The article presents a comparative content analysis of the first major scientific work by N.I. Pirogov his dissertation entitled “Is Ligation of the Abdominal Aorta for Inguinal Aneurysm an Easily Performable and Safe Intervention?”, prepared and defended in 1832 at the Imperial University of Dorpat. It is shown that this work is the world’s first experimental surgical study in which the 22-year-old N.I. Pirogov demonstrated his talent as an anatomist, surgeon, and scientist. His achievements include: 1) an evolutionary anatomical-physiological approach to a relevant problem of angiology and vascular surgery; 2) development of an extraperitoneal approach to the abdominal aorta; 3) justification of the ligation site of the abdominal aorta between the origins of the mesenteric arteries; 4) development of an operation for gradual narrowing of the aortic lumen up to complete occlusion; 5) the conclusion that paralysis of the lower half of the body and limbs is caused by impaired blood supply to the spinal cord and peripheral nerves distal to the ligature; 6) the conclusion that death in animals following aortic ligation was due to blood congestion in vital organs proximal to the occlusion site; 7) proof that, when following the pathophysiological principles and technical features of the operation developed by N.I. Pirogov, ligation of the abdominal aorta is feasible in experiment. It is concluded that N.I. Pirogov’s dissertation can be attributed to both angiology (topographic and pathological anatomy of the cardiovascular system, normal and pathological physiology of circulation) and vascular surgery (surgical approaches and methods).

Aim: to compare in-hospital outcomes of coronary artery bypass grafting (CABG) in patients with diffuse coronary artery disease, performed either off-pump or on-pump, and to identify patient categories that may benefit from off-pump surgery.

Materials and Methods: a single-center retrospective study analyzed data from patients with diffuse coronary artery disease who underwent CABG between 2020 and 2023 (n=340). After propensity score matching, two comparable groups were formed: Group 1 (n=77) off-pump CABG, Group 2 (n=77) on-pump CABG. Perioperative complications assessed included: myocardial infarction (MI), acute cerebrovascular accident (stroke), severe respiratory failure requiring prolonged mechanical ventilation, and acute renal failure (ARF) requiring renal replacement therapy (RRT). A combined endpoint (CE), encompassing these events, was used as the primary outcome measure.

Results: the frequency of perioperative cardiovascular events was low. MI was registered in 2.6% and 1.3% of patients in Groups 1 and 2, respectively (p=0.623). No strokes occurred in Group 1, compared to 1.3% in Group 2 (p=0.499). Severe respiratory failure with prolonged mechanical ventilation occurred in 6.5% and 5.2% (p=0.742). The need for RRT due to ARF was noted only in Group 2 (3.9%, p (for groups)=0.123). The cumulative incidence of the CE was 9.7% (n=15), showing a trend towards an increase in the on-pump group (OR=2.1; 95% CI 0.7-6.6; p=0.277). Multivariate analysis revealed a significant influence of peripheral artery disease (OR=3.4; 95% CI 1.1-10.8; p=0.034) on the risk of CE, while female sex (OR=3.1; 95% CI 0.9-10.2; p=0.058) and previous myocardial infarction (OR=3.8; 95% CI 0.8-18.1; p=0.099) demonstrated a trend towards association. In a subanalysis of high-risk patients, a trend towards more favorable outcomes with off-pump CABG was identified (OR=3.28, 95% CI 0.83–12.92, p=0.098).

Conclusion: this study demonstrates comparable in-hospital outcomes for off-pump and on-pump coronary artery bypass grafting in patients with diffuse coronary artery disease. However, a trend towards a benefit of off-pump surgery was identified in high-risk patients, suggesting it can be recommended as a preferred strategy for this selective group.

Objective: to evaluate early and long-term outcomes of endoscopic versus open great saphenous vein harvesting in patients undergoing offpump coronary artery bypass grafting (OPCAB).

