Based on an analysis of archival materials, the authors summarize the key milestones of the life and career of the Hero of Socialist Labor, Laureate of the Leni Prize and the State Prize of the USSR, full member of the USSR Academy of Medical Sciences, academician of the Russian Academy of Medical Sciences, director of A.N. Bakulev Institute of Cardiovascular Surgery of the USSR Academy of Medical Sciences (1966–1992), founder and first director of the Scientific Center for Cardiovascular Surgery of the Russian Academy of Medical Sciences (1992 – 1994), Professor Vladimir Ivanovich Burakovsky (1922– 1994). V.I. Burakovsky is the founder of a new medical and scientific specialty in the former Soviet Union, who established the national school of thought in cardiovascular surgery, and is considered a pioneer of the modern cardiovascular surgery.

Aim: To assess the outcomes of surgical treatment of thoracic aortic disease in patients following elective cardiac surgery.

Methods: Medical records of 44 patients following elective surgery on the proximal thoracic aorta who underwent re-interventions in the period from January 2011 to September 2022 at the Federal Center of Cardiovascular Surgery (Chelyabinsk) were retrospectively reviewed. The mean age of patients at the time of the re-intervention was 55.3±12.8 (24–76) years. Indications for re-intervention were as follows: aortic aneurysm (n=17 (38.6%)), dysfunction of aortic valve (AV) prosthesis (n=10 (22.7%)), native aortic valve disease (n=8 (18.2%)), false aortic aneurysm (n=4 (9.1%)), type A aortic dissection (n=2 (4.6%)), and prosthetic valve endocarditis (n= 3 (6.8%)).

Results: One patient died (2.3%) due to multiple organ dysfunction syndrome. The mean aortic crossclamp time was 151.4±42.1 (69–245) min and the mean cardiopulmonary bypass (CPB) time was 240.9±63.5 (141–390) min. Thirteen patients (29.5%) underwent hypothermic circulatory arrest with antegrade cerebral perfusion in aortic arch surgery. The mean hypothermic circulatory arrest time was 24.8±10.2 (12–40) min. Resternotomy for excessive bleeding was performed in 3 patients (6.8%). Eight patients (18.2%) required prolonged mechanical ventilation (over 24 hours). The length of stay in the intensive care unit was 8.3±14.6 (3–100) days and 23.1±15.9 (10–111) in the general ward. Successfully discharged patients were regularly followed up. The mean follow-up period was 42.2±26.6 (from 1 to 130) months. Four patients died in the follow-up period. The long-term survival was 85.2%.

Conclusion: These patients are considered as a group of increased surgical risk. Optimal surgical management with a precise planning (access for the re-intervention, cannulation, cerebral and myocardial protection, etc.) allows achieving favorable in-hospital outcomes. This group of patients require regular follow-up.

Aim: To assess the results of autopericardial neocuspidization of the aortic valve through J-shaped ministernotomy with thoracoscopic pericardial harvesting compared to full median sternotomy.

Methods: 64 medical records of patients were retrospectively reviewed. 20 patients who underwent AVNeo through J-shaped ministernotomy with thoracoscopic pericardial harvesting were assigned to Group 1. 44 patients who underwent classical AVNeo procedure were assigned to Group 2. Both groups were similar in terms of comorbidities and concomitant cardiac diseases. In Group 1, fourteen patients (70%) received femoral vein-femoral artery cardiopulmonary bypass (CPB) and six patients (30%) – femoral vein-aorta CPB. Pericardium harvesting was performed on the dry heart using port-access. The mean harvesting time was 29.2±4.2 minutes. The size of the collected pericardium did not differ between the two groups. J-shaped ministernotomy was performed on the third or the fourth intercostal space based on MSCT imaging.

Results: J-shaped ministernotomy was associated with increased mean CPB time and aortic cross-clamp time (175.5±11.6 min and 102.5±7.8 min in Group 1, p>0.001 vs. 114.4±40.6 min and 84.4±19.9 min in Group 2, p>0.001, respectively). Our findings showed less blood loss with J-shaped ministernotomy (576±114.7 mL in Group 1 and 763.6±446.7 mL in Group 2, p=0.027). All patients in Group 1 were successfully discharged from the hospital, but two patients died in Group 2 (4.5%). The duration of postoperative mechanical ventilation was significantly less in Group 1 (2.85±2.3 hours) compared to Group 2 (5.18±3.9 hours, p>0.001). Group 1 patients reported less intense pain on the VAS scale (p>0.001). The length of in-hospital stay after surgery was significantly shorter in Group 1 compared to Group (7.1±3 days vs. 13.9±5.5 days, respectively, p>0.001). Both surgical approaches did not differ in terms of the effectiveness.

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

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 discharge 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 period. 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.

Aim: To compare safety and efficacy of MIDCAB and OPCAB for isolated LAD disease.

Methods: 53 patients were assigned to the MIDCAB group and 54 patients who underwent anterior descending coronary artery bypass grafting were assigned to the OPCAB group. Patients were recruited in the period from 2019 to 2022. Exclusion criteria were as follows: simultaneous surgical treatment of coronary artery disease, brachiocephalic artery disease, myocardium, valvular heart disease, as well as urgent and repeated surgical interventions.

