Objective: to evaluate the immediate outcomes of surgical treatment for concomitant atrial fibrillation (AF) during structural heart disease repair using various radiofrequency ablation techniques.

Materials and Methods: the study included 149 patients with AF who underwent concomitant valve and/or coronary surgery. Patients were divided into four groups according to intervention type: coronary artery bypass grafting (CABG) with radiofrequency ablation (RFA), minimally invasive thoracoscopic ablation with LAD grafting (MIDCAB), mitral valve surgery with RFA, and aortic valve surgery with RFA. Both Maze IV and Dallas lesion sets were utilized. Outcomes assessed included sinus rhythm restoration, permanent pacemaker implantation, complications, and early postoperative mortality. Multivariate statistical analysis was performed.

Results: median time of operation ranged from 195 to 230 minutes (p = 0.001). Statistically significant differences were observed in cardiopulmonary bypass and aortic cross-clamp times (p = 0.001). The MIDCAB group showed the shortest time of mechanical ventilation and ICU stay. Overall mortality was 2.0% with no intergroup differences. The rate of uncomplicated postoperative recovery reached 78.6% in the MIDCAB group. Sinus rhythm at discharge was restored in 91.5% of CABG group, 100% of MIDCAB group, 71.0% of the mitral group, and 68.4% of the aortic group. The Maze IV procedure showed significant association with sinus rhythm restoration (OR=5.0; p=0.03) without increased permanent pace-maker implantation rates.

Conclusion: concomitant surgical AF ablation during structural heart disease correction demonstrates high sinus rhythm restoration efficacy. The Maze IV procedure provides superior rhythm control compared to the Dallas lesion set. Minimally invasive interventions with thoracoscopic ablation yield the most favorable early results.

Aim: to demonstrate the possibilities of a surgical robot during aorto-femoral reconstructions.

Material and methods: the article presents a clinical case of treatment of a patient with atherosclerotic lesions of the aorta and its branches, occlusion of the infrarenal aorta and iliac arteries, total calcification of the abdominal aorta using robotic surgery.

Results: the patient underwent total endovideosurgical thoracohemoral bypass surgery using a Da Vinci Xi robot. The duration of the surgical intervention was 300 minutes, the time of lateral compression of the aorta was 45 minutes, and the volume of blood loss was 200 ml. The patient was extubated 20 minutes after the end of the operation on the operating table and transferred to the intensive care unit. The patient's postoperative period was uneventful and uneventful. Ischemia of the lower extremities has been stopped.

Conclusion: performing thoracoemoral bypass surgery is the surgery of choice when standard aorto-femoral bypass surgery is not possible. The active introduction of robotics into vascular surgery makes it possible to minimize surgical trauma, which is reflected in improved results of surgical interventions and the rehabilitation period of patients.

Aim: to evaluate immediate and long-term outcomes of transcatheter heart valve replacement using a polytetrafluoroethylene leaflets prosthesis.

Materials and methods: this single-center retrospective study included 521 patients following implantation of the MedLAB-CT prosthesis: 503 with aortic valve (AVR) replacement, 8 in pulmonary artery (PA) position, and single cases of mitral (MV) and tricuspid (TV) valve replacements. The maximum clinical follow-up extended to 9 years. The cohort predominantly comprised high surgical risk patients (mean EuroSCORE II: 8.7%) of advanced age, with TAVI recipients having a mean age of 74.8 years."8.7%) and elderly, the average age in the TAVI group was 74.8 years.

Results: for transcatheter aortic valve implantation (TAVI), the mean gradient was 6.7±2.1 mm Hg with a peak gradient of 11.2±5.1 mmHg. Freedom from reintervention and cumulative survival rates at 9 years were calculated using the Kaplan-Meier method, with the following results: freedom from reoperation 99% and survival rate 68%. In cases of transcatheter pulmonary, tricuspid, and mitral valve replacements, all patients showed clinical improvement with reduction of heart failure symptoms to NYHA functional class I-II.

Conclusion: the immediate and mid-term outcomes of MedLab-CT valve implantation in the aortic position were comparable to those of established international transcatheter systems, both in clinical outcomes and in hemodynamic parameters. All MedLab-CT implantations in PA position included in this study resulted in good immediate clinical and hemodynamic results, that were comparable to similar interventions using other systems. MedLab-CT implantation in the mitral valve position using the «valve-in-ring» technique and in the tricuspid position using the «valve-in-valve» technique showed good immediate results, consistent with global data. However, as is the case worldwide, the problem of transcatheter replacement of native atrioventricular valves remains unresolved.

Aim: to assess the efficacy and safety of Maze V procedure for treating atrial fibrillation (АF) concomitant to coronary artery bypass grafting (CABG).

Material and methods: 82 patients with coronary artery disease and concomitant AF were recruited in a single-center study. Patients received hypothermia during on-pump CABG with warm blood hyperkalemia cardioplegia. Maze V was routinely performed before CABG under parallel perfusion without aortic cross-clamping. The primary and secondary endpoints included recurrent arrhythmia, sinus rhythm at discharge and in the long-term period, permanent pacemaker implantation, major cardiovascular and cerebrovascular events(MACCE).

