Highlights

Developing international registry that would unify different patient populations not represented in other registries and studies, and include patients with both manifested and subclinical atherosclerosis, is crucial for cardiovascular field. The collected data can be used in national guidelines, teaching and learning guides, and in clinical practice.

Abstract

Multifocal atherosclerosis (MFA) is one of the key issues in modern medicine. Several vascular beds are involved in the pathological process in every fifth patient with detected atherosclerosis. Moreover, patients with MFA have high risk of ischemic events, lower quality of life, shorter life expectancy and disability. “The Eurasian Association of Internal medicine” proposed to create a registry on real clinical practice in order to collect data on the frequency, detection methods, clinical course, risk factors and outcomes of patients with MFA in specialized centers in Russia and Commonwealth of Independent States (Republic of Kazakhstan, Republic of Uzbekistan, Republic of Belarus).

Highlights

There are data about speech disorders in children with congenital heart defects. The results of the speech research in 4–6 years old children before and after surgery are described according to the surgical tactics.   

Aim. To compare linguistic and cognitive disorders in in 4–6 years old children with congenital heart defects before and after surgery.

Methods. A prospective investigation of group of children (n = 92) with septal heart defects was done before and after surgery and within decreed terms: in 1 and 2 years after the surgical correction of congenital heart defects in cardiopulmonary bypass or in cath-lab in Research Institute for Complex Issues of Cardiovascular Diseases. The anamnesis, clinical and hemodynamic aspects were studied before and after surgery, as well as early postoperative period, residual hemodynamic disorders and speech diagnostic was also done.

Results. 57% children had different speech disorders (general or delayed speech development) in preoperative period. It was made worse by cardiosurgery: the number of children with speech disorders increased to 63% in a year after surgery and was 59.8% in 2 years, while there was a positive dynamic in clinical and hemodynamic aspects.     

Conclusion. There are speech disorders in children with septal heart defects after surgery in long-term postoperative period despite of clinical and hemodynamic normalization. That can lead to the real risks and quality of life worsening in general in the absence of timely correction. 

Highlights

The presence of preoperative mild cognitive impairment (MCI) in patients undergoing combined carotid endarterectomy and coronary artery bypass grafting is associated with an increased theta activity at the frontal and parieto-occipital regions of both hemispheres after surgery.

Abstract

Aim. To study the impact of preoperative cognitive impairment on changes in electrical activity of the brain in patients undergoing combined carotid endarterectomy and coronary artery bypass grafting.

Methods. Sixty-three patients undergoing combined carotid endarterectomy (CAE) and coronary artery bypass grafting (CABG) were included in the study. The patients were divided into three groups, depending on the preoperative cognitive functions: without cognitive impairment (n = 17), with MCI (n = 29), and with severe cognitive impairment (n = 17). High-resolution electroencephalography (EEG) (62 channels, bandpass filtered between 0.1–50.0 Hz, sampling rate of 1000 Hz) was performed 3–5 days before and 7–10 days after surgery.

Results. Patients with severe cognitive impairment at baseline presented with higher theta activity at the frontal region of the left hemisphere compared to patients without cognitive impairment and patients with MCI (p = 0.048). At the same time, patients with MCI showed the most pronounced theta activity increase after surgery compared to preoperative levels at the frontal and parieto-occipital cortical regions of both the left and right hemispheres (p≤0.05). Postoperative changes of theta activity in patients with severe cognitive impairment were minimal and statistically insignificant.

Conclusion. Patients without severe preoperative cognitive impairment presented with higher grade brain dysfunction in the form of increased theta activity at the frontal and parieto-occipital regions after combined CAE and CABG. A smaller decrease in theta power after surgery in patients with severe preoperative cognitive impairment, on the one hand, can indicate compensation after cerebral ischemia and resistance to hypoperfusion during on-pump cardiac surgery, and on the other, can be a manifestation of the ceiling effect and insufficiency of brain functional reserves.

