The article presents a content analysis of brief articles from the Moscow Medical Newspaper (1858–1874) devoted to significant events of the «Pirogov» period in angiology, surgery of arterial aneurysm and bleeding from large vessels. The analysis showed that the period under study in angiology and vascular surgery should be characterized, as a transitional period from the pre-anesthetic and pre-antiseptic era to the post-anesthetic and antiseptic era.

As a result of the introduction of general anesthesia and antisepsis in vascular surgery, the geography of vascular interventions expanded, and their results improved. However, the choice of method for stopping blood flow through vessels (compression, ligation, or sclerotherapy), as well as the techniques for temporary and permanent stopping of bleeding, remained relevant and poorly studied. The selection of reports by both Russian and foreign surgeons, their translation, and the experience of Russian surgeons allow us to conclude that vascular surgery in Russia was at a European level in terms of the variety of methods used to treat vascular diseases and their outcomes.

We note the newspaper references by both Russian and foreign surgeons to N.I. Pirogov's dissertation (1832), his atlas «Surgical Anatomy of Arterial Trunks and Fasciae» (1861), and his contribution to angiology and vascular surgery.

Aim: to evaluate the dynamics of changes in the diameter of the initially dilated ascending aorta and aortic root up to 6.5 years after the TAVI procedure.

Materials and methods: a single-center retrospective study included 50 patients diagnosed with severe aortic stenosis who underwent TAVI and had a preoperative ascending aorta size of ≥40 mm and ≤50 mm. The maximum follow-up period was 6.5 years; the average follow-up period was 40 months. The primary endpoint was the fact of changes in the sizes of the ascending aorta and aortic root after the TAVI procedure according to echocardiography.

Results: in the study cohort, the maximum diameter of the ascending aorta statistically insignificantly decreased in the remote period (42.28±2.12 mm versus 41.84±3 mm, respectively, p=0.2). The diameter at the level of the sinuses of Valsalva increased statistically insignificantly (35.66±3.65 mm versus 35.82±4.05 mm, respectively, p=0.72). There was a statistically significant increase in the diameter in the remote period at the level of the sinotubular junction (31.32±4.53 mm versus 33±5.23 mm, respectively, p=0.01). According to the results of Cox regression, no predictors of an increase in the size of the sinotubular junction in the remote period were found.

Conclusion: in the group of patients with initially existing dilation of the ascending aorta, no significant increase in the diameter of this section was noted up to 6.5 years after TAVI using the MedLAB-KT balloon-expandable prosthesis. A tendency towards an increase in the diameter of the sinotubular junction in the remote period after the intervention was revealed; Cox regression analysis did not reveal any independent predictors of dilation of this aortic root element.

Introduction: endoscopic vein harvesting during myocardial revascularization reduces the risk of complications in the lower extremities, but is associated with a high risk of venous bypass damage and its dysfunction.

Аim: to evaluate the clinical results after endoscopic and open vein harvesting within 5 years of follow-up after surgery.

Materials and methods: in the cardiac surgery department No. 1 of the Research Institute of Cardiology, 344 coronary artery bypass grafting operations were performed from 2014 to January 2024 using the endoscopic method of vein harvesting using the Karl Storz endoscopic stand (Germany). Of these, 170 patients were included in the main group of postoperative observation (group 1), and 174 patients were included in the control group (group 2) after standard open vein harvesting.

Results: in the results of the observation, patients of both groups significantly differed in the number of postoperative complications on the lower extremities in the area of vein harvesting (1.14% in group 1 and 5.3% in group 2, p <0.0002). These are cases of lymphorrhea, hematomas, infections, suture divergence, which in 4.8% of cases led to secondary surgical treatment in patients after open vein harvesting. Ultimately, the length of hospital stay in patients of group 2 significantly increased to 12±3.5 days compared to patients of group 1 (8±1.3 days) (p<0.0001). In the mean time frame of 5±0.3 years, no significant difference in the incidence of the primary composite endpoint (MACCE) was noted in both groups. which was noted in 23 (13.5%) cases in the OVH group and in 25 (14.4%) cases in the EVH group (p=0.883). In patients of both groups there was no difference in the incidence of complications such as myocardial infarction (8.8% and 9.8%, p=0.519), repeated revascularizations (7.6% and 9.8%, p=0.37), cerebrovascular accidents (2.9% and 3.4%, p=0.794) and mortality (6.5%, and 7.5%, p=0.729).