Results: the in-hospital mortality rate was 2.4% (2 patients). The recurrence rate of AF/AFl after surgery was 23.1%. Stable sinus rhythm at dis- charge was recorded in 92.4% of patients. There were no unfavorable cardiovascular and cerebrovascular events during the in-hospital period. The median follow-up was 30.5[18.2;47.7] months. The cumulative freedom from AF/AFl without antiarrhythmic therapy after 12 months was 91%, after 24 months – 88%, and after 48 months - 77%. The freedom from MACCE was 94%.

Conclusion: maze V procedure is a safe and effective procedure for treating concomitant AF without any adverse events in the postoperative peri- od. It has demonstrated favorable results in maintaining the sinus rhythm, both in the in-hospital and long-term period. Therefore, Maze V procedure should be considered for treating AF in patients undergoing CABG.

Objective: to compare early and long-term outcomes of aortic valve (AV) replacement with mechanical versus biological prostheses in patients aged 60–65 years.

Materials and methods: а retrospective cohort study included 383 patients who underwent isolated AV replacement between 2009 to 2019. Propensity score matching yielded two comparable groups (n=84 mechanical, n=85 biological). Evaluated outcomes included in-hospital complications, survival rates, stroke incidence, and reintervention requirements. The median follow-up was 84 months (53–113 months).

Results: both groups had zero in-hospital mortality. Postoperative complications and stroke incidence were comparable. The mechanical prosthesis group demonstrated significantly lower peak transvalvular gradients (25.0±8.7 mmHg vs 28.3±11.8 mmHg, p=0.029). Ten-year survival was 90.7% for mechanical valves vs 72% for biological prostheses (p = 0.038). Reoperations and stroke rates were similar between groups (p > 0.05).

Conclusion: in patients aged 60–65 years, mechanical aortic valve prostheses demonstrate superior long-term survival and hemodynamic out- comes. The choice of prosthesis type should be individualized considering the patient’s clinical characteristics and life expectancy.

Aim: to conduct an analytical review of the literature to study the role and place of open surgery in the treatment of type B aortic dissections.

Material and methods: a review of the medical literature published between 2000 and 2022 was conducted using the information and analyti- cal systems MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar and Web of Science. The search strategy was carried out in accordance with the PICO (Patient-Intervention-Comparison-Outcome) criteria. The following keywords were used to search the medical literature: «aortic dissection», «type B aortic dissection», «type B acute aortic dissection», «open thoracic aortic surgery», «endovascular surgery». The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. As a result of the search, 95 scientific publications were selected. Inclusion criteria: original articles on type B aortic dissection; Full-text articles on the diagnosis, treatment, and treatment outcomes of patients with type B aortic dissection. Exclusion criteria: abstracts, review articles, editorial notes and comments, book chapters; experimental and laboratory studies on animals or cadavers. After screening for compliance with the inclusion criteria, 66 scientific publications were excluded, 29 studies were included in the detailed analysis

Results: as a result of the search and analysis of the literature data, it was found that the treatment tactics for patients with type A aortic dissection (AD) are currently well studied and defined, while the choice of the optimal treatment method for type B AD is the subject of ongoing discussions. Today, there are serious debates among surgeons regarding the optimal treatment for chronic type B aortic dissection. The modern paradigm for managing this group of patients has undergone significant changes due to the development of minimally invasive procedures, which have become especially popular over the past decade. Current evidence suggests that endovascular treatment of RA is an effective treatment for acute type B RA, which helps prevent malperfusion and promotes further aortic remodeling.

Conclusion: randomized clinical trials with long-term follow-up comparing open surgery and TEVAR are needed to determine the optimal treatment strategy for chronic type B RA. Therefore, the optimal treatment strategy for chronic type B RA needs to be precisely defined, and at present it is difficult to establish any convincing recommendations in favor of a specific technology.

Objective: to study electrode-associated infection and justify the explantation of pacemaker electrodes through mini-thoracotomy under X-ray control in a patient with a history of multiple surgical treatment of the pacemaker seating and CABG.

Material and methods: a clinical case of surgical intervention in the volume of explantation of infected electrodes through a right-sided mini-thoracotomy under X-ray control at the Research Institute of Cardiovascular Surgery and Cardiovascular Surgery in Kemerovo

Result: The surgical intervention performed at the Research Institute of Cardiovascular Surgery in Kemerovo, within the scope of electrode explantation through a right-sided mini-thoracotomy under X-ray control, allowed for the complete elimination of the source of infection that was not amenable to drug therapy. Surgical access reduced the risk of intra- and postoperative complications and shortened the patient's rehabilitation period.

Conclusion. Thus, the choice of surgical intervention tactics is individual for each patient. In this clinical case, minimally invasive access within the scope of minithoracotomy allowed not only to successfully perform the operation, but also reduced possible complications.

