Aim: To assess the safety and efficacy of multivessel minimally invasive coronary artery bypass grafting (MICS CABG) in the immediate and mid-term period.

Methods: A total of 611 patients with multivessel coronary artery disease who underwent MICS CABG in the period from 2011 to 2022 were recruited in a cohort study. All patients underwent complete myocardial revascularization via left mini-thoracotomy on the beating heart. The age of the patients was 58.9±8.1 years. 87 (14.2%) patients were women. Diabetes mellitus was detected in 129 (21.1%) patients, obesity – in 233 (38.1%). The EuroScore was 1.2±0.7 and the SyntaxScore was 26.7±8.9.

Results: The mean operation time was 261.7±93.5 minutes, the number of distal anastomoses was 2.5±0.7. 292 (47.8%) patients underwent mammary coronary artery bypass grafting, whereas 319 (52.2%) patients underwent coronary artery bypass surgery without touching the aorta. Cardiopulmonary bypass was initiated in 25 (4.1%) patients, of them 14 patients (2.3%) patients underwent emergency conversion. The median intraoperative blood loss was 250 (200; 300) mL, and the 24-hour blood loss after the intervention – 270 (150; 350) mL. Transfusion of blood and its components was performed in 56 (9.2%) patients. There were no cases of deep wound infection. Perioperative stroke was recorded in 2 (0.33%) patients, myocardial infarction – in 8 (1.3%) patients. The 30-day mortality was 0.49% (n=3). The postoperative in-hospital stay was 7 (7; 10) days, the median time up to return to full physical activity – 14 (9; 24) days. With the follow-up of 5.1 (3.2; 7.1) years, the 8-year cumulative survival rate was 91.4% and the freedom from major adverse cardiac and cerebrovascular events was 87.6%.

Conclusion: MICS CABG is a safe operation, associated with a low incidence of perioperative complications. MICS CABG can be applied to multi-vessel CAD patients saving the effectiveness during mid-term follow-up, comparable to traditional CABG. MICS CABG is a reproducible operation, but more demanding on surgical skills and requiring patient selection, especially at the beginning of the learning curve.

Aim: To assess the association of the common origin of the brachiocephalic trunk and the left common carotid artery (a bovine arch branching pattern) with aortic diseases.

Methods: 194 medical records of patients undergoing surgical treatment of aortic dissection and ascending aneurysm in the period from 2017 to 2021 were retrospectively reviewed. All patients were divided into 2 groups based on the anatomy of the aortic arch: patients with the common origin of the brachiocephalic trunk and the left common carotid artery (a bovine arch branching pattern) were assigned to Group 1, whereas patients without any anomalous origins of the supra-aortic vessels were assigned to Group 2. Clinical and demographic data, echocardiographic findings, and radiologic images were analyzed in both groups.

Results: Thoracic aortic aneurysm was more commonly detected significantly in Group 1 patients compared to those who did not have any abnormalities of the aortic arch (100% vs. 80.1%, p=0,021, respectively).

Conclusion: The common origin of the brachiocephalic trunk and the left common carotid artery have been associated with a higher incidence of thoracic aortic aneurysms.

Background: The incidence of venous extension to the renal vein and inferior vena cava (IVC) in renal cell carcinoma (RCC) due to the least resistance to invasive growth is markedly increased compared to other tumors. Their length can reach up to 20 cm and reach the heart chambers. Tumor thrombus originates from the tumor in the kidney parenchyma and floats at different levels in the lumen of the IVC.