Conclusion. endoscopic vein harvesting using the Karl Storz endoscopic stand, is less traumatic for the lower extremities during an observation period of more than 5 years and demonstrates an insignificant difference in the incidence of cardio-cerebral events.

Aim: to compare outcomes of autopericardial neocuspidization (AVNeo) of the aortic valve performed via J-shaped ministernotomy with thoracoscopic pericardial harvesting versus conventional full median sternotomy.

Materials and methods: we retrospectively analyzed 64 patient records: 20 undergoing AVNeo via J-shaped ministernotomy with thoracoscopic harvesting (Group 1) and 44 receiving conventional sternotomy (Group 2). The groups were matched for comorbidities and concomitant cardiac pathology. In Group 1, cardiopulmonary bypass (CPB) was established via femoral vein-femoral artery (70%) or femoral vein-aorta (30%) cannulation. Thoracoscopic pericardial harvesting was performed on the arrested heart (mean duration: 29.2±4.2 min) through port access, yielding comparable pericardial patch sizes between groups. The ministernotomy level (3rd/4th intercostal space) was determined by preoperative MSCT.

Results: J-shaped ministernotomy was associated with significantly increased mean CPB time and aortic cross-clamp time (175.5±11.6 min and 102.5±7.8 min in Group 1 vs. 114.4±40.6 min and 84.4±19.9 min in Group 2, p>0.001 for both comparisons). The minimally invasive approach demonstrated reduced blood loss (576±114.7 mL in Group 1 vs. 763.6±446.7 mL in Group 2, p=0.027). All Group 1 patients were discharged successfully, while Group 2 had two deaths (4.5% mortality). Postoperative mechanical ventilation duration was shorter in Group 1 (2.85±2.3 hours vs. 5.18±3.9 hours in Group 2, p>0.001). Group 1 also showed lower VAS pain scores (p >0.001) and reduced postoperative hospital stay (7.1±3 days vs. 13.9±5.5 days in Group 2, p>0.001). No significant differences were found in procedural effectiveness between the approaches.

Conclusion: thoracoscopic pericardial harvesting allows using less traumatic approach to perform AVNeo procedure. Minimally invasive autopericardial neocuspidization of the aortic valve is a safe and effective procedure.

Aim: to compare the safety and efficacy of minimally invasive direct coronary artery bypass grafting (MIDCAB) versus off-pump coronary artery bypass grafting (OPCAB) for revascularization in patients with isolated left anterior descending artery (LAD) disease.

Materials and methods: fifty-three patients were assigned to the MIDCAB group and 54 patients undergoing left anterior descending (LAD) coronary artery bypass grafting were assigned to the OPCAB group. Patient recruitment occurred between 2019 and 2022. Exclusion criteria included: (1) concomitant surgical treatment of coronary artery disease, (2) brachiocephalic artery disease, (3) myocardial pathology, (4) valvular heart disease, and (5) urgent or redo surgical interventions.

Results: the mean operative time was comparable between groups (189.9±77 min for MIDCAB vs. 174.9±54.5 min for OPCAB, p=0.247). OPCAB demonstrated: significantly greater intraoperative blood loss (348.6±63.7 mL vs. 143.3±34.5 mL, p <0.001); longer postoperative ventilation (6.5±2.46 vs. 5.4±3.1 hours, p=0.044); extended ICU stay (1.27±0.8 vs. 1.03±0.3 days, p=0.043); prolonged hospitalization (12.7±5.5 vs. 8.3±2.4 days, p <0.001). Transfusion requirements were higher in OPCAB (22.2% vs. 5.7%, p=0.024). Perioperative complications showed a nonsignificant trend favoring MIDCAB (7.4% vs. 20.4%, p=0.093). No in-hospital mortality occurred in either group. At 4-year follow-up survival rates were comparable (96.8% MIDCAB vs. 92.8% OPCAB, p=0.673). Freedom from adverse cardiac events was similar (91.2% vs. 91.9%, p=0.421).

Conclusion: MIDCAB represents a safe and effective surgical approach for coronary artery disease treatment, demonstrating optimal clinical outcomes and enhanced quality of life. These findings support its consideration as a preferred treatment strategy in routine clinical practice.

The open abdominal aorta repair is a highly traumatic intervention and analgesia is an important aspect of enhanced recovery after surgery. Epidural analgesia (EA) is the «gold method» of perioperative pain management after this surgery. Despite the fact that the best of analgesic effect in the group EA the first 24 hours after surgery, later other regional techniques become comparable of analgesic effect in this patients. The other regional technique can be to use how an alternative method of multimodal analgesia after laparotomy.

