, могут быть отсроченный характер клинических проявлений или молниеносное течение с резким развитием острой сердечной недостаточности, аритмий, а также преходящий характер повреждения со сравнительно быстрым восстановлением на фоне лечения. Необходимы дальнейшее динамическое наблюдение за пациентами с перенесенными воспалительными поражениями миокарда, анализ других случаев миокардита при COVID-19, формирование полноценной выборки для последующего детального анализа.

Aim To study the effectiveness of nebulized surfactant therapy as a part of a multimodality treatment of severe and extremely severe COVID-19 viral pneumonia with concomitant cardiovascular diseases (CVDs).Material and methods This retrospective controlled study analyzed a multimodality treatment of 38 patients with severe and extremely severe COVID-19 viral pneumonia and concomitant CVDs who were administered nebulized surfactant for correction of acute respiratory distress syndrome (ARDS). The control group consisted of 105 patients with severe and extremely severe novel coronavirus infection with concomitant CVDs who were not administered surfactant as a part of the multimodality therapy.Results Administration of nebulized surfactant as a part of the multimodality treatment in patients with COVID-19 allowed alleviating the severity of respiratory insufficiency (р<0.001), which decreased the death rate of patients with severe and extremely severe COVID-19 and undoubtedly demonstrated the effectiveness of this medicine. The timely multimodality therapy, including nebulized surfactant, improves the course of the disease. Thus, the absence of a possibility for administering nebulized surfactant for more than 4 days was associated with fatal outcomes (р=0.045).Conclusion Administration of nebulized surfactant as a part of the multimodality treatment of severe and extremely severe COVID-19 and concomitant CVDs increases the survival (р<0.001) and reduces the mortality by 46 %. The risk factors of an unfavorable outcome of this disease include an age older than 65 (р=0.020), a positive polymerase chain reaction test (р=0.037), a ferritin concentration at baseline >600 mg /ml (р<0.001), and a surfactant treatment duration < 4 days (р=0.045). Further study of the efficacy of nebulized surfactants as a part of the multimodality therapy is required and should include randomized clinical trials with a large number of patients and the development of distinct criteria for the treatment of ARDS.

Despite the fact that the general clinical manifestations of COVID-19 are well known, there remain problems associated with the impact of COVID-19 on human health, in addition to its effects on the respiratory system. Patients with COVID-19 and concomitant cardiovascular diseases are more likely to be hospitalized and to pass treatment in the intensive care units and to have worse prognoses. The article discusses the problems arising from the effect of type 2 coronavirus acute respiratory syndrome (SARS-CoV-2) on the cardiovascular system, starting with the mechanisms associated with angiotensin converting enzyme 2 (ACE2) receptors, as well as discusses cases of major pathological changes in the heart and blood vessels that are detected in these patients. In addition to the known risk factors for severe COVID-19: cardiovascular diseases, diabetes mellitus, chronic lung diseases and old age, even young patients without a history of risk factors may develop myocardial damage. We present a description of a clinical case of acute myocardial infarction against the background of a new coronavirus infection COVID-19 in a patient aged 28 years with a diagnosis of coronary heart disease.

We thank Deja and colleagues 1 Deja M.A. Malinowski M. Widenka K. et al. Repair or replacement for secondary mitral regurgitation: results from Polish National Registry. Ann Thorac Surg. 2022; 113: 146-156 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar for their detailed analysis in The Annals of Thoracic Surgery of the issue of surgical treatment of mitral regurgitation (MR). We have studied several of these investigators’ works on the problem and methods of surgical correction of MR, 2 Deja M.A. Janusiewicz P. Gruszczynska K. et al. Mechanisms of functional mitral regurgitation in cardiomyopathy secondary to anterior infarction. Eur J Cardiothorac Surg. 2014; 45: 1089-1096 Crossref PubMed Scopus (7) Google Scholar and we are very impressed with the volume of patients treated and the results obtained. Repair or Replacement for Secondary Mitral Regurgitation: Results From Polish National RegistryThe Annals of Thoracic SurgeryVol. 113Issue 1PreviewThe optimal surgical strategy (repair vs replacement) for patients with secondary mitral (MV) regurgitation is questionable. Full-Text PDF