Highlights

High cardiovascular morbidity and mortality in the Russian Federation and in Kuzbass is mainly due to high number of elderly and senile patients; it simply reflects the current demographic situation in the country. Elderly and senile patients with acute coronary syndrome (ACS) account for 50% of hospitalized patients. In real clinical practice, a significant number of elderly patients with ACS receive conservative treatment, whereas the prognosis in this cohort is determined by the development of recurrent coronary events and the progression of heart failure. Due to small number of patients older than 75-80 years included in randomized clinical trials, there are certain gaps in the management of elderly patients with ACS and heart failure. Obviously, elderly patients require a special approach to patient management, taking into account the complexity of clinical and anamnestic factors affecting the prognosis.

Abstract

Aim. To study clinical and prognostic features of elderly patients with unstable angina pectoris undergoing conservative treatment depending on left ventricular ejection fraction (LVEF).

Methods. 130 elderly patients, with mean age of 82 (77; 89) years, hospitalized for unstable angina with a GRACE score of less than 140 to a vascular center in Kemerovo were included in the study. During hospitalization, standard laboratory and instrumental studies were performed, except coronary angiography. The quality of life was assessed using the EQ-5D 3L questionnaire. After 12 months, patient compliance with treatment recommendations, primary and secondary endpoints, and quality of life were analyzed.

Results. All patients were diagnosed with heart failure, 50 (38.5%) patients presented with LV EF less than 40% (the group I), 80 (61.5%) patients presented with LV EF more than 40% (the group II). The groups were comparable in gender, age, presence of multifocal of atherosclerotic disease, prevalence of aortic stenosis, arrhythmias and comorbidities. Women predominated in both groups, and arterial hypertension was noted in all patients. In the group I, a history of myocardial infarction, coronary revascularization, and NYHA FC III were more common (p<0.05). The level of quality of life at discharge was low in both groups: 34.8 (29; 42) and 39.4 (34; 46) points, respectively (p>0.05). Almost all patients were on triple neurohumoral blockade (beta-blockers, renin-angiotensin-aldosterone system inhibitors and mineralocorticoid receptor antagonists) for heart failure and dual antiplatelet therapy. One year later, 85.2% of patients in the group I and 90% of patients in the group II were taking all prescribed medication at low or medium therapeutic doses (without the need for drug titration). The overall mortality in the groups was 46% and 37.5%; cardiovascular deaths accounted for 32% and 30%, respectively (p>0.05). There were no differences in the frequency of endpoints (hospitalization, stroke, acute coronary syndrome, coronary revascularization) between the groups. The level of quality of life remained low in both groups.

Conclusion. In patients over 75 years hospitalized for unstable angina, main clinical and anamnestic characteristics, annual prognosis and quality of life do not depend on LV EF, whereas the need for coronary revascularization during the 1 year remains high.

Highlights

• The authors conducted a comparative analysis of early postoperative complications, mortality and economic costs in patients who underwent additional urgent endovascular revascularization and patients with standard postoperative period.
• There are statistically significant differences between the groups in terms of the number of resternotomies performed, the need for transfusable blood components and economic costs.
• It is necessary to introduce routine intraoperative quality control of the intervention, and a set of measures aimed at early detection of coronary graft failure in real clinical practice.

Abstract

Aim. To assess the impact of coronary graft failure and subsequent urgent endovascular revascularization in the early postoperative period after elective coronary artery bypass grafting on hospital outcome.

Materials and methods. 8801 patients underwent isolated coronary artery bypass grafting at the Federal State Budgetary Institution “Federal Center for Cardiovascular Surgery” of the Ministry of Health of the Russian Federation in Chelyabinsk from 2011 to 2020. Inclusion criteria were as follows: patients with stable coronary heart disease, patients undergoing elective coronary artery bypass grafting. Exclusion criteria were as follows: patients with unstable angina and acute myocardial infarction who underwent urgent revascularization. The primary endpoint was hospital mortality, secondary endpoints are bleeding requiring resternotomy, acute abdominal and infectious complications, and multiple organ failure. Due to suspected acute myocardial injury, 196 (2.23%) patients underwent urgent coronary angiography, and according to angiogram, additional endovascular correction was performed in 60 (0.68%) patients (the group I). To assess the impact of coronary graft failure and subsequent revascularization on hospital outcome we have analyzed: hospital mortality, complications in the early postoperative period, financial costs. Moreover, we have formed the group II of 60 people with uncomplicated postoperative period for comparative analysis.