Purpose: to summarise the available compare the effectiveness of rectus sheath block (RSB) and epidural analgesia (EA) in postoperative pain management after open surgical repair of abdominal aortic.

Materials and metods: the prospective single-center randomized trial included 36 patients who underwent open surgical repair of abdominal aortic with median laparotomy during the period 2017-2023. Before surgery, the patients were randomized using a random number generator. Group 1 - epidural analgesia with injection of 0.2% -10 ml/hour of ropivacaine into the epidural space, followed by dose adjustment according to hemodynamic parameters; Group 2 - rectus sheath block performed under ultrasound control with the injection of 20 ml of 0.2% ropivacaine on each side after induction, followed by the insertion of catheters and bolus injection of 10 ml of 0.2% ropivacaine into the catheter on each side, every 4 hours. In all patients in the group, the pain level according to VAS was 0 points at the time of the start of anesthesia, then the assessment was carried out on the 1st day. All patients underwent surgery under standardized combined general anesthesia and the selected additional method of analgesia.

Results: in the study, the groups were similar in terms of basic anthropometric and hemodynamic parameters (p >0.05). The time of anesthesia, aortic clamping, and blood loss were also similar in the groups (p >0.05). We found that the pain level in our study corresponded to other studies. We did not observe a significant difference between the two groups when comparing and was 2.5 [2-4] cm in 1st group vs 3 [2-3] cm in the 2nd group, and 3 [0-5] in 1st group vs 2,5 [0-3] cm both on awakening and at the morning of the next day (p>0.05). Additionally, there were no signs of arterial hypotension when comparing EA to RSB upon awakening (Mean arterial pressure was 87±14 mmHg in the 1st group vs 92±15 mmHg in the 2nd group, p=0.33). The doses have used norepinephrine of intraoperatively in the groups did not differently (0.12±0.06 mcg/kg/min in the 1st group vs 0.1±0.05 mcg/kg/min in the 2nd group, p>0.05). We did not observe a difference in the amount of fentanyl administered during anesthesia in the EA and RSB groups, 2.31 [1.88-3.07] vs 2.84 [2.46-3.16] mcg /kg/hour (p=0.2). In the postoperative period, we observed higher doses of tramadol in the in 2nd group, 20 [18-23] mg/hour versus 14.5 [12-16] mg/hour in the 1st group (p=0.001). This is associated with the presence of drainage. The length of hospital stay was statistically comparable between the groups: 7.5 [7-8] days for the 1st group and 8 [7-10] days for 2nd group (p=0.1).

Conclusion: the study has shown that rectus sheath block is a viable alternative to epidural analgesia in a multimodal analgesia approach to pain management.

Atrial fibrillation (AF) is the most common tachyarrhythmia, and its incidence in the general population is 1-2% among all cardiac arrhythmias. The search for optimal, safe, minimally invasive methods of diagnosis and treatment of isolated nonparoxymal forms of AF is a global problem of modern arrhythmology.

Aim: to provide a systematic literature review on the possibilities of surface mapping of persistent forms of AF and to consider modern approaches to the treatment of resistant forms of AF.

Materials and methods: the review of the medical literature published in the period from 2013 to 2023 was conducted using data from the information and analytical systems MEDLINE, Scopus, Clinicaltrials.gov , Google Scholar and Web of Science. The presented literature review includes 30 studies.

Results: noninvasive surface mapping of the heart allows overcoming a number of limitations of invasive endocardial mapping systems: (1) reducing the frequency of complications; (2) simultaneous biatrial electrophysiological assessment; (3) anatomical features of the localization of an arrhythmogenic focus; (4) the possibility of mapping in one cardiac cycle.

Catheter methods of AF treatment show extremely low efficacy against non-paroxysmal forms of AF, decreasing with each subsequent ablation procedure. For patients with resistant forms of AF, it is rational to consider a two-stage or hybrid treatment approach combining epi- and endocardial ablations. The effectiveness of this treatment method reaches 86,9% in the long-term follow-up period.

The prospect of future treatment of resistant forms of AF is the use of noninvasive stereotactic radioablation, which has shown high efficacy in the treatment of life-threatening ventricular tachyarrhythmias.

Conclusion: the prospect of future treatment of persistent forms of AF should be considered as surface mapping of all chambers of the heart, followed by noninvasive stereotactic radiotherapy, which can ensure minimal risks of complications and achieve efficiency comparable to the classic Cox-Maze procedure.