Aim To study the effect of type 2 diabetes mellitus on changes of intracardiac haemodynamics and myocardial morphology in patients with ischaemic heart disease and a postinfarction aneurysm of the left ventricle before and after corrective operations on the heart. Patients and methods The study included 79 patients with ischaemic heart disease and a chronic aneurysm of the left ventricle (Group I - patients with type 2 diabetes mellitus (n=27), mean age 57.5±3.9 years, average number of shunts 2.9±0.6; Group II - patients without diabetes mellitus (n=52), mean age 55,3 ±7.1 years, average number of shunts - 2.7±0.3). In the preoperative period all patients were examined taking into account the functional class of angina pectoris, with the assessment of the left ventricular ejection fraction, end-diastolic index, end-systolic index, sphericity index. All patients underwent coronary artery bypass grafting and surgical restoration of the normal geometry of the left ventricle according to the Menicanty technique with the target end-systolic index of 60 ml/m2, during which 39 patients from both groups were subjected to intraoperative biopsy of the left ventricular myocardium and right atrial auricle. Results The intergroup analysis revealed no statistically significant differences in age, angina pectoris class, level of arterial pressure between the groups. Neither were there statistically significant differences in the echocardiographic parameters at the preoperative stage. In the postoperative period, we detected a significant decrease in the end-systolic and end-diastolic volumes of the left ventricle in both groups, with a statistically significant increase of the left ventricular ejection fraction observed only in non-diabetic patients. One year after the operation, such patients still continued to demonstrate more favourable parameters of the systolic and diastolic functions of the left ventricle. A detailed analysis with determining the delta of the alterations in the parameters revealed more significant positive dynamics in the postoperative period in patients with ischaemic heart disease not associated with type 2 diabetes mellitus. Conclusion The obtained findings are indicative of negative dynamics of the course of chronic ischaemic heart disease aggravated by type 2 diabetes mellitus after reconstruction of the left ventricle. Macro- and microangiopathy in type 2 diabetes mellitus significantly deteriorated the myocardial trophism. Subsequent bleedings draw phagocytic cells into the myocardial stroma, thus adversely affecting the further prognosis and course of the disease, since we demonstrated that the presence of inflammatory infiltrate in the myocardial stroma is a key factor of unfavourable outcomes of surgical treatment of patients with ischaemic cardiomyopathy.

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Pediatric Cardiologists, Society for Holter Monitoring and Noninvasive Electrocardiology.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

At present, there is a single procedure for surgical treatment of atrial fibrillation (AF). The Cox-maze IV procedure, which was developed by professor of surgery James Cox, is the gold standard for surgical treatment of AF in patients undergoing open heart surgery. The procedure allows the restoration and maintenance of sinus rhythm with high efficiency. However, there is also the possibility of using catheter ablation and a hybrid maze procedure in patients with long-standing persistent AF, because open surgical ablation is too invasive.1Cox J.L. Churyla A. Malaisrie S.C. et al.A hybrid maze procedure for long-standing persistent atrial fibrillation.Ann Thorac Surg. 2019; 107: 610-618Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar The research results of Lapenna and colleagues2Lapenna E. De Bonis M. Glambuzzi I. et al.Long-term outcomes of stand-alone Maze IV for persistent or long-standing persistent atrial fibrillation.Ann Thorac Surg. 2020; 109: 124-131Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar demonstrate the efficacy and safety of the stand-alone Cox-maze IV procedure in patients with persistent and long-standing persistent AF for a 7-year period.2Lapenna E. De Bonis M. Glambuzzi I. et al.Long-term outcomes of stand-alone Maze IV for persistent or long-standing persistent atrial fibrillation.Ann Thorac Surg. 2020; 109: 124-131Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar In addition, the authors noted significant increase in left ventricular ejection fraction, which undoubtedly had a favorable effect on prognosis in this patient category. The article has no comprehensive information about antiarrhythmic therapy, although it could have an effect on surgical outcomes. Has the influence of antiarrhythmic therapy on the effectiveness of a stand-alone Cox-maze IV procedure been assessed? What antiarrhythmic drugs were used in these patients before and after surgery? At our center, we performed a small study confirming the efficiency of amiodarone use before a maze IV procedure and dual-chamber programmed stimulation after a maze IV procedure. The treatment group consisted of 22 patients, and the control group contained 42 patients. In our work, amiodarone (200 mg/day) was administered preoperatively and within the 7-day period after surgery, and postoperative dual-chamber programmed stimulation was used in the mode by 10 heart beats above self-cardiac rhythm.3Trofimov NA, Babokin VE, Medvedev AP. Method for prevention of recurrent atrial fibrillation following cardiosurgical operations. Patent RF, RU2567920C1, 2014.Google Scholar In the treatment group, amiodarone helped to reduce the number of recurrences of AF by 24.2% (P = .038) and to reduce rhythm disorders in the postoperative period by 34.9% (P = .008) compared with control group patients. Long-term Outcomes of Stand-Alone Maze IV for Persistent or Long-standing Persistent Atrial FibrillationThe Annals of Thoracic SurgeryVol. 109Issue 1PreviewThe study sought to assess the long-term outcomes of the stand-alone Cox-Maze IV procedure in symptomatic patients with refractory, persistent, or long-standing persistent atrial fibrillation (AF). Full-Text PDF ReplyThe Annals of Thoracic SurgeryVol. 109Issue 5PreviewWe thank Drs Babokin and Trofimov1 for their comments on our study.2 They underline that the use of perioperative antiarrhythmic drugs (AADs) may positively affect surgical outcomes. However prophylactic use of amiodarone after surgical atrial fibrillation (AF) ablation has been debated for a long time. As recognized in the 2017 HRS/EHRA expert consensus statement, “the usefulness of initiation or discontinuation of AADs therapy during the post-ablation healing phase in an effort to improve long-term outcomes, is unclear (Class IIb) (p. Full-Text PDF

