Introduction: hypertrophic cardiomyopathy (HCM) is a common inherited myocardial disorder. In a significant proportion of patients with obstructive HCM, abnormalities of the papillary muscles (PM) are a key contributor to dynamic left ventricular outflow tract (LVOT) obstruction, beyond septal hypertrophy alone. Surgical papillary muscle reorientation is a targeted method for correcting this pathology.
Aim: to perform a comprehensive analysis of the structural and anatomical features of the mitral valve (MV) and subvalvular apparatus using cardiac CTA and MRI in patients with obstructive HCM to identify candidates for PM reorientation and to compare their characteristics and short-term outcomes with patients undergoing standard surgical procedures.
Materials and Methods: a prospective single-center study included 102 patients with obstructive HCM, divided into groups: Group 1 (n=75/102) – patients undergoing isolated myectomy; within this group, a subgroup, Group 2 (n=19/75) underwent concomitant PM reorientation in addition to myectomy; Group 3 (n=27/102) – patients undergoing myectomy with MV repair/replacement. All patients underwent preoperative evaluation, including echocardiography, CTA, and MRI, to assess MV, PM, and subvalvular apparatus morphology.
Results: patients in Group 2 were characterized by significantly lower basal septal thickness (1.6 ± 0.3 cm vs. 2.1 ± 0.4 cm; p<0.001), the presence of bifid PMs (100% vs. 21.7–38.5%; p<0.001), and a greater anterolateral PM mobility angle (14.5° ± 2.0° vs. 9.5° ± 2.5°; p<0.001). ROC analysis showed high predictive value for an anterolateral PM mobility angle >12.5° (AUC=0.891) and the presence of bifid PMs (AUC=0.892) in selecting candidates for reorientation. The combination of these features provided a sensitivity of 95.5% and specificity of 88.5%. Postoperatively, the reorientation group achieved the lowest LVOT gradient (9.5 ± 6.3 mm Hg vs. 15.2 ± 8.5; p=0.004) with no need for permanent pacemaker implantation (0% vs. 11.2%; p<0.05).
Conclusions: multimodal imaging identifies a specific phenotype of obstructive HCM where PM abnormalities are the primary substrate for LVOT obstruction. PM reorientation is an effective and safe surgical treatment for selected patients, relieving obstruction with a low risk of complications.

Aim: to assess the safety and efficacy of multivessel minimally invasive coronary artery bypass grafting (MICS CABG) in the immediate and midterm period.
Materials and methods: a cohort study included 611 patients with multivessel coronary artery disease who underwent MICS CABG between 2011 and 2022. All patients underwent complete myocardial revascularization via left mini-thoracotomy on the beating heart. The mean patient age was 58.9±8.1 years; 87 (14.2%) were women. Diabetes mellitus was present in 129 (21.1%) patients, and obesity in 233 (38.1%). The mean EuroScore II was 1.2±0.7 and the mean SyntaxScore was 26.7±8.9.
Results: the mean operation time was 261.7±93.5 minutes, with a mean of 2.5±0.7 distal anastomoses. Mammary coronary artery bypass grafting was performed in 292 (47.8%) patients, while 319 (52.2%) underwent coronary artery bypass surgery without aortic manipulation. Cardiopulmonary bypass was used in 25 (4.1%) patients, including emergency conversion in 14 (2.3%). The median intraoperative blood loss was 250 (200; 300) mL, and the 24-hour blood loss after the intervention was 270 (150; 350) mL. Blood transfusion and its components was required in 56 (9.2%) patients. No cases of deep wound infection were observed. Perioperative stroke occurred in 2 (0.33%) patients, myocardial infarction – in 8 (1.3%) patients. The 30-day mortality was 0.49% (n=3). The postoperative in-hospital stay was 7 (7; 10) days, and the median recovery time was 14 (9; 24) days. With a median follow-up of 5.1 (3.2; 7.1) years, the 8-year cumulative survival rate was 91.4% and freedom from major adverse cardiac and cerebrovascular events was 87.6%.
Conclusion: MICS CABG is a safe procedure associated with a low incidence of perioperative complications, conversions to cardiopulmonary bypass, and sternotomy, as well as short hospital stays and rapid recovery. MICS CABG can be applied to patients with multi-vessel coronary artery disease, maintaining the effectiveness in the mid-term follow- up, comparable to traditional CABG. MICS CABG is a reproducible operation, but is more demanding on surgical skills and requiring patient selection, especially during the initial learning curve.

Aim: to assess the association between the common origin of the brachiocephalic trunk and the left common carotid artery (bovine arch branching pattern) with aortic diseases.
Material methods: a retrospective review of 194 medical records of patients who underwent surgical treatment of aortic dissection or ascending aneurysm between 2017 and 2021 were conducted. Patients were divided into two groups based on aortic arch anatomy: Group 1 included patients with a common origin of the brachiocephalic trunk and the left common carotid artery (bovine arch), and Group 2 included patients with a normal aortic arch anatomy without anomalies. Clinical and demographic data, echocardiographic findings, and radiological imaging data were analyzed for both groups.
Results: thoracic aortic aneurysm was detected significantly more frequently in Group 1 patients compared to Group 2 (100% vs. 80.1%, p=0.021). No cases of aortic dissection were found in the bovine arch group.
Conclusion: the common origin of the brachiocephalic trunk and the left common carotid artery (bovine arch) is associated with a higher incidence of thoracic aortic aneurysm.