Materials and methods: a retrospective single-center study included 1851 patients who underwent OPCAB between 2009 and 2022. Depending on the vein harvesting technique, patients were divided into two groups: endoscopic vein harvesting (EVH) 115 patients and open vein harvesting (OVH) 1736 patients. To minimize baseline imbalance, propensity score matching (PSM) was performed, resulting in two comparable groups of 114 patients each. Intraoperative parameters, postoperative complications, hospital mortality, and long-term survival were analyzed. Results: the incidence of lower limb wound complications was significantly lower in the EVH group compared with OVH (0% vs 8.8%; p<0.001). No significant differences were observed in the rates of perioperative myocardial infarction (1.8% vs 0.9%; p=1.0), stroke (1.8% vs 2.6%; p=1.0), acute kidney injury (0.9% vs 3.5%; p=0.369), postoperative atrial fibrillation (9.6% vs 10.5%; p=0.826), or hospital mortality (1.8% vs 0.9%; p=1.0). Median follow-up duration was 77 [10–125] months. Ten-year survival reached 86.0% in the EVH group and 91.6% in the OVH group, with no significant differences between Kaplan–Meier survival curves.

Conclusion: endoscopic great saphenous vein harvesting during OPCAB is a safe and clinically effective technique associated with a significant reduction in lower extremity wound complications without compromising early or long-term outcomes.

Introduction: postinfarction left ventricular (LV) aneurysms are associated with a high risk of heart failure and mortality. The role of intra-aortic balloon counterpulsation (IABP) in this patient population remains controversial.

Materials and methods: this retrospective single-center cohort study included 160 patients with postinfarction LV aneurysms and ejection fraction (EF) <40% who underwent LV reconstruction and coronary artery bypass grafting. After propensity score matching (1:1), two groups were formed: IABP (n=80) and no IABP (n=80). The primary endpoint was long-term mortality.

Results: IABP use showed no statistically significant difference on 30-day (OR=6.08; p=0.17) or long-term mortality (HR=0.76; p=0.41). Independent predictors of long-term mortality included diabetes mellitus (HR=2.65; p=0.02), chronic lower limb ischemia (HR=2.76; p=0.038), baseline LV end-diastolic volume (HR=1.01; p=0.039), and cardiopulmonary bypass time (HR=1.01; p=0.029). The Dor procedure was associated with reduced risk (HR=0.35; p=0.014).

Conclusions: perioperative IABP use in patients with postinfarction LV aneurysms and EF<40% does not improve 30-day or long-term survival, supporting current guidelines for a more selective approach to IABP utilization.

Aim: to analyze the immediate and long-term outcomes results of off-pump coronary artery bypass grafting (CABG) via left anterolateral thoracotomy. 

Methods: This retrospective single-center study included 1,178 patients who underwent surgery at the Federal Center for High Medical Technologies (Kaliningrad) between September 2012 and June 2023. All patients underwent off-pump CABG of the left anterior descending artery (LAD) via left anterolateral thoracotomy. The majority of patients were male (n=946; 80.3%). The mean age was 64.3 ± 15.4 years. A significant number of patients had class II (n=387; 32.8%) and class III (n=691; 58.6%) angina. A history of myocardial infarction was present in 694 (58.9%) patients. Approximately half of the patients had generalized atherosclerosis involving other vascular beds: brachiocephalic arteries (n=182; 15.4%) and arteries of the lower limbs and kidneys (n=161; 13.6%). Hybrid procedures were performed in 627 (53.2%) patients. Subclavian-coronary bypass was performed in 13 (1.1%) patients. Risk stratification was performed using the EuroSCORE II (2.2 ± 1.1%). Early mortality, postoperative complications, and mid-term outcomes were analyzed.