Цель исследования проанализировать результаты хирургического лечения пациентов с митральными пороками, осложненными фибрилляцией предсердий (ФП) и высокой легочной гипертензией, выявить основные предикторы рецидива ФП, а также оценить эффективность превентивного использования амиодарона у данной группы больных. Материал и методы. Проанализированы результаты хирургического лечения 151 пациента с митральным пороком, сопутствующей ФП и высокой легочной гипертензией (более 40 мм рт. ст.), которым в условиях искусственного кровообращения выполнена коррекция клапанной патологии (контрольная группа, n62) и хирургическое лечение митрального порока в сочетании с оперативным лечением ФП (основная группа, n89) посредством выполнения процедуры Maze-IV с использованием радиочастотного деструктора под контролем трансмуральности в период с 2015 по 2017 гг. Результаты. Исследование показало эффективность процедуры Maze-IV на уровне 66 через 2 года у пациентов с митральным пороком, ФП и высокой легочной гипертензией. Также не выявлено значимого влияния хирургического лечения ФП на снижение легочной гипертензии в послеоперационном периоде. Анализ случаев рецидива ФП позволил выявить неблагоприятные предикторы исходную дилатацию левого предсердия и давность аритмического анамнеза, что необходимо учитывать при планировании у таких пациентов хирургической коррекции. Заключение. Радиочастотная аблация предсердий по схеме Maze-IV является эффективным и безопасным способом хирургической коррекции ФП у пациентов с пороками митрального клапана и высокой легочной гипертензией, позволяет сохранить синусовый ритм у66 пациентов в послеоперационном периоде при наблюдении в течение 2 лет. Хирургическое лечение ФП не оказывает значительного влияния на снижение легочной гипертензии у пациентов с пороком митрального клапана, осложненным ФП и высокой легочной гипертензией. Наличие высокой легочной гипертензии значительно ухудшает результаты хирургического лечения ФП у пациентов с митральными пороками (p-0,041) и сохраняется на высоком уровне после изолированной коррекции клапанной патологии, что требует дополнительного специфического лечения. Предикторами рецидива ФП после процедуры Maze-IV являются исходная дилатация полости левого предсердия более 5,5 см (р20,001) и давность аритмического анамнеза более 2 лет (р20,001).