Aim: to evaluate the effectiveness of perfusion methods for removing inflammatory mediators and metabolites, and their impact on reducing the incidence of postoperative organ dysfunction in patients with comorbidities undergoing prolonged cardiopulmonary bypass.
Materials and Methods: a single-center retrospective non-randomized study included 154 comorbid patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) duration ≥90 minutes. Standardized anesthesia was administered. Patients were divided into three groups: Group 1 (n=51) – standard extracorporeal circuit with a roller pump; Group 2 (n=36) – hemofiltration (HF) during CPB; Group 3 (n=67) – hemodiafiltration (HDF) with a polymethyl methacrylate (PMMA) dialyzer. The groups were comparable in terms of surgery type, CPB duration, aortic cross-clamp time, and severity of comorbidities (respiratory failure, renal failure, diabetes mellitus). Levels of biochemical markers of organ damage, oxygenation index (PaO₂/FiO₂), hemolysis by free hemoglobin (fHb), and inflammatory response markers – interleukin-6 (IL-6), interleukin- 10 (IL-10), procalcitonin (PCT), C-reactive protein (CRP), sTREM-1 – were measured 1 hour after CPB initiation and 24 hours after its termination. The incidence of respiratory and renal complications, postoperative drainage blood loss, need for vasopressor support, and length of ICU and hospital stay were assessed.
Results: with comparable doses of inotropic support, the doses of vasopressor therapy were significantly lower in the PMMA group and were not required in the HF group. The degree of hemolysis by fHb and lactate levels were lower in the study groups, remaining within reference ranges in the PMMA group. Analysis of biologically active molecule concentrations showed that filtration and sorption during CPB reduced levels of inflammatory cytokines and trigger molecules of the systemic inflammatory response. The duration of adequate spontaneous breathing recovery was significantly longer in the conventional perfusion group, as was the need for renal replacement therapy.
Conclusion: hemofiltration using a polyionic buffer solution and a polymethyl methacrylate dialyzer filter with sorption capacity during prolonged cardiopulmonary bypass in comorbid patients can reduce the risks of organ dysfunction in the postoperative period.

Introduction: minimally invasive surgery via right minithoracotomy represents a promising alternative to sternotomy for aortic root procedures.
Aim: to evaluate the safety and efficacy of this approach in a selected patient cohort.
Materials and Methods: a single-center retrospective study included 7 patients who underwent reconstructive operations (David procedure,
Bentall-de Bono) via right minithoracotomy in the second intercostal space with peripheral femoral cannulation for cardiopulmonary bypass.
Results: no conversions to median sternotomy occurred during the study. The median cardiopulmonary bypass time was 223 minutes, and aortic
cross-clamp time was 150 minutes. One in-hospital mortality was recorded.
Conclusion: right minithoracotomy proves to be a safe and technically feasible approach for performing reconstructive procedures on the aortic
root and ascending aorta, while demanding specialised instrumentation and preoperative CT-based planning.

Background: in modern surgical practice, aortic valve replacement can be performed using: standard replacement by median sternotomy, various minimally invasive approaches and transcatheter methods. However, while each technique has of advantages, it also has a potential concern, that leading to the dilemma of choosing one technique for a particular patient. The aim of our study was to retrospectively analyze the immediate and long-term outcomes of three types of surgical treatment for isolated aortic valve diseases.
Materials and methods: from October 2012 to September 2025, 950 operations - isolated aortic valve replacements were performed in our Center. For each type of operation, was developed indications. According these criteria, all patients were divided for groups: Group I - median sternotomy, Group II - mini-J sternotomy and Group III - TAVI. The mean age in the groups was: 68.1±11.4, 67.8±12.4 and 77.9±10.5 years, respectively (p < 0.001). Female gender predominance: 63.7%, 63.3% and 62.3%, respectively (p = 0.168). The peak gradient in aortic valve was 73.9±19.4, 74.2±19.8 and 76.2±16.6 mmHg (p < 0.001). Overall EuroScore II 2.6±0.5%.
Results: hospital mortality was 1.7%, 1.1% and 3.4%, respectively (p < 0.001). Complications: complete atrioventricular block, ventricular septal defect - didn't differ significantly (p = 1.0). Duration of surgery was: 206.6 ± 22.7, 209.9 ± 20.9 and 65.5 ± 12.5 min. The average follow-up period for group I was 87.7 months, for group II - 85.8 months. and group III - 86.5 months. The 7-year survival rate was 81.2%, 85.1% and 77.2% (Logrank test = 0.014). Freedom from thromboembolic complications at 7 years was 87.5%, 92.5%, and 97.7% (Log-rank test = 0.192).
Conclusion: Applagin differentiated approach for surgical treatment of aortic valve disease, how based on comorbidity and severe aortic valve disease of patients, allows effective and safe surgical treatment of this group of patients and shows good immediate and long-term results.

