Aim: To determine the optimal treatment strategy in patients with coronary artery disease complicated by moderate ischemic mitral regurgitation.

Methods: A total of 80 patients consecutively operated in the Surgical Department of Coronary Artery Disease of the B.V. Petrovsky Russian Scientific Center of Surgery in the period from 2015 to 2022 were included in the study. Of them, 38 patients underwent isolated coronary artery bypass grafting (Group 1) and 42 patients underwent simultaneous coronary artery bypass grafting and mitral valve repair (Group 2). The exclusion criteria were as follows: patients after emergency and repeated surgical interventions, patients operated for postinfarction left ventricular aneurysm.

Results: No significant differences in the perioperative parameters were found in the early postoperative period. There were no deaths in both groups. The most common postoperative complications included respiratory failure (15.8% in Group 1 vs. 23.8% in Group 2, p> 0.05) and arrhythmia (18.4% in Group 1 vs. 28.6% in Group 2, p> 0.05). There were no significant differences in the 7-year survival rate between the groups (94.7% in Group 1 vs. 95% in Group 2, p> 0.05). The freedom from adverse cardiac events did not differ significant as well (53% in Group 1 vs. 66.7% in Group 2, p> 0.05).

Conclusion: A personalized approach based on the quantitative and qualitative assessment of the individual patient status, intracardiac hemodynamic parameters, a detailed analysis of mitral regurgitation, and spatial-geometric ratio of the valve and the left ventricle determine the success of surgical intervention in this group of patients.

Aim: To evaluate the short-term outcomes of hybrid stent-grafting for aortic rapier in patients admitted at the Federal Center for Cardiovascular Surgery named after S.G. Sukhanov, Perm.

Methods: 34 patients underwent hybrid stent-grafting at the Federal Center for Cardiovascular Surgery named after S.G. Sukhanov in the period from January 2018 to August 2023. The mean age of patients was 56±14 years. Twenty-four (71%) patients were males 24. Three patients (9%) were present with a positive history of stroke. Six patients (18%) suffered from coronary artery disease and nine (26%) patients had diabetes mellitus. All patients were divided into 4 groups depending on the aortic disease: 17 (50%) patients with arch aneurysm and ascending aorta aneurysm and without it were included in Group 1, 10 (29%) patients with DeBakey type III dissection were enrolled in Group 2, 4 (12%) patients with acute DeBakey type I aortic dissection – Group 3 and 3 (9%) patients with hemodynamically corrected type I aortic dissection.

Results: The in-hospital period ranged from 13 to 28 days. In-hospital mortality was 6% (n=2). One patient experienced ischemic stroke in the early postoperative period resolving within the first 24 hours. All patients underwent a control computed tomography, confirming the absence of endoleaks. There were no cases of stent-graft translocation.

Conclusion: Hybrid stent-grafting in patients with ascending aortic arch and descending aorta pathologies allows reconstructing almost the entire thoracic aorta in a single stage. In case the thoracoabdominal segment is involved, it significantly facilitates the second one.

Purpose: To evaluate the immediate results, safety and replicability of the method of correction of atrioventricular valve defects through right-sided video-assisted minithoracotomy based on the first experience of 37 operations.

Materials and Methods: from March 2022 to October 2023, 37 adult patients underwent correction of isolated and combined mitral and tricuspid valve lesions via right-sided video-assisted minithoracotomy. There were 21 (56.7%) females in the group, and the age of the patients was 49±10 years. Overweight (BMI 25-30) was identified in 11 (29.7%) patients. Single-valve intervention was performed in 25 (67.6%) patients, two-valve correction in 12 (32.4%). The EuroScore II risk was 1.3±0.7%.

Results: Cardiopulmonary bypass time was 184±41 min, aortic cross-clamping time was 131±34 min. Valve reconstruction was performed in 25 (67,6%) patients. Intraoperative blood loss was 490±115 ml, component transfusion was performed in 3 (8%) patients. Converting from minithoracotomy to midline sternotomy was in 1 (2,7%) patient. The duration of ALV was 15.9±16.7 hours, the duration of stay in the intensive care unit (ICU) was 22±15.9 hours, and the duration of postoperative hospital stay was 10±2.8 days. There were no incident atrial fibrillations in the postoperative period in any patient. There were also no cases of deep wound infection, ACVA and fatal outcomes. In one case (2.7%) the patient developed postoperative delirium, which required prolonged ALV.