Results. Of 196 (2.23%) patients who underwent urgent angiography 60 (0.68%) patients required stenting of native coronary arteries or conduits due to coronary graft failure. Hospital mortality in the group with complicated postoperative period was 10 % (6 cases), hemorrhagic complications occurred in 13 (21.7%) patients, acute abdomen was noted in 4 patients, and sternal wound infection was noted in 5 patients, hemodialysis due to multiple organ failure was performed in 5 patients. An intergroup comparative analysis revealed a clear trend towards an increase in deaths in the group I (n = 6/10%) compared to the group II (n = 1/1.7%), however, there were no significant differences (p = 0.11^F). Hemorrhagic complications occurred significantly higher in group I (13/21.7% versus 1/1.7%, p = 0.001^F); there were no statistically significant differences associated with the other complications. The number of bed-days spent in the hospital and in the intensive care unit was statistically significantly higher in the group I, financial costs per patient were also significantly higher in the group I.

Conclusion. Coronary bypass graft failure in the early postoperative period leads to an increase in hospital mortality, in the frequency of multiple organ failure and hemorrhagic complications, and significantly increases the amount of needed economic resources.

Highlights

The article describes the first conducted pseudorandomized comparative study of mitral valve replacement using either traditional or “valve-in-valve” techniques.

Abstract

Aim. To compare short-term (perioperative) and medium-term (6 months) outcomes of surgical treatment of bioprosthetic mitral valve dysfunction using traditional and “valve-in-valve” methods.

Methods. The study included 18 patients undergoing “valve-in-valve” replacement and 18 patients undergoing traditional mitral valve replacement (open mitral valve replacement) chosen according to the following criteria: heart disease type, predominant type of defect, age, gender, severity of the disease and the presence of concomitant pathology and using 1:1 matching on the propensity score.

Results. No perioperative mortality was noted in both groups. The cardiopulmonary bypass and cross-clamping of the aorta time was significantly lower in the “valve-in-valve” group. Comparison of echocardiographic parameters revealed a decrease in the mean pulmonary arterial pressure gradient, and a decrease in the size of the heart chambers in both groups. The peak and mean transvalvular gradient were lower in the “traditional” group. There were no cases of patient-prosthesis mismatch. In the mid-term period, patients in both groups presented with a lower functional class of heart failure.

Conclusion. Bioprosthetic mitral valve replacement using the “valve-in-valve” technique provides comparable clinical and hemodynamic results compared to the “traditional” technique in short-term and mid-term periods, and significantly reduces cardiopulmonary bypass and aortic cross clamping time.

Highlights

• The «TiAra» bioprosthetic heart valves have better hemodynamic characteristics, such as higher effective orifice area and a lower mean pressure gradient.
• The «UniLine» bioprosthetic heart valve demonstrated better closing dynamic, expressed in a smaller regurgitation volume.

Aim. To assess hydrodynamic characteristics of the «TiAra» bioprosthetic heart valve with flexible supporting frame compared with the classic stented «UniLine» bioprosthetic aortic valve.

Methods. Using the Vivitro Pulse Duplicator (Vivitro Labs, Canada), we simulated the function of the heart via generating pulsatile flow to analyze bioprosthetic heart valves. To comprehensively assess the bioprosthesis function, three valves of each standard size (21, 23, 25 mm) were submitted to hydrodynamic testing, thus making a sample of nine bioprostheses of each model. The article provides the analysis of  the effective orifice area, mean pressure gradient, regurgitation volume, and assessment of the statistical sensitivity of the parameters between groups at p = 0.05.