Results: All 1,178 patients underwent off-pump CABG via left anterolateral thoracotomy. In 627 cases, CABG was performed as part of a hybrid procedure. Conversion to sternotomy after minithoracotomy occurred in 4 (0.3%) cases. The mean length of stay in the intensive care unit was 1.1 days, and the mean hospital stay was 5.9 days. The early postoperative period was complicated by bleeding in 13 (1.1%) patients, requiring wound revision. Atrial fibrillation occurred in 29 (2.5%) patients and was managed medically. Superficial wound infection was observed in 8 (0.7%) cases. In-hospital mortality was 0.7% (n=8). Mid-term outcomes were analyzed during a follow-up period of up to 56 ± 7 months, with a patient follow-up rate of 13.6% (n=161). Elective percutaneous coronary intervention was performed in 15 (9.3%) patients. None of the patients underwent repeat CABG. Stroke was recorded in 3 (1.8%) patients, and myocardial infarction in 6 (3.7%) patients. Five (3.1%) deaths were registered. 

Conclusion: off-pump coronary artery bypass grafting via left antero-lateral thoracotomy can be performed with favorable immediate and longterm outcomes in patients with coronary artery disease, both for isolated LAD lesions and as part of a hybrid procedure for multivessel disease.

Neuroprotection is a set of measures that not only aim to halt but also to restore the functional state of already damaged structures of the central nervous system. Despite the advancements in cardiac surgery and anesthesiology-intensive care, a relevant clinical problem in the postoperative period for patients who have undergone cardiac surgery under conditions of cardiopulmonary bypass (CPB) remains the development of neurological disorders. The pathogenesis of intraoperative brain injury in cardiac surgery patients during cardiopulmonary bypass includes material embolism, ischemia-reperfusion injury, dyscytokinemia, lipid peroxidation, disruption of the blood-brain barrier, and the transformation of pulsatile blood flow into laminar flow. Therefore, maintaining an adequate level of arterial pressure during CPB is an extremely important task and, in some sense, a tool for neuroprotection. The higher the risk of neurological complications, the more relevant the use of neuromonitoring becomes for early diagnosis and adequate treatment of developed complications. In conditions of heparinization, monitoring should be non-invasive and continuous. Under such circumstances, this can only include EEG, transcranial Doppler ultrasound, cerebral oximetry, and cerebral blood flow autoregulation.

Purpose: evaluate the effectiveness of various approaches to assessing autoregulation in cardiac surgery under conditions of cardiopulmonary bypass. Summarize the available data on intraoperative neuroprotection in cardiac surgery based on monitoring of cerebral blood flow autoregulation.

Materials: a literature search was carried out in the databases: Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Scopus, PubMed, E-library, Web of Science and guidelines on the management of postoperative pain. All selected Literature search contained of actual data the clinical and scientific studies focus on the problem of pain relief in patients undergoing open abdominal aortic repair and also alternative methods for relieving acute pain after laparotomy.

Results: this review addresses the issues of neuromonitoring and neuroprotection in cardiac surgery patients. It discusses the types of neuromonitoring and the possibilities of neuroprotection aimed at adequately influencing the autoregulation of cerebral blood flow. 

Conclusion: postoperative neurological complications following cardiac surgeries performed under conditions of cardiopulmonary bypass (CPB) are among the most clinically significant and quantitatively frequent complications in the postoperative period. In this regard, issues of neuroprotection are extremely important and relevant. The most studied and widely accepted method of intraoperative neuroprotection is managed hypothermia or normothermia. However, this approach has reached its neuroprotective limits, and the incidence of neurological complications remains high. There is a need to explore new possibilities that can provide real intraoperative neuroprotection. Achieving and maintaining optimal arterial blood pressure, based on real-time monitoring of cerebrovascular autoregulation, is a promising and important component of anesthetic management. Further studies are necessary to investigate the effectiveness of the neuroprotective potential of continuous intraoperative monitoring of cerebrovascular autoregulation.

Aim: to present an overview of current research on the pathogenesis of atrial fibrillation (AF). 

Materials and methods: a literature review was conducted for the period 2000-2025 in Russian and English using accessible databases including Pubmed, Medline, Scopus, and E-library.

Results: data on the prevalence of AF in the general population and in groups with concomitant cardiac pathology (coronary artery disease, mitral and aortic valve disease) are presented. The concept of triggers and mechanisms of AF initiation is outlined. The issue of AF maintenance involving focal mechanisms is considered. Information on AF maintenance via reentry mechanisms is presented. Particular attention is paid to issues of electrical and structural atrial remodeling. 