Aim: to evaluate the early outcomes of using the Heartstring device for proximal anastomosis formation in patients undergoing isolated off-pump coronary artery bypass grafting (CABG).
Materials and Methods: a retrospective analysis was performed in 1,720 patients operated on between 2009 and 2022. Demographic characteristics, intraoperative variables, and early postoperative outcomes were assessed. All procedures were performed without cardiopulmonary bypass, using the Heartstring device for proximal anastomoses. The incidence of stroke, perioperative myocardial infarction, bleeding requiring reexploration, and in-hospital mortality was analyzed.
Results: the median age of patients was 63 (58–69) years; 88.3% were men. Aortic atheromatosis was detected in 54.3% of cases. The median operative time was 155 (135–180) minutes; conversion to cardiopulmonary bypass was required in 0.6% of patients. The incidence of perioperative myocardial infarction was 1%, stroke — 1.2%, acute kidney injury — 1.6%, and re-exploration for bleeding — 1.6%. The in-hospital mortality rate was 0.9%. Use of the Heartstring device allowed safe construction of proximal anastomoses without aortic clamping, even in patients with advanced atheromatosis, resulting in low rates of neurological and hemorrhagic complications.
Conclusions: application of the Heartstring device in off-pump CABG is a reliable and safe technique that reduces the risk of stroke and other aorta-related complications. This method can be considered an effective alternative to conventional clamping techniques in patients with a high risk of atheroembolism.

Atrial fibrillation is the most common atrial tachyarrhythmia worldwide. The risks of systemic thromboembolic events are significantly increased in patients with atrial fibrillation. In this patient group, it is thought that up to 95% of the thrombus is thought to be localised in the left atrial appendage. An important problem of modern arrhythmology is the search for optimal and effective methods of prevention of thromboembolic events in atrial fibrillation. Although the therapeutic methods are proven to be highly effective, this method has a number of limitations and contraindications in lifelong administration.
Surgical isolation or exclusion of the auricle of the left appendage is an alternative option, but this procedure is only possible as a simultaneous procedure in open cardiac surgery.
Occluder implantation is a promising direction in isolation of the left atrial appendage, but has a high dependence on the anatomical structure of the anatomy of the latter and requires the administration of antiaggregants in the postoperative period.
Due to high traumatic nature of open surgical interventions and technical difficulties of occluder implantation, methods of isolation of the left atrial appendage from the systemic blood flow from minimally invasive accesses have been developed. Video-assisted thoracoscopic ablations are not only a promising way to perform epicardial ablation, but also offer the possibility of performing a one-stage left atrial appendage exclusion.
An unresolved challenge of minimally invasive surgical isolation of the left atrial appendage is its detailed visualisation at the surgical planning stage. Computed tomography with contrast has a high resolution, which together with the ability to build three-dimensional models allows a more accurate selection of the size, type and optimal position of the occluding device for the patient according to his anatomical features. Thus, the main objective of the presented report was to describe the role of contrast-enhanced computed tomography at the planning stage of thoracoscopic left atrial appendage endostapler amputation to improve the safety and efficacy of the procedure.

Introduction: for a long time, median sternotomy was considered the “gold standard” in cardiac surgery, providing wide exposure of the operative field. With the advancement of minimally invasive surgical techniques and growing evidence of their long-term effectiveness, there has been a trend towards expanding the indications for these approaches.For complex procedures such as aortic arch replacement, mini J-sternotomy has emerged as a valuable alternative to the standard approach. This incision ensures postoperative chest wall stability, reduces discomfort and pain for patients, and provides superior cosmetic outcomes.
Aim: to evaluate the effectiveness and safety of aortic arch replacement via mini J-sternotomy based on a clinical case.
Materials and methods: at the Department of Cardiovascular Surgery, I.M. Sechenov First Moscow State Medical University (Moscow), a novel approach was tested in the treatment of a patient with aortic arch pathology using mini J-sternotomy. We applied this technique in a 56-year-old patient diagnosed with type I aortic dissection according to M. DeBakey, subacute course. After comprehensive preoperative assessment, the patient underwent aortic valve, ascending aorta, and aortic arch replacement through mini J-sternotomy.
Results: this case demonstrated the technical features and advantages of mini J-sternotomy compared with full median sternotomy for aortic arch replacement: reduced surgical trauma, earlier patient mobilization, lower incidence of respiratory failure, decreased risk of bleeding, reduced postoperative pain, shorter duration of mechanical ventilation, lower rate of postoperative atrial fibrillation, as well as improved cosmetic outcomes. From a financial perspective, this approach was associated with shorter stays in the ICU and specialized ward.