Results. The assessment revealed that the «TiAra» bioprosthesis has bigger effective orifice area (p = 0.006) and lower mean pressure gradient (p = 0.02): 1.6–2.2 cm² and 3.6–6.3 mmHg versus 1.08–1.73 cm² and 4.8–12.1 mmHg, respectively. The regurgitation volume, however, was lower in the «UniLine» bioprostheses 0.8–4.1 mL/cycle versus 6.2–9.0 mL/cycle (p = 0.0004).

Conclusion. Despite the fact that both studied models showed good hydrodynamic performance, the prosthesis with the flexible supporting frame («TiAra») showed better results regarding its effectiveness in vitro via presenting with bigger effective orifice area and lower mean pressure gradient. At the same time, the «UniLine» stented bioprosthesis had lower regurgitation volume, i.e. better closing dynamics.

Highlights:

The article presents data on the availability of various types of high-tech cardiovascular care services to residents of subjects of the Russian Federation. The authors used original methodology based on the data of the Healthcare Administration of the subjects of the Russian Federation. The obtained data were compared with the data from the Federal Tax Service Office No. 12, and 14, demographic and socio-economic indicators of the subjects of the Russian Federation. The results of the analysis open up new opportunities for studying the causes of pronounced differences in the provision of high-tech cardiovascular care to the population of the country's regions and taking appropriate regulatory measures, thus contributing to practical healthcare.

Aim. To analyze the provision of high-tech cardiovascular care (HTCC) to residents of the Russian Federation regions in 2021 taking into account social and economic factors.

Methods. The data from the original form designed in A.N. Bakulev National Medical Research Center of Cardiovascular Surgery containing information on the number of patients who underwent cardiovascular surgeries were compared with the data from the Federal Tax Service Office follow-up forms No.12 and No.14, taking into account demographic and social-economic factors of the RF regions according to the Federal Service of State Statistics. 74 regions were included into the analysis. The following methods of univariate statistics were used: Spearman’s and Kendall’s rank correlation, measures of central tendency and variance were calculated. Intergroup comparison was carried out using Mann-Whitney two-tailed test and Kruskall-Wallis one-way analysis of variance.

Results. The mean provision of HTCC included in the Section I of the Free Health Care Policies for Citizens (HTCC-1) was 1910 surgeries per 1 million population, provision of HTCC included in the Section II (HTCC-2) – was 789.5, respectively. We have noted the negative correlation between the amount of HTCC -1 and HTCC -2 surgeries and hypertension mortality (p = 0.034). The mortality from other acute CAD correlated negatively with the provision of coronary artery bypass grafting (CABG, p = 0.034). The authors also noted the negative correlation between the provision of HTCC -2 surgeries and circulatory diseases (CD) overall incidence (p = 0.032), primary CD incidence (p = 0.014), CAD overall incidence (p = 0.034) and more. The region’s economic development level influenced the provision of HTCC -2 surgeries. The positive correlation coefficients were obtained for per capita income (p = 0.004), median per capita income (p = 0.002), real amount of granted pensions (p = 0.003) and other parameters. The number of CABG per 1 million and life expectancy was higher in the RF regions where CABG was performed locally compared to the regions that did not provide cardiovascular care (205.82 vs 165.55 and 69.49 vs 68.64).

Conclusion. The indicators of HTCC-1 and HTCC-2 provision in the RF regions differed by 8.4 and 9.2 times, respectively; the indicators of provision of surgeries by 14.7 and 201.9 times. Providing residents of the RF regions with cardiovascular surgeries is influenced by a number of factors among which we highlight the availability of this type of treatment in the region, regional economic resources to co-finance HTCC -2 treatment, population`s compliance with the surgical treatment safety checklist.

Highlights

The article outlines the modern concept of arterial myocardial revascularization, presents the most promising directions for development of coronary surgery, and describes the results and prospects of the clinical application of autogenous arterial grafts using two internal thoracic arteries in various graft configuration and in situ, making it possible to assess the effectiveness of the procedure. 