Aim. To analyze the dynamics of echocardiographic parameters after surgical treatment of severe pulmonary hypertension in patients with mitral valve disease and atrial fibrillation.Material and Methods. Data of surgical treatment in 202 patients with mitral valve disease complicated by severe pulmonary hypertension with blood pressure more than 40 mm Hg and atrial fibrillation were analyzed. Surgical intervention in these patients consisted in surgical correction of mitral dysfunction with artificial prosthetic valve or valve-preserving intervention (group 1, n = 62). In patients of group 2 (n = 89), correction of mitral valve defect was also performed as well as the Maze IV procedure for concomitant atrial fibrillation using bipolar radiofrequency ablator AtriCure. Patients of group 3 (n = 51) underwent integrated surgery, which consisted in the elimination of mitral valve defect, surgical correction of atrial fibrillation by Maze IV procedure, as well as circular radiofrequency denervation of the trunk and mouth of the pulmonary arteries (pulmonary artery denervation (PADN)).Conclusions. The circular PADN procedure was effective and safe, significantly reduced the level of pulmonary hypertension in the postoperative period (p = 0.018), and promoted reverse remodeling of the heart cavities. Integrated surgical correction in patients with mitral dysfunction, atrial fibrillation, and severe pulmonary hypertension may significantly reduce the phenomenon of heart failure (p = 0.023). Further analysis of the effectiveness of radiofrequency denervation of pulmonary arteries with the study of a larger number of patients, analysis of long-term results, as well as determining the possibility of this technique in patients with non-valvular forms of pulmonary hypertension are required.

Currently, the analysis of the fibrosis severity during the restructuring of the surrounding extracellular matrix (ECM) is studied in most of the research works devoted to “cardiac remodeling”. At the same time, the role of the basal membrane of cardiomyocytes in heart diseases was not studied. The basal membrane of cardiomyocytes is a highly organized layer of the ECM which is located on the outer side of the sarcolemma. Degradation of ECM components is carried out by different types of matrix metalloproteinases (MMP), which have proteolytic activity and are actively involved in the process of ECM remodeling, destroying its components such as collagen, elastin, fibronectin, glycosaminoglycans and other structural components.Aim. To evaluate the ECM status in patients with coronary artery disease and its effect on left ventricular myocardial remodeling.Material and methods. Morphological and immunohistochemical (IHC) examination of left ventricular myocardial biopsies was performed in 16 patients undergoing left ventricular reconstruction in combination with coronary artery bypass grafting.Results. The IHC study revealed the accumulation of matrix metalloproteinase-9 in the cytoplasm of cardiomyocytes. This accumulation was combined with partial or complete destruction of the basal membranes (BM) of cardiomyocytes formed by type IV collagen.Conclusion. Type IV collagen destruction in basal membranes of left ventricular cardiomyocyteswasrevealed. It iscausedbytheactionofmatrixmetalloproteinase-9, which accumulates in the cell cytoplasm.

The article by Hui and colleagues 1 Hui D.S. Restrepo C.S. Calhoon J.H. Surgical decision making for left ventricular aneurysmectomy. Ann Thorac Surg. 2020; 110: e559-e561 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar shows a thrombus dissection surgical technique for aneurysmectomy after opening the left ventricle (LV) in the area of the aneurysm. In our study, we used the experience of Dor and colleagues 2 Dor V. Di Donato M. Sabatier M. Montiglio F. Civaia F. RESTORE GroupLeft ventricular reconstruction by endoventricular circular patch plasty repair: a 17-year experience. Semin Thorac Cardiovasc Surg. 2001; 13: 435-447 Abstract Full Text PDF PubMed Scopus (98) Google Scholar and used endocardectomy, exfoliating the centimeter after the centimeter of the epicardium from the endocardium without completely opening the LV cavity, thereby not stratifying the thrombus, but removing it completely together with the fibrous endocardium. This made it possible to reduce the time of the operation, including aorta clamping time, as well as to reduce the risk of intraoperative thromboembolism. Surgical Decision Making for Left Ventricular AneurysmectomyThe Annals of Thoracic SurgeryVol. 110Issue 6PreviewLeft ventricular aneurysms may be repaired by the linear technique or endoventricular circular patch plasty technique. Choice of technique should be based on the individual patient, including cavity and aneurysm geometry. In this article, we describe the principles underlying decision making with 2 illustrative cases. Full-Text PDF On Ventricular Aneurysms, Thrombi, and COVID-19: ReplyThe Annals of Thoracic SurgeryVol. 111Issue 5PreviewWe read with interest the letter by Dr Babokin1 and agree with his points regarding resection of periinfarct myocardium that may harbor foci of ventricular tachycardia. The technique he describes is one of several to manage postinfarct left ventricular (LV) aneurysms, ranging from the simple linear technique to endoventricular circular patch plasty, as we described.2 The choice of technique should be patient-specific, with the salient points being restoration of normal LV volume and appearance as much as possible, exclusion of akinetic segments and nidus for thrombus, and preservation of mitral competency. Full-Text PDF