Objective: to explore the possibilities and advantages of performing aortic and aortic valve surgery on a beating heart compared to the traditional method involving cardiopulmonary bypass and cardioplegia.

Materials and methods: the experience of prosthetic replacement of the ascending aorta and aortic valve on a beating heart is presented, which allows avoiding circulatory arrest and the use of cardioplegia.

Results: positive clinical experience indicates that surgery on a beating heart promotes physiological myocardial contraction and continuous perfusion, thereby reducing myocardial injury compared to conventional techniques.

Conclusions: traditional surgery with cardioplegic arrest is associated with «mandatory ischemia», which disrupts electrolyte and oxygen balance in the myocardium and can lead to metabolic and structural damage. Consequently, there is a growing practice of performing surgeries on a beating heart using continuous retrograde coronary perfusion (CRCP), which helps reduce ischemia duration, lower complication risks, and improve procedural safety. The paper presents clinical cases of successful operations using this method, as well as comparative studies demonstrating the advantages of CRCP over traditional cardioplegia: shorter operation times, reduced postoperative mortality and complications, and more precise assessment of pathology under physiological conditions. Notably, the method shows particular effectiveness in correcting sinus of Valsalva ruptures and in surgeries involving the aortic root and valves. Overall, beating-heart surgery represents a promising approach to enhancing the safety and efficacy of cardiac surgical procedures.

Aim: to present the results of surgical treatment of a patient with a narrow fibrous ring of the aortic valve by replacing it with a frameless prosthesis

Material and methods: this article discusses a clinical case of aortic valve replacement with a frameless Freestyle Medtronic prosthesis using the "full root" technique in a patient with a narrow fibrous ring and severe stenosis. According to the results of Echo before surgery, the diameter of the fibrous ring of the aortic valve was 17 mm, the maximum gradient on the valve was 119 mm Hg, average 68 mm Hg, valve opening - 5 mm, effective orifice area - 0.5 cm2. According to coronary angiography, stenosis at the mouth of the left coronary artery (LCA) was 75%.

Results: the patient underwent aortic valve and aortic root replacement with a Medtronic Freestyle 19 mm biological prosthesis using the "full-root" technique, and left coronary artery trunk replacement with a Uni-Graft 6 mm prosthesis using the Svensson technique under artificial circulation and cold cardioplegia with Custodiol solution. In the postoperative period, the maximum gradient was 12 mm Hg, the average was 5 mm Hg. The patient was discharged in a stable condition without clinical signs of heart failure

Conclusion: using a frameless biological prosthesis with the «full-root» implantation technique in a patient with critical aortic valve stenosis and an ascending aorta diameter of 20 mm, we achieved the best hemodynamic result. The additional time required for this technique of implantation of frameless prostheses compared to implantation of pericardial framed valves does not affect early clinical results and may be rewarded with better mid- and long-term results. The presented technique does not have a negative effect on early morbidity or mortality and can be recommended for use in patients with a combination of severe aortic valve stenosis and a narrow aortic root.

Aim: analysis of simulation training experience in minimally invasive cardiac surgery with evaluation of a beating-heart simulator efficacy.

Methods: а cardiac surgery training simulator was developed to practice skills while simulating myocardial contractions and maintaining intracavitary/intravascular circulation. Two training programs were implemented: 1) off-pump coronary artery bypass grafting (OPCAB), including minimally invasive coronary artery bypass (MIDCAB), and 2) thoracoscopic left atrium ablation (T-Maze). The OPCAB program involved 5 students/residents (full course) and 15 (partial course), while the T-Maze program trained 15 cardiovascular surgeons. Procedures were performed on porcine hearts (WetLab). OPCAB training stages are: 1) anastomoses technique demonstration, 2) Practice on arrested hearts, 3) beating-heart anastomoses (Pomor Beating Heart simulator). Trained LAD bypass with 15 repetitions per participant. Evaluated parameters: conduit preparation, anastomosis time, procedural duration, shunt routing, tightness, patency, and stenosis absence. The T-Maze training stages: 1) lecture course, 2) simulation training, 3) participation in surgery, 4) supervised independent performance.

Results: аn improvement in anastomosis quality was observed. The average quality score increased from 1.8 to 3.8 (scale: 1-5) between the first and fifteenth attempt, while procedure time decreased from 20 to 15 minutes. Currently, no standardized assessment methods exist for T-Maze procedure skill acquisition. Following the training program, two cardiac surgery centers successfully implemented isolated atrial fibrillation treatment protocols.

Conclusion. Аlthough limited in scale, this experience demonstrates initial progress in addressing surgical training challenges. The evolution of cardiac surgery necessitates training in novel techniques. A structured, step-by-step approach to minimally invasive surgery education is crucial for achieving optimal clinical outcomes. The WetLab method remains the gold standard for simulation. The Pomor Beating Heart simulator shows potential as a comprehensive cardiac surgery training device, combining accessibility, versatility, realistic tissue handling, and hemodynamic accuracy to significantly enhance surgical skill acquisition.