Abstract

There are many approaches to coronary artery bypass grafting with the internal thoracic arteries: the use of I and Y configuration, in situ grafts, and composite grafts. However, there is no consensus on the most effective type of configuration of arterial grafts. This is due to the complexity of making the composite Y graft, determination of the risk factor, and the lack of sufficient evidence regarding the main approaches to bypass grafting with autogenous arterial grafts. 

Highlights

The article is a comprehensive literature review on anatomical variations and anomalies of cardiac veins. A classification of coronary venous anatomy and anomalies detailing clinical, anatomical and radiological features is proposed. Developing such classification is important for the field of left ventricular lead placement, as it would cover a variety of clinically significant anomalies of cardiac veins.

Abstract

With the advancements in the cardiac resynchronization therapy, the role of cardiac vein anatomy has become vital due to the complications associated with poor left ventricle lead placement. The cardiac vein anatomy varies much more than the anatomy of the coronary arteries, thus making cardiac veins much harder to study. In this article we have analyzed different approaches to description and naming of cardiac veins, and have summarized venous anomalies and features described in literature or encountered in real clinical practice. All anatomical features described in the article have a clinical significance in the left ventricle lead placement. Moreover, we have analyzed the wide variety of suggestions to overcoming anatomical obstacles. As a result of the analysis, we have proposed a clinical classification of the coronary venous anomalies and features that can be used during the implantation of cardiac resynchronization therapy devices.

Highlights

The development and implementation of video-assisted thoracoscopic atrial fibrillation ablation since 2005 by R. Wolf and colleagues have undergone a number of modifications for improvement and simplification. A study of the evolutionary development of thoracoscopic ablation of atrial fibrillation is necessary to optimize ablation recruitment and surgical technique for different forms of atrial fibrillation.

Abstract

There is a variety of treatments for atrial fibrillation (AF): therapeutic, interventional and surgical. The effectiveness of these methods varies significantly depending on the form of AF. For a long time, surgery was considered the only highly effective treatment for AF. In modern arrhythmology, «Maze IV» and its modifications are considered only as a simultaneous procedure in cardiac surgery. The work of M. Haïssaguerre et al. has established that the main focus of catheter ablation (CA) in AF should be the pulmonary veins, but their isolation in non-paroxysmal AF is questionable. This discovery has stimulated the development of alternative treatment modalities for resistant AF. Recently, video-assisted thoracoscopic epicardial ablation (TSA), which does not require sternotomy, cardiopulmonary bypass and cardioplegia, has been increasingly preferred. TSA of AF is an alternative surgical treatment for isolated forms of AF on the working heart. This procedure may include: pulmonary vein ablation, posterior left atrial wall and pulmonary vein ablation and left atrial appendage exclusion, but its effectiveness varies considerably due to the heterogeneity of patients, surgical technique and follow-up period. The aim of this review is to provide data on the evolutionary development of thoracoscopic ablation of AF depending on the choice of surgical access, ablation line set and ablation device.

Highlights

• Valve replacements using mechanical prostheses are not inferior, and sometimes even advantageous to bioprostheses in terms of transvalvular hemodynamics and left ventricle reverse remodeling;
• During the average follow-up period, a significantly lower average pressure gradient and a higher effective opening area were recorded in the group undergoing neocuspidization with autologous pericardium compared to other types of implants;
• Despite the obvious hemodynamic advantages of transcatheter aortic valve replacement, the midterm follow-up has revealed significant residual aortic regurgitation, which is highly undesirable.

