Objective: to evaluate the efficacy and safety of T-graft (vein in LVGA) application in mini-invasive coronary artery bypass grafting in patients with CHD.

Material and methods: Retrospectively from October 2012 to February 2023, 1111 patients who underwent CABG from mini-invasive access were analysed for inclusion. Thirty-six (3.2%) cases (T-graft at CB) were included in the study. Primary endpoint was mortality, secondary endpoints were parameters such as: myocardial infarction, stroke and wound infections. The mean age was 67.9 ± 14.2 years (48 to 85 years). Gender: males 24 (66.6%) and females 12 (33.4%). Mean EuroSCORE II score: 3.6 ± 1.4.

Results: There was no mortality in the study group. All operations were performed on a beating heart. The average operation time was 136 ± 34 min. The average number of distal anastomoses was 2. There were no complications related to the operation such as: postoperative bleeding, wound infection and stroke. The average length of stay in the intensive care unit was 1.7 ± 0.7 days. The mean duration of hospitalization was 7.9 ± 1.2 days. The mean follow-up period was 42.4 months (95% CI 36.4.1-46.7). Kaplan-Meier survival estimate showed a 36-month survival rate of 97.8% (95% CI 97.1-99).

Conclusions: The use of T-graft in mini-invasive coronary artery bypass grafting for myocardial revascularization is an effective and safe procedure that demonstrates good immediate and mid-term surgical outcomes in patients with CHD.

Background. Atrial fibrillation is the most common form of arrhythmia in patients with hypertrophic cardiomyopathy. Atrial fibrillation is associated with a significant deterioration in the clinical condition, a high risk of thromboembolic complications in patients with HCM. However, mid-term data on the simultaneous surgical treatment of hypertrophic cardiomyopathy and atrial fibrillation are limited.

Aim. The aim of this study was to evaluate mid-term results of concomitant surgical ablation of atrial fibrillation during septal myectomy in patients with obstructive hypertrophic cardiomyopathy.

Methods. Since 2014 till 2019 55 eligible patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation underwent concomitant surgical ablation and septal myectomy. A left atrial set for performing ablation was chosen in 38 patients (69.1%), maze IV - 17 patients (30.9%). Surgical ablation was performed using an isolated cryoablation energy source or combination with radiofrequency source. The primary endpoint was recurrence of atrial fibrillation, atrial flutter and atrial tachycardia (AF/AFL/AT) in the mid-term follow-up period., Holter monitoring was performed 2 times a year during 24 months of the postoperative period, then 1 time per year.

Results. Median follow-up was 47 months (Q1-Q3: 34-67). Freedom from AF/AFL/AT (primary endpoint) was 73.3% (95% CI: 60.0-86.7%) in 36 months after surgery. Use of a cryoablation energy source was an independent risk factor of arrhythmias (Hazard Ratio 45.56; 95% CI: 1.55-1340.85; p=0.027). Mid-term survival was 88.6% (95% CI: 76.3-94.7%) in 36 months after surgery. Freedom from thromboembolic events was 98.2% (95% CI: 87.7-99.7%) in 36 months after surgery.

Conclusion. Surgical atrial ablation during septal myectomy in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation is a highly effective procedure in freedom from AF/AFL/AT. In addition, the procedure of surgical ablation allows improving mid-term results in freedom from thromboembolic events.

Cardiac resynchronization therapy (CRT) is an effective surgical treatment for heart failure (HF) with reduced ejection fraction when drug therapy is ineffective. By reducing electrical dissynchrony, CRT enhances systolic and diastolic heart function, leading to symptoms improvement, decreasing hospitalization rate, as well as cardiovascular mortality. Nevertheless, in 5-10% of cases CRT may be troublesome due to small coronary sinus diameter, pronounced tortuosity of the coronary venous system, high left ventricle (LV) threshold values, diaphragm nerve stimulation and other factors. Some patients do not respond to CRT because of suboptimal left ventricular lead location, incorrect selection of patients, inadequate device programming parameters, etc. To overcome these issues alternative techniques such as minithoracotomy, thoracoscopic, robotic-assisted as well as transseptal, transapical and transventricular approaches to LV-lead implantation are developed and described in details by the authors. Particular attention is paid to conduction system pacing and leadless LV endocardial pacing system, that are also observed in this article.

Aim: to evaluate the immediate and long-term results of using the HRM technique in patients with multivessel coronary lesions.