Conclusion: over the past few decades, significant progress has been made in understanding the mechanisms underlying the initiation and maintenance of AF. Further research in this area will improve treatment outcomes for patients with AF.

Objective: to present a case of surgical treatment of aortic valve (AV) stenosis combined with a giant aneurysm of the descending thoracic aorta. Material and Methods: а 52-year-old male patient was admitted to the Federal Center for Cardiovascular Surgery (Chelyabinsk) with a diagnosis of aortic valve stenosis and an aneurysm of the descending thoracic aorta. Echocardiography revealed a bicuspid AV with severe stenosis (peak gradient 80 mmHg, mean gradient 44 mmHg) and moderate insufficiency. Left ventricular ejection fraction (LV EF) was 66%, and the end-diastolic dimension (EDD) was 55 mm. Mitral and tricuspid valve function were normal. Estimated pulmonary artery pressure was 30 mmHg. MSCT of the thoracic aorta demonstrated a giant aneurysm of the descending thoracic aorta (10 cm in diameter) with signs of rupture (imbibition of surrounding tissue with blood, left-sided hemothorax).

Results: to correct the combined pathology, a non-standard surgical approach was used: an upper L-shaped ministernotomy in the 5th intercostal space extended into a left lateral thoracotomy. This provided adequate exposure for the simultaneous procedures. As part of the surgical intervention, a 25-mm MedInzh mechanical prosthesis ((MedInzh LLC, Penza, Russia) was implanted in the aortic position using 15 individual U-shaped sutures on synthetic pads. The ascending aorta was occluded for 96 min. After aortic unclamping and restoring cardiac activity, direct cannulation of the right femoral artery was performed. Following aneurysm mobilization and thoracic aortic cross-clamping, prosthetic replacement of the thoracic aorta was performed using a 24-mm Gelweave vascular graft (Vascutek, Inchinnan, UK). The thoracic aorta cross-clamp time was 97 min, and the total cardiopulmonary bypass time was 336 minutes. The surgery was completed without significant complications. The patient was discharged in satisfactory condition.

Conclusions: For selected patients,, an L-shaped sternothoracotomy can be the approach of choice when simultaneous intervention on the ascending and descending thoracic aorta is required.

Objective: refractory ventricular tachycardia arising from anatomically challenging subepicardial regions, such as the left ventricular summit, remains an unresolved clinical problem when catheter ablation and antiarrhythmic therapy have been exhausted. Stereotactic arrhythmia radioablation (STAR) represents a promising non-invasive alternative in this setting. The aim of this report is to present a case of STAR in a young female patient with refractory ventricular tachycardia originating from the anterobasa l part (summit) of the left ventricle on a post-myocarditic substrate. 

Material and methods: the arrhythmogenic substrate was identified by invasive electroanatomical mapping with subsequent integration of electrophysiological data with cardiac MRI findings and topographic registration to the 17-segment model of the left ventricle (AHA). Based on the fused dataset, the cardiac target volume (CardTV, 10.43 cmі) and planning target volume (PTV, 22.74 cmі) were delineated. Single-fraction irradiation at a dose of 25.5 Gy to 95% of CardTV was delivered using the CyberKnife M6 robotic system with real-time respiratory motion tracking (Synchrony system) and a temporary coronary sinus electrode serving as an intracardiac radiopaque fiducial marker.

Results: at discharge (day 8), the ectopic burden decreased from 28,690 to 3,426 PVCs/day with complete elimination of VT. At 4.5-month follow-up, burden was 3,041 PVCs/day with no VT recurrence. MRI demonstrated post-radiation fibrosis formation and reactive myopericarditis. 

Conclusion: STAR provided a pronounced and sustained antiarrhythmic effect in a patient with refractory VT, with no recurrence over 4.5 months of follow-up. The method may be considered as an alternative when catheter ablation options are exhausted.