Abstract

Currently, there are not enough data on the comparative analysis of echocardiographic outcomes, especially in regards to the state of the left ventricle in the long term after different aortic valve interventions. In this review, we present up-to-date literature data (publications published over 20 years) concerning echocardiographic outcomes after different aortic valve replacements. For the search of publications, the authors used international databases such as Scopus, Web of Science, Pubmed and Cochrane. The search keywords were: “aortic valve surgery”, “long-term period”, “echocardiographic outcomes”, “quality of life”. The analysis includes only comparative randomized, prospective or retrospective studies. A comparison between mechanical and biological prostheses has demonstrated that mechanical valves, in addition to displaying higher durability, can be advantageous in certain situations to bioprostheses in relation to transvalvular hemodynamics and reverse left ventricle remodeling. Regarding the comparison of stentless and stented bioprostheses with respect to peak transvalvular gradients and the effective orifice area, an obvious advantage was observed in the stentless bioprosthesis group. The majority of randomized clinical trials have showed great hemodynamic advantages of the Ross procedure in comparison with other types of aortic valve replacement, and an increase in the number of participants (due to future trials) may demonstrate even greater statistical significance. We have found only one publication that presents data on the comparison of the mid-term hemodynamic outcomes of neocuspidization of the aortic valve using autologous pericardium with other types of interventions. With an average follow-up period of 426±270 days, a significantly lower average pressure gradient and a higher effective orifice area were recorded in the neocuspidization group. Despite hemodynamic benefits of transcatheter aortic valve replacement in the mid-term period after surgery, the results of postoperative monitoring show significant residual aortic regurgitation, which is highly undesirable.

Highlights

The article describes a clinical case of a patient with metastatic breast cancer detected after aortic valve replacement. The case was initially treated as sternal osteomyelitis due to ministernotomy performed during aortic valve surgery. However, the diagnosis of metastatic breast cancer with sternal and spinal (third thoracic vertebra) metastatses, and ribs lesion was established upon further study. Adjuvant endocrine therapy was prescribed to the patient due to her age and previous surgery.

Abstract

Breast cancer is an urgent problem in oncology as it remains the most frequent type of cancer in the Russian Federation and world wide. Long-term treatment success and survival of patients depend on selected treatment modality, and long-term postopertive monitoring of patients as the means of the early detection of metastatic recurrence. Furthermore, concominant somatic ilness could change or mask the symptoms of local recurrence or metastasis, resulting in difficulties with establishing the proper diagnosis. We report a clinical case of metastatic breast cancer in a patient with severe aortic stenosis who underwent aortic valve replacement. We have not found analogious cases in domestic and foreign literature.

Highlights

• The article presents the analysis of anxiety and depressive disorders in patients who were followed as outpatients after surgery for chronic thromboembolic pulmonary hypertension in the long term, taking into account the study during the COVID–19 pandemic.
• The prevalence of clinically pronounced anxiety disorders in the group was 10.9%, depression - 18.6%, a combination of anxiety-depressive disorders was noted in 10.3% of cases.
• Multifactorial analysis revealed that the development of severe anxiety disorders in patients with chronic thromboembolic pulmonary hypertension in the long term is associated with a complicated postoperative course. Independent risk factors for clinically pronounced depressive disorders in these patients were older age, a history of cerebral circulation disorders, as well as pronounced post-COVID-19 functional disorders.

Aim. To study the frequency and severity of anxiety-depressive disorders in patients with chronic thromboembolic pulmonary hypertension (CTEPH) in the long term after pulmonary thromboendarterectomy and to identify factors affecting their development.

Methods. 156 patients with CTEPH were examined in the long term after surgery using the generalized anxiety disorder (GAD) questionnaire GAD-7 and the Beck`s Depression Inventory. In patients who suffered COVID-19, a “Post-COVID-19 Functional Status scale” (PCFS) was used to measure functional status over time after COVID-19. Logistic regression analysis was used to identify predictors of clinically pronounced GAD and depression in the long-term period after surgery.

Results. In patients with CTEPH, clinically significant GAD and depression in the long term after surgery were observed in 10.9 and 18.6% of cases, respectively. A combination of anxiety and depressive disorders was noted in 10.3% of patients. The development of GAD was associated with cardiopulmonary insufficiency in the early postoperative period (ОR 3,1; CI 1,2–13,8; p = 0,009). Clinically pronounced depression was associated with older age (ОR 1,3; CI 1,04–2,0; p = 0,02), chronic cerebral circulatory insufficiency (ОR 7,6; CI 1,8–17,5; p = 0,02) and pronounced post-COVID-19 functional neurological disorders according to the PCFS scale (ОR 6,7; CI 1,9–14,5; p = 0,007). The combination of clinically expressed anxiety and depression was correlated with older age (ОR 1,1; CI 1,02–1,3; p = 0,04).

