Introduction. The risk of endovascular interventions in various forms of cardiac pathology is significantly lower than in surgical correction of similar conditions under cardiopulmonary bypass.

The aim of the study was to evaluate the dynamics of key indicators of central hemodynamics following transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis and reduced left ventricular contractile function.

Materials and methods: 22 TAVI procedures were performed (13 men and 9 women) in patients with severe aortic stenosis combined with severe systolic dysfunction of the left ventricle. The functional class of heart failure according to NYHA was: Class III - 15 patients, Class IV - 7 patients. The average age was 65.6±2.18 years (ranging from 44 to 78 years).

Results. On average, there was a 30% increase in the left ventricular ejection fraction (LVEF) from 27.5 ± 2.9% to 41.2 ± 6.1% (P<0.001). There was a significant decrease in left ventricular volume. The left ventricular end-diastolic volume decreased from 176.3 ± 54.2 ml to 140.4 ± 40.1 ml (P<0.001). A significant improvement in central hemodynamics was confirmed by a substantial reduction in pulmonary artery pressure, which approached normal values - 34.3 ± 1.3 mmHg, compared to the initial value of 65±2.4 mmHg (P<0.001). The results of TAVI in patients with severe systolic dysfunction of the left ventricle demonstrate a radical improvement in cardiac performance. The degree of change in central hemodynamic parameters after the elimination of aortic stenosis reflects the level of myocardial functional reserve and may serve as a real criterion for determining of the prognosis of the disease.

Conclusion: Data from instrumental investigations performed in the postoperative period indicate a high level of technical and clinical success in performing TAVI in patients with reduced left ventricular contractile function.

Aim: To conduct comparative analysis of the early and long-term results of surgical reconstruction of the aortic arch with and without the “Frozen elephant trunk” technique in patients with aortic dissection.

Methods: A retrospective study has been conducted, 72 patients with acute and chronic aortic dissection who underwent surgical treatment were enrolled. All patients were divided into two groups. Group I (non- FET, n=17) consisted of patients who underwent conventional reconstructive surgery without using the “Frozen elephant trunk” technique. Group II (FET, n=55) included patients who underwent the “Frozen elephant trunk” procedure. A comparative analysis of early and mid-term postoperative results was carried out.

Results: In the early postoperative period in the non-FET and FET groups, the incidence of transient neurological complications was 0 vs. 3.6% (p>0.999) and cerebral stroke was 0 vs. 3.6% (p>0.999). Paraplegia was not noted in any of the groups. The need for prolonged respiratory support after surgery was recorded in 82.4% of cases in patients in the non-FET group and in 17.6% in the FET group (p<0.001). Acute kidney injury was diagnosed in 17.6% and 5.9% in the non-FET and FET groups, respectively (p=0.601). Early postoperative mortality in the non-FET group was 17.6%, in the FET group – 7.3% (p=0.344). Patient survival for 5 years after surgery was 71% in the non-FET group and 76% in the FET group. Freedom from distal aortic reintervention was 86% in the non-FET group and 100% in the FET group (p=0.861). Freedom from negative remodeling of the thoracoabdominal aorta in the non-FET and FET groups reached comparable values, not exceeding 62 and 62%, respectively (p=0.875).

Conclusion. The “Frozen elephant trunk” technique in the treatment of patients with aortic dissection is promising and characterized by satisfactory early and long-term results in this category of patients.

Redo cardiac surgeries are associated with a high operative risk and mortality, particularly when using conventional median resternotomy. In recent years, increasing attention has been paid to minimally invasive techniques as an alternative to resternotomy in redo procedures. This review analyzes current data from 2015 to 2025 regarding the use of minimally invasive approaches in reoperative cardiac surgery, including mini-thoracotomy, mini-sternotomy, thoracoscopic and robot-assisted techniques, as well as transcatheter interventions. The findings of major meta-analyses and observational studies are summarized, demonstrating a 40–50% reduction in operative mortality, shorter hospital stays, and a lower incidence of complications (infections, acute kidney injury, blood loss) when minimally invasive strategies are employed. Particular attention is given to technical aspects of surgical access, indications, limitations, and future prospects. The review confirms the high efficacy and safety of minimally invasive procedures in redo cardiac surgery and emphasizes the importance of an individualized approach involving a multidisciplinary team.

The emergence of novel non-invasive methods of body surface cardiac mapping allows detecting arrhythmogenic focus localization with high accuracy and contributes to superior long-term outcomes following interventional and cardiac procedures. The implementation of the original body surface cardiac mapping system “Amicard 01C” into routine clinical practice has increased drastically the reproducibility of preoperative diagnosis of life-threatening arrhythmias, timely assessment, and investigation of the complex electrophysiological pathogenesis of ventricular and atrial tachyarrhythmias.

Extensive clinical experience has proven the high accuracy of body surface cardiac mapping enabling to perform interventional procedures without additional intraoperative endocardial mapping. Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting 1-2% of the general population. Catheter AF ablation is less effective for treating persistent and long-standing persistent AF. A failed catheter ablation is associated with more reduced efficacy of further ablation procedure in patients with persistent and long-standing persistent AF.

Therefore, it rationale to consider a two-stage or hybrid approach combining epi- and endocardial ablations in patients with persistent and long-standing persistent AF. The 3-year freedom from persistent and long-standing persistent AF reached 86.9% among patients who underwent staged treatment in the A.V. Vishnevsky National Medical Research Center of Surgery.

Non-invasive stereotactic radioablation of cardiac arrhythmias using linear accelerators is projected to become highly-demanded method in the near future along with non-invasive cardiac mapping modes. The first clinical cases of non-invasive radioablations have shown beneficial effects for treating life-threatening cardiac arrhythmias.

In patients over the age of 18, 6% needed homograft replacement within 10 years. Taking into account the planned volume of surgery, a cryopreserved vascular valve-containing homograft was chosen as a conduit. The classic approach providing exposure to the root, ascending section and arch of the aorta is median sternotomy. Considering the need for a single-stage intervention on the descending thoracic aorta, it was decided to use a transverse double-pleural thoracotomy of the "shell" type for better visualization.

We present a case of surgical treatment of a patient with DeBekey type II chronic aortic dissection, pronounced degenerative changes in the arch and descending aorta, and the development of severe aortic insufficiency against this background.

Current trends in coronary surgery are due to significant changes in the contingent of patients undergoing surgery for coronary heart disease, the prevalence of high-risk patients among them due to old age, comorbid pathology, disabled myocardium, diffuse coronary lesions, and the combined nature of operations on the coronary arteries and various structures of the heart. Therefore, the search for reserves for improving the results of coronary artery bypass grafting in this large and heterogeneous group of high-risk patients is very relevant. The detailed analysis of the state of modern coronary surgery shows that the level of its development at the B.V. Petrovsky Russian Scientific Center of Surgery corresponds to all its current trends. Various myocardial revascularization operations are presented and their place in the surgical treatment of patients with coronary heart disease is determined. Improvement of MR methods, personalized solutions for determining indications and tactics of operations in patients with varying degrees of risk, a pragmatic approach to the introduction of new technologies are the basic principles of surgical activity. This allows performing operations of varying complexity, introducing new technologies with high clinical effectiveness with minimal acceptable risk.