Methods: A total of 91 kidney cancer patients with IVC tumor thrombus were recruited in a prospective study in the period from 2014 to 2022. Of them, 68 (74.7%) were men and 23 (25.3%) were women. The mean age of the patients was 60.9 ± 9.1 years. TNM staging: рТ1а—3bN0-2M0–1 G1–3. IVC block symptoms were detected in 54 (59.3%) patients. The upper border of the tumor thrombus head was limited by the renal vein (RV) in 24 (26.4%) patients. 21 (23.1%) patients suffered from tumor thrombus extended less than 2 cm above RV. 16 (17.6%) patients had IVC tumor thrombus of more than 2 cm above RV, but below the hepatic veins. Tumor thrombus did not reach the main hepatic veins in 15 (16.5%) patients. The head of tumor thrombus was located between the mouths of the main hepatic veins and the diaphragm in 7 (7.7%) patients, and 1 (1.1%) patient had tumor thrombus head between the pericardium and the diaphragm. One (1.1%) patient had tumor thrombus head at the level of the diaphragm, four (4.4%) patients –in the intrapericardial segment, above the diaphragm, and two (2.2%) patients – at the right atrium. At the time of the index surgery, 47 (51.6%) patients had distant metastases.

Results: The duration of surgery ranged from 105 to 715 minutes (the mean time of 294±111.5 min). The mean blood loss was 1178±2165.4 mL. Intraoperative complications occured in one (1.1%) patient. The total number of postoperative complications according to Clavien-Dindo was 13 (14.3%). Grade 1-2 complications were detected in 9 (9.9%) patients, grade 3-4 – in 4 (4.4 %). The follow-up ranged from 3 to 86 months (58.7±19.1). Tumor progression was reported in one (1.1%) patient.

Conclusion: Nephrectomy with IVC thrombectomy is the gold standard for treating patients with RCC and IVC tumor thrombosis. This surgical treatment remains challenging and requires a multidisciplinary approach to improve patient survival.

Aim: To evaluate the effectiveness of perfusion methods to remove inflammatory mediators and metabolites, as well as to reduce the incidence of postoperative organ dysfunction in patients with comorbidities following prolonged cardiopulmonary bypass.

Methods: 154 comorbid patients who underwent cardiac surgeries with cardiopulmonary bypass (CPB) over 90 min were included in a single-center retrospective non-randomized study. Patients received standard anaesthesia. All patients were assigned to three groups: group 1 (n=51) patients received extracorporeal circuit with a conventional roller pump, group 2 (n=31) patients received hemofiltration (HF) during CPB, and group 3 (n=67) patients - hemodiafiltration (HDF) with polymethyl methacrylate dialyzer (PMMA). The groups were comparable in clinical (severity of concomitant diseases – respiratory failure, renal failure, diabetes mellitus) and intraoperative parameters (CPB duration, aortic cross-clamp time). Levels of biochemical markers of organ failure, the oxygenation index (PaO2/FiO2), the degree of hemolysis by plasma free hemoglobin (fHb) and markers of the inflammatory response (interleukin-6 (IL-6), interleukin-10 (IL-10), procalcitonin (PCT), C-reactive protein (CRP), sTrem-1) were measured 1 hour after CPB initiation and 24 hours after its termination. The rate of respiratory and renal complications, postoperative drainage blood loss, the need for vasopressor support, and the length of in-hospital and IVU stay were assessed.

Results: The doses of vasopressor therapy were significantly lower in the PMMA dialyzer group with similar inotropic support. Importantly, patients in the HF group did not require vasopressor therapy. The degree of hemolysis, as well as the levels of lactate were lower in the conventional CPB group and the HF group, while in the PMMA dialyzer group they did not exceed the reference levels. The measurement of biomarker levels showed that filtration and sorption during CPB reduced the level of inflammatory cytokines and trigger molecules of the systemic inflammatory response. The recovery of adequate spontaneous breathing was significantly higher in the conventional CPB group, as well as the need for dialysis and filtration therapy.

Conclusion: Hemofiltration using polyionic buffer solution and polymethyl methacrylate filters with sorption capacity during prolonged cardiopulmonary bypass in comorbid patients can reduce the risk of developing organ failure in the postoperative period.

Aim: To compare the results of the internal mammary artery (IMA) harvesting under direct vision and by thoracoscopy.