Conclusion. The prevalence of clinically pronounced GAD in the group was 10.9%, depression was 18.6%, and a combination of anxiety and depressive disorders was noted in 10.3% of patients. The development of clinically significant GAD is associated with a complicated course of cardiac surgery. Independent risk factors for clinically significant depression were older age, a history of cerebral circulatory disorders and pronounced post-COVID-19 functional neurological disorders.

Highlights

The authors have studied anemia`s impact on the long-term mortality after mitral valve surgery. The research results indicate the need to address this modifiable factor in the preoperative period.

Aim. To analyze the impact of anemia on the long-term survival of patients after mitral valve surgery.

Methods. The study included 103 patients, 46 of them were men, 57 were women. Thirteen patients presented with anemia before surgery, and 90 patients did not have anemia. The survival rate of patients was compared using the Kaplan-Meier estimate.

Results. The survival rate after surgery in the group of patients without anemia was higher compared with patients with anemia (p = 0,002). By the end of the follow-up period, the survival rate among patients without anemia reached 50.2%, whereas among patients with anemia it was 0.0%.

Conclusion. Anemia is an independent predictor of complications in the postoperative period in patients with low preoperative hemoglobin levels. According to the results, the presence of anemia increases the risk of adverse events by 7.71 times in the preoperative period. Moreover, patients without anemia had the highest (up to 50.2%) survival rate in the long-term period, while patients with anemia had a survival rate equal to 0.0%.

Highlights

• The present study was conducted to evaluate in-hospital outcomes of one of the most effective and simultaneously controversial surgical techniques for myocardial revascularization using two internal thoracic arteries (ITA).
• To this date, this is the most complete analysis that has been carried out at the Research Institute on the topic of studying bilateral internal thoracic artery grafting (BITA). The results obtained are of great importance for the subsequent evaluation of long-term results.

Abstract

Aim. To analyze in-hospital outcomes of BITA.

Methods. The study included 232 patients who were admitted to the Cardiac Surgery Department for coronary artery bypass grafting (CABG). All patients were divided into 2 groups depending on the use of either single or bilateral ITA conduits. Both groups included equal number of patients – 116. In-hospital outcomes were analyzed.

Results. BITA and CABG with single ITA were proven to be comparable regarding myocardial infarction, stroke, the need for percutaneous coronary intervention, death, and composite endpoint. At the same time BITA patients significantly more often had longer hospital stay and required inotropic drugs.

Conclusion. BITA is a safe procedure comparable to classic CABG in terms of in-hospital complications, but at the same time, this intervention is associated with longer hospital stay, and extended inotropic drugs use.

Highlights

The article presents the latest data on the techniques of implantation of the mitral homograft in the tricuspid position, and identifies groups of patients who are best suited for this method. Moreover, the article describes the evolution of this type of replacement, and highlights that many surgical techniques, although justified, require further study to show demonstrate their advantages.

Abstract

Despite the general trend in cardiac surgery towards valve-preserving interventions, valve replacements remain relevant, and the search for the perfect prosthetic valve continues. Many believe that tricuspid valve replacement using a mitral homograft can be the method of choice in certain situations. The analysis of the studies found in the PubMed database led the authors to the following conclusions: most of the data on the use of this technique in patients with infective endocarditis (IE), other indications are congenital heart disease (CHD) and rheumatic heart disease. Patients with IE who have undergone tricuspid valve replacement using a mitral homograft have good medium-term prospects, and respond well to medical treatment of recurrent IE. The mitral homograft in the tricuspid position remains intact even after prosthetic endocarditis. In this regard, it is possible to perform reconstructive intervention in case of prosthetic valve dysfunction without the need for repeated replacement. Such interventions are relevant for patients with growing heart for whom annuloplasty at the first stage of surgery is undesirable. Moreover, it is also cost-effective due to the high cost and low availability of homografts. The possibility of repeated tricuspid valve-in-valve replacement is important for patients who may not survive open surgery. To date, there are not enough long-term and short-term data on using a mitral homograft for tricuspid valve replacement, however, it can be assumed that the results of this technique will be positive provided that the appropriate implantation technique and strict patient selection are ensured. Many authors have come to the conclusion that the optimal homograft implantation technique includes sewing of the graft`s papillary muscles into the wall of the myocardium of the right ventricle (RV), fixating them on the outer surface of the RV, anatomical positioning of the homograft (anterior leaflet faces towards the IVS), and the use of an annuloplasty ring.