Material and methods: The retrospective single-center study included 865 patients, of which 522 (60.3%) were men; the average age of the patients was 65.8±11.5 years. 749 (86.5%) had angina pectoris; the average number of affected coronary arteries (CA) was 2.8. Post-infarction cardiosclerosis was present in 326 (37.6%), the number of patients with atherosclerotic lesions of the arteries of the lower extremities was 122 (14.1%) and the carotid system - 104 (13.5%). The risk of patients was stratified according to the Euroscore II scale - 1.9±1.5%. The first stage was predominantly coronary bypass surgery - 729 (84.2%) patients; while 671 (92%) underwent anterolateral left thoracotomy, 58 (8%) patients underwent median sternotomy (surgeries, history of chest trauma). 136 (15.7%) patients underwent PCI at the first stage for emergency indications due to the development of acute coronary syndrome (ACS). The second stage (mainly PCI) was performed within a period of up to 60 days, usually in one hospitalization.

Results: All patients who underwent hybrid intervention underwent complete myocardial revascularization. The average length of stay in intensive care after CABG was 1.1, hospital stay 6.6 beds/days. The early postoperative period (after the first stage) in 7 (2.2%) patients was complicated by bleeding, which required revision of the wound. In 31 (4.2%), a rhythm disturbance such as atrial fibrillation (AF) occurred, which was treated with medication. Superficial suppuration of the postoperative wound occurred in 5 (0.6%) cases. The second stage (mainly PCI) was carried out as planned - 729 (84.2%) patients. There were no cases of postoperative AMI. 136 patients underwent CABG using a sternotomy approach. The overall mortality rate of HRM was 6 (0.6%), which was observed mainly in patients with ACS. The long-term results of breastfeeding were analyzed at an average follow-up period of 65.1±5 months. According to the results of the Kaplan– Meier analysis, the probability of patient survival was 99.4% at 12 months, 94.9% at 36 months, and 89.7% at 60 months. The probability of repeat revascularization rates during the same follow-up period was 12 months – 0.3%, 36 months – 1.7%, 60 months – 8.4%.

Conclusion: Hybrid interventions have good immediate and long-term results in older patients with multivessel coronary disease, patients with severe comorbidities, and in patients with previous cardiac surgery. Prospective randomized studies are required to definitively evaluate the method.

The aim of the research: to analyze the results of coronary bypass surgery without IC on a "working heart" in patients with coronary artery disease performed during the incubation period of COVID-19.

Materials and methods: From January to December 2020, 305 patients with coronary artery disease were operated in the cardiac surgery Department No. 1 of the GBUZ IOCB. All patients were operated with access from a median sternotomy on a "working heart" within 1-5 days after hospitalization. 72 hours before hospitalization, all patients were tested for SARS-CoV-2 coronavirus RNA and had a negative result. Of the 305 operated patients, 8 (2.6%) underwent COVID-19 during hospitalization, confirmed by PCR for SARSCoV-2. In the biochemical analysis of blood, elevated levels of C-reactive protein and ferritin were noted. According to CT data, all patients had lung lesions.

Results: Depending on the condition, patients were transferred to the PITiR or general wards for the treatment of COVID-19 patients. Conservative treatment was carried out in accordance with the recommendations of the Ministry of Health of Russia. The time of stay of patients in the hospital was 37.6 (28-45) days. After treatment, 5 patients were discharged in satisfactory condition, 3 died. Hospital mortality was 37.5%.

Conclusion: Thus, a small number of observations of CHD patients operated on during the incubation period of COVID-19 with the exception of IC on a "working heart" allows us to draw a preliminary conclusion that postoperative mortality depends on the severity of lung damage caused by a new coronavirus infection (COVID-19) with the clinic of acute respiratory syndrome (SARS-CoV-2).

Aim: The purpose of our clinical study is to compare the incidence of peripheral embolism during endovascular recanalization with a paclitaxel-coated balloon angioplasty versus open endatherectomy with a paclitaxel-coated balloon angioplasty.

Materials and methods: Prospective, randomized, single-center pilot study of patients with superficial femoral artery occlusive lesions. Patients of group 1 (PTA+DCB) underwent recanalization of the superficial femoral artery (SFA) with drug-coated balloon angioplasty. Patients of group 2 (RE+DCB) underwent remote semi-closed endarterectomy from the SFA with drug-coated balloon angioplasty. Doppler emboldetection was performed during the revascularization procedure.

Results: The study included 10 patients in each group. The patients did not differ in age, comorbidity, and severity of lower extremity ischemia. The majority were patients with intermittent claudication. In the PTA+DCB group, the median number of ebmols during the procedure was 200.0 [100.0; 200.0], and in the group RE+DCB 7 [6;8], p= 0.0002. Moreover, in the PTA+DCB group, peripheral embolism occurred both during the passage of the target artery lesion (in 100% of cases) and during drug-coated balloon angioplasty (in 60% of cases), while in the RE+DCB group peripheral embolism occurred only during drug-coated balloon angioplasty (100% of cases).

Conclusion: There was a higher incidence of material distal embolism with PTA+DCB compared with RE+DCB.