Aim. To estimate the efficacy of catheter ablation in patients with type 2 diabetes mellitus (T2D) present with atrial fibrillation and sick sinus syndrome (SSS) undergoing permanent pacemaker implantation.Methods. 56 patients (34 females) with persistent AF and SSS were enrolled in the study. The mean age of patients was 67.7±10.7 years. Dual chamber cardiac pacemaker with remote monitoring function were implanted in all patients. All the patients were assigned to two groups: Group 1 comprised 31 patients aged 67.3±9.6 years, and Group 2 comprised 25 patients aged 72.6±9.9 years, including 22 (39.2%) diabetic patients. 2-3 days after pacemaker implantation, group 1 patients underwent intracardiac electrophysiology study and RFA of the pulmonary vein ostia, mitral isthmus and the left atrial posterior wall. Group 2 patients received antiarrhythmic drug therapy. Results. 3 patients (9%) in Group 1 had recurrent AF within the 6-month follow-up. The efficacy of the RFA for AF was 55% (n = 17) 1 year after the indexed hospitalization. 8 patients had short paroxysmal attacks which gradually lessened and stopped after. 5 patients (21%) in Group 2 did not have any AF paroxysms within the 1-year follow-up (Х2 = 5.52, р = 0.02). All these patients received amiodarone as antiarrhythmic drug therapy, whereas the others had paroxysmal attacks. Frequent attacks in 10 patients (40%) led to a change in antiarrhythmic drug use. Hospital readmission rates for AF were 16% and 52%, respectively (Х2 = 4.15, р = 0.04). The impact of atrial and ventricular stimulation on the development of recurrent AF was statistically insignificant (atrial stimulation – X2 = 0.01, cc = 1, p = 0.90; ventricular stimulation – X2 = 0.15, cc = 1, p = 0.69). None paroxysmal attacks were recorded in 10 diabetic patients (45%) after the RFA within the 1-year follow-up.Conclusion. Catheter ablation for persistent AF and SSS treated with permanent pacemakers is highly effective and safe method. In addition, it is superior to pharmacological approach. The presence of T2D likely did not significantly affect the efficacy of RFA for persistent form of AF.

Introduction. Despite recent achievements in medicine, many issues in the diagnosis and treatment of infective endocarditis (IE) remain outstanding. This is mainly due both to an increase in the incidence and changes in the clinical picture of this nosology. An important factor here is the continuing presence of existing principles governing the approach to the surgical treatment of infective endocarditis, including prosthetic endocarditis.Objective: to evaluate the effectiveness of an integrated approach to the treatment of infective endocarditis in patients with valvular heart disease on the basis of 37 years of experience.Materials and methods. An analysis of the surgical treatment of 1097 patients with infectious lesions of the valvular heart apparatus was carried out. The mean age of the sample was 35.1 ± 9.7 years (from 4 months to 68 years); 67.2 % were men, while women made up 32.8 %. Additionally, 122 patients had infectious lesions affecting 2 or more valves. In 109 cases, valvular prosthetic endocarditis was diagnosed; in 37 patients, IE was detected against the background of congenital heart defects. 99 patients had perianular abscesses. Of all surgical interventions carried out, 18 were repeated, including those with non-valvular congenital heart defects.Results and discussion. Overall hospital mortality was 4.3 % (47 patients). In patients with IE complicated by a congenital heart defect (CHD), mortality was 14.7 %; with endocarditis of mechanical heart valves — 13.2 %; in drug-dependent patients — 4.5 %; with infectious destruction of native heart valves — 2.8 %; in patients with a background of electrodeinduced endocarditis, no deaths during hospitalisation were observed.Conclusions. The effectiveness of surgical intervention of infective endocarditis can reach 85.4 %. When supplemented with pathogenetic and etiotropic therapy, surgical correction of affected heart structures contributes to the rapid and reliable sanitation of all infection foci, as well as to a reduction in multiple organ failure. Timely surgery significantly reduces the degree of heart failure and improves the NYHA functional class. In the long term, reconstructive interventions contribute to a better heart recovery than prosthetic operations. It should be noted that the proposed treatment approach for this group of patients creates conditions for adequate labour and social rehabilitation in a distant postoperative period.