Results: The mean time of surgery was 189.9±77 min in the MIDCAB group vs. 174.9±54.5 min in the OPCAB group (p=0.2467). The intraoperative blood loss was significantly higher in the OPCAB group (348.6±63.7 mL vs. 143.33±34.5 mL, p<0.0001). The mean postoperative mechanical ventilation time (6.5±2.46 hours vs. 5.4±3.1 hours, p=0.0444), the length of stay in the intensive care unit (1.03±0.3 vs. 1.27±0.8 days, P=0.0431) and the length of the in-hospital stay (8.3±2.4 vs. 12.7±5.5 days, p<0.0001) were significantly higher in the OPCAB group. There were no in-hospital deaths in both groups. The need for blood transfusion was higher in the OPCAB group (22.2% in the OPCAB group vs. 5.7% in the MIDCAB group, p=0.0235). Perioperative complications were more common after sternotomy (20.4% in the OPCAB vs. 7.4% in the MIDCAB group, p=0.0926). The 4-year cumulative survival was 96.8% in the MIDCAB group vs. 92.8% in the OPCAB group (p = 0.673). The cumulative freedom from adverse cardiac events was 91.2% in the MIDCAB group vs. 91.9% in the OPCAB group (p=0.421).

Conclusion: MIDCAB is a safe and effective surgical method for treating patients with coronary artery disease ensuring optimal clinical outcomes and improved quality of life. Therefore, MIDCAB should be considered as an optimal treatment strategy for the routine clinical practice.

Over the past decade, minimally invasive procedures including partial upper mini-sternotomy and right mini-thoracotomy have become the «gold standard» for isolated aortic valve replacement. However, minimally invasive approach is not routinely performed in aortic root surgery, and median sternotomy remains the incision of choice. The review is aimed at assessing and commenting on the surgical techniques and the current evidence on minimally invasive aortic root surgery with a particular focus to their evolution, and future perspectives. The literature search was carried out in international databases - Medline, Google Scholar and the Cochrane Library, as well as in the domestic source - «eLibrary.Ru - Russian scientific electronic library».

Recent studies have shown promising clinical results of minimally invasive aortic root surgerycomparable to median sternotomy in terms of safety and efficacy. Minimally invasive approaches are associated with low blood loss, quicker healing, a reduced risk of infectious complications, and superior cosmetic results. However, the reported studies have a low level of evidence. Randomized clinical trials with a long-term follow-up are required to validate these results and motivate the surgeons to routinely apply minimally invasive procedures to the majority of patients requiring intervention on the aortic root.

Postoperative non-infectious sternal dehiscence is a rare, but relatively favorable complication following cardiac surgery. The article describes the surgical technique and presents a series of cases of surgical treatment of non-infectious partial sternal dehiscence using Sternal Talon titanium implants. The advantages of Sternal Talon are the large thickness of the device at the sternum grip (reduces the risk of cutting through the bone), reliable and rigid fixation, as well as ease of use. Delayed (several months) osteosynthesis reduces the risk of complications due to the elimination of perioperative factors associated with the index surgery. 

Background: Atrial fibrillation (AF) is the most common type of treated heart arrhythmia. AF occurs in 5-10% of patients with coronary artery disease undergoing coronary artery bypass grafting. Only a few of them undergo concomitant AF treatment. Off-pump CABG and minimally invasive access are considered the key reasons why surgeons refuse to perform concomitant AF surgery.

Case Report 1: A 64-year-old patient presented with AF paroxysms lasting from 2016 and persistent AF lasting from 2019. Coronary angiography reported LAD stenosis of 95%. The patient had LVEF of 64%, LA anterior-posterior size of 50 mm, and no signs of valvular heart disease by ECHO-CG. AF was confirmed by ECG with giant F waves in the leads V1-V2. The patient underwent thoracoscopic radiofrequency ablation of the left atrium with the resection of the left atrial appendage and minimally invasive coronary artery bypass grafting of the anterior descending artery (MIDCAB). The patient was extubated after 6 hours. Postoperative blood loss was 100 mL. There were no recurrent angina pectoris and AF paroxysms. The patient was successfully discharged after 8 days. There were no symptoms of heart failure after 12 months. The patient was in sinus rhythm confirmed by 72-hour Holter monitoring.

Case Report 2: A 56-year-old patient was presented with AF paroxysms lasting from 2020. Coronary angiography reported LAD stenosis of 85%. The patient had LVEF of 61%, LA anterior-posterior size of 45 mm, and no signs of valvular heart disease pathology by ECHO-CG. The patient was in sinus rhythm by ECG. The patient underwent thoracoscopic radiofrequency ablation of the left atrium with the resection of the left atrial appendage and MIDCAB of the anterior descending artery. The patient was extubated after extubated after 4 hours. Postoperative blood loss was 100 mL. There were no recurrent angina pectoris and AF paroxysms. The patient was discharged after 7 days. There were no signs of recurrent angina and heart failure after 1 month of the surgery. The patient was in sinus rhythm confirmed by 24-hour Holter monitoring.

Conclusion: Both care reports have demonstrated that the minimally invasive approach to treat AF and left anterior descending artery is an effective and safe procedure.