Highlights

This clinical case describes the management of a 29 weeks pregnant patient with myocardial infarction. The material will be useful for cardiologists, physicians, obstetricians and gynecologists, and endovascular surgeons.

Abstract

Unavoidable drastic changes in lifestyle due childbirth are pushing women to postpone it to an older age, thus increasing the risk of coronary artery disease (CAD) in pregnant women. This can be a problem not only for patients, but also for specialists. Currently there are 3-6 cases of acute coronary syndrome (ACS) per 100 thousand pregnancies, meaning such cases occur rarely in real clinical practice. Discomfort in the chest area does not directly indicate cardiac problem, so women do not visit cardiologist right away, and thus ACS remains undiagnosed. Besides traditional risk factors for CAD (age, dyslipidemia, smoking, physical inactivity), there are some additional obstetric factors: preeclampsia, thrombophilia and postpartum bleeding. About 40% of patients have myocardial infarction in the third trimester. Atherosclerosis is the most common cause of ACS, with coronary artery spasms, coronary artery dissection and thrombosis following behind. Currently the maternal mortality due to MI has decreased from 20% to 5% due to introduction of the percutaneous coronary intervention (PCI) into the treatment of ACS. There are not enough data on the use of thrombolytics and other medicine in the treatment of CAD, because pharmacological therapy can be dangerous in the early pregnancy at the peak of organogenesis. Moreover, PCI should be used with caution due to harmful effects of radiation on the pregnant woman and the fetus. The main task in later stages of pregnancy is to balance out the risk of stent thrombosis upon discontinuing double antiplatelet therapy and bleeding during childbirth and in the postpartum period. This article describes a clinical case of a 29 weeks pregnant patient with myocardial infarction.

Highlights

Intravascular leiomyoma with heart extension is a rare occurring condition. According to the available data, the number of cases does not exceed 30 despite many years of studies. Often cardiac hospitals cannot establish the clinical picture, so the surgeon removes only cardiac tumors, which inevitably leads to the recurrence of the tumor after a few months.

Abstract

Leiomyomatosis is an extremely rare disease that occurs in women of childbearing age. The development of the malignant tumor is preceded by the removal of the uterine fibroids or hysterectomy. Radical surgery guarantees the complete absence of relapses, while partial removal leads to relapses in a third of cases. We performed a reoperation on a 35-year-old patient who underwent partial removal of leiomyoma in the right atrium but 3 months later had a tumor causing severe obstruction of the right heart.

Highlights

The article describes a rare case of surgical treatment of pulmonary artery intimal sarcoma. The authors analyzed the causes for incorrect diagnosis of pulmonary embolism in detail, and proposed alternative options for distinguishing the diseases under consideration. Moreover, the authors analyzed different surgical treatment modalities of intracardial sarcomas, and demonstrated the prospect of using molecular hydrogen as a component of an anesthetics during surgical interventions with cardiopulmonary bypass.

Abstract

The article describes a rare clinical case of a patient with pulmonary artery sarcoma. The absence of specific symptoms of sarcoma, as well as features of developing cardiovascular and respiratory failure, characteristic of pulmonary embolism, contributed to the incorrect diagnosis. The article analyzes the main problems of primary diagnostics, and proposes new parameters for evaluating manifesting symptoms and the results of additional examination, which should improve the results of surgical treatment of malignant tumors.