Methods: 339 patients (249 men, 90 women) who underwent minimally invasive coronary artery bypass grafting – MIDCAB (n=303) and MICS CABG (n=36) in the period from February 2014 to July 2021 were included in the retrospective analysis. All the patients were assigned into two groups depending on the IMA harvesting. 174 patients were assigned to the OPEN group with IMA harvesting under direct vision through the left minithoracotomy and 165 patients were assigned to the ENDO group with endoscopic IMA harvesting. The primary endpoint was major adverse cardiovascular events (MACCE), the secondary endpoint was the 1-year graft patency.

Results: There was no perioperative mortality. Two patients died in the OPEN group due to the graft dysfunction in the early postoperative period. There were no cases of the in-hospital mortality in the ENDO group. The 4-year freedom from MACCE in the ENDO and OPEN groups was 92.8% and 93.3%, respectively (p = 0.82). The 53-months survival in the ENDO and OPEN groups was 89.1% and 91.3%, respectively (p=0.95). The 1-year patency of the IMA grafts (MIDCAB and MICS CABG) was similar in both groups - 92%. To determine the predictors of mortality and major cardiovascular events in the long-term period, a univariate analysis was performed. Based on the obtained results, there were no statistically significant predictors of mortality and major cardiovascular events.

Conclusion: Our study has confirmed that endoscopic IMA harvesting is a safe approach with good long-term outcomes. Endoscopic harvesting should be performed in cardiovascular centers experienced in performing minimally invasive artery bypass grafting.

Background: Coronary artery perforations following minimally invasive diagnostic and therapeutic procedures require the urgent treatment due to the high risk of death. The implantation of a coronary stent graft is the strategy of choice to treat free perforations. Coronary stent grafts are covered self-expanding stents used to seal the damaged vascular wall by the external membrane.

Aim: to perform numerical and experimental investigation of promising polymeric materials that can be used for manufacturing the membrane for the coronary stent graft.

Methods: The study design was subdivided into two stages: stage 1 – assessment of the physical and mechanical properties of potential polymers (polytetrafluoroethylene, styrene-isobutylene-styrene, polyvinyl alcohol) and stage 2 – numerical modeling of the biomechanical response to the coronary stent graft functional diameter designing. The properties of the selected polymers were assessed with a Zwick/Roell-2.5H universal testing machine (Zwick/Roell, Germany) using uniaxial tensile testing mode. Numerical modeling was performed by the finite element method in Abaqus/CAE software (Dassault Systemes, France) with an increment in the graft diameter of 50% to the original one.

Results: Styrene-isobutylene-styrene copolymer demonstrated the greatest tensile strain with the elongation at break of 744.9 [737.0-837.8]% against initial size. Other polymers showed significantly lower tensile amplitudes. Polytetrafluoroethylene and polyvinyl alcohol samples broke when an elongation of 274.4 [270.9-280.4]% and 384.9 [313.4-390.6]% was reached. Numerical modeling for all materials showed moderate von Mises stress amplitudes, not exceeding the tensile strength. Polytetrafluoroethylene achieved the maximum stress of 7.50 MPa, styrene-isobutylene-styrene copolymer – 2.80 MPa, and polyvinyl alcohol – 0.08 MPa.

Conclusion: All the studied materials showed promising results and may be considered for manufacturing the stent graft membrane. However, styrene-isobutylene-styrene copolymer showed the beneficial properties among the rest. Based on our findings, it is rationale to focus on styrene-isobutylene-styrene copolymer and use it for the further prototyping.

The review article discusses the evolution of the surgical treatment of innominate artery disease with a particular focus on the validity of surgical interventions in asymptomatic patients, the surgical methods of choice, including endarterectomy from the brachiocephalic artery and extrathoracic reconstructions. Recent endovascular approaches to innominate artery disease are reported with the subsequent comparative analysis. Original studies and the obtained results are discussed.

Pregnancy and childbirth are risk factors for the development of aortic aneurysms and dissections even in the absence of predisposing factors. In addition, the risk of aortic dissection increases in women with connective tissue disorders.

We report a case of successful surgical intervention for giant thoracic aortic aneurysm in a postpartum patient who underwent aortic root replacement with repeated aortic valve replacement nine years ago.