LVAD therapy (implantation of a long-term mechanical left ventricular support device) is an adjunct (bridge therapy) or alternative (permanent therapy) to heart transplantation. In particular, the advantages of using minimally invasive approaches during LVAD implantation are known in world practice.

A serious limiting factor of LVAD therapy is still the low awareness of doctors and patients about this treatment method due to its long unavailability in our country.

Aim:1) to report on the successful implantation of LVAD from mini-thoracotomy to a patient with terminal chronic heart failure as a bridge therapy to heart transplantation, 2) to discuss the advantages and disadvantages of both LVAD therapy and the use of mini-thoracotomy, and 3) to identify key prognostic factors contributing to the positive outcome of such operations.

Materials and methods. We present a clinical case of surgical treatment of a patient with dilated cardiomyopathy who underwent implantation of a long-term mechanical left ventricular support device from a mini-thoracotomy. LVAD therapy was indicated to a patient with severe chronic heart failure who was on the waiting list for a heart transplant, and was performed as planned as bridge therapy against the background of the first signs of decompensation and incipient deterioration of right ventricular function.

Results. The patient is compliant, takes adequate care of the device, successfully takes warfarin according to the target range of INR, and regularly visits the hospital for follow-up examinations. He is waiting for the next stage of therapy, a heart transplant.

Conclusions. LVAD therapy from mini-thoracotomy is a safe, effective and reproducible method of surgical treatment of terminal CHF. The use of modern LVAD devices of the third generation, combined with competent and timely patient selection, makes it possible to increase survival and reduce the incidence of complications. The use of mini-thoracotomy, in addition to the general advantages of minimally invasive surgery, is especially indicated for patients.

Aim: to present the experience of performing David's procedure in conditions of a beating heart and parallel cardiopulmonary bypass.

Materials and methods: 59 y.o. man was admitted to the clinic for further examination for ascending aortic ectasia. According to the results of the echocardiography (EchoCG): ascending aorta – 46 mm, aortic root – 50 mm, arch – 35 mm, ejection fraction (EF) LV– 56%,  end diastolic volume  LV(EDV) – 130 ml, end systolic volume LV(ESV) – 56 ml, aortic regurgitation – 3 degrees. MSCT of the aorta: the fibrous ring of the aortic valve is 30.1 mm, the diameter of the aorta at the level of the sinuses of Valsalva is 48.3×54.4 mm, the ST zone is 38.5 mm, the ascending aorta at the level of the trunk of the pulmonary artery is 36.3 mm, the arch of the aorta in front of the brachiocephalic artery is 34.2 mm.

Results: the patient underwent valve-preserving prosthetics of the root and ascending aorta with reimplantation of the aortic valve on a functioning heart. The total time of the operation was 410 min, the CPB time was 177 min, and the time of clamping on the aorta was 150 minutes without myocardial ischemia. The postoperative period was uneventful. The patient was extubated on the day of surgery, the total ventilation time was 10 hours, he was transferred from the intensive care unit on the second day, drains were removed on the third day and the patient became active. EchoCG after surgery: ESV LV – 36 ml, EDV LV – 82 ml, EF LV – 54%, aortic regurgitation - 0. The patient was discharged in stable condition with improved well-being.

Conclusion: in this clinical case, for the first time in our clinic, an intervention on the aortic valve, aorta and coronary arteries (David's operation) was performed in a beating heart. David's successful experience of surgery on a beating heart has shown that the technique is not only applicable, but also effective.

Aim: to evaluate the efficacy and safety of combined minimally invasive surgical treatment for coronary artery disease (CAD) and atrial fibrillation (AF) in patients with isolated lesions of the left anterior descending artery (LAD).

Materials and methods: the study presents two clinical cases of combined minimally invasive treatment for CAD and AF. Both patients underwent: thoracoscopic radiofrequency ablation of the left atrium with left atrial appendage resection and minimally invasive direct coronary artery bypass grafting (MIDCAB) of the LAD. Procedures were performed using a video endoscopic system and the AtriCure radiofrequency generator.

Results: the postoperative course was uneventful: extubation at 6 and 4 hours postoperatively, drainage blood loss of 100 mL. Both patientsmaintained sinus rhythm with no angina recurrence, AF episodes, or heart failure symptoms during hospitalization and follow-up (12 and 1 month, respectively).

Conclusion: these cases demonstrate the feasibility, efficacy, and safety of a combined minimally invasive approach for treating CAD and AF in select patients