Conclusion: Correction of atrio-ventricular valve defects through right-sided video-assisted minithoracotomy is a safe intervention because it is associated with a low rate of post- and intraoperative complications and conversion to midline sternotomy. Less blood loss and quicker recovery of patients compared to standard surgery. This technique can be safely applied both in patients with isolated mitral valve defects and with combined atrio-ventricular valve defects. Correction of atrio-ventricular valve defects through right-sided video-assisted minitorcotomy is a reproducible operation, but it is more demanding on surgical skills and requires patient selection, especially at the stage of technology implementation.

Purpose: To evaluate the immediate results of mitral defect correction from right sided lateral minithoracotomy.

Materials and Methods: From August 2021 to September 2023, 30 patients with mitral valve defects underwent surgical correction of mitral defect through right sided lateral minithoracotomy under direct visual control. The indications for the minimally invasive approach were the presence of mitral valve defect without concomitant coronary artery disease requiring revascularisation, absence of aortic insufficiency of more than 1 degree. Among the operated patients there were 19 (63,3%) women and 11 (36,7%) men. The mean age was 48.1±18.8 years. Body mass index was 24.8±6.3 kg/m. The insufficiency was a haemodynamic variant of the defect in 27 patients (90%).

Results: The mean volume of postoperative blood loss was 272±87 ml. The mean time on ALV was 8±3 hours. The mean time in the intensive care unit was 22.6±15.3 hours. There were no repeated interventions and transfusion of blood components in the group of operated patients. There was no hospital mortality, AMI and ACVA among the operated patients. There was no surgical site infection, lymphorrhoea. Pneumothorax requiring drainage was detected in one (3.3%) case. A first-time paroxysm of heart rhythm disturbance (atrial fibrillation/flutter) was recorded in 7 (23%) patients. The average time of hospital stay was 11,9±7 days.

Conclusions: Minimally invasive correction of mitral valve defects from right-sided minithoracotomy under direct visual control is a safe and reproducible operation. IV i/s access provides optimal visualisation of the mitral valve, allowing to perform the whole range of both reconstructive techniques and MV prosthetic repair without the use of video-assisted surgery. In case of proper selection of patients for this type of intervention, the operation is associated with a low incidence of complications in the perioperative period. Preservation of the thoracic cage framework, absence of complications associated with traditional access, and early activation of the patient, combined with an excellent cosmetic effect, contribute to a shorter hospital stay.

Tricuspid valve atresia (TVA) is a congenital critical heart defect characterized by a lack of communication between the right atrium and the right ventricle. The classic approach at the first stage of surgical treatment is aimed at maintaining pulmonary blood flow and consists of applying a systemic-pulmonary anastomosis or shunt. As an alternative surgical approach, it is possible to use the patent ductus arteriosus (PDA) stenting technique. The minimally invasive procedure is low-traumatic and ensures adequate pulmonary blood flow. The article presents the experience of PDA stenting for tricuspid atresia in newborns. Good immediate and long-term results were obtained, staged surgical treatment was performed, consisting of a complete cava-pulmonary anastomosis. The authors consider stenting of a PDA to be an effective and safe method of surgical treatment, since this method of treatment does not provoke additional risks during subsequent surgery, and can be used in providing emergency care to newborns with critical congenital heart defects.

The aim of our study was a retrospective evaluate of effective and safety aortic valve replacement by Mini-J sternotomy in patient with body mass index more than 31.

Methods: Between October 2012 to April 2023, in our Center was performed 660 operations - isolated aortic valve replacement. Mini-J sternotomy approach for AVR performed in 212 cases. In 135 cases we diagnostic BMI more then 31, in 50 cases from this BMI was wore then 35. Additionally, for comparison, we formed a group of patients who underwent aortic valve replacement by standard approach. Mean EuroScore II was 2.6 ± 0.5%.

Results: Hospital mortality and operations relation complications such as: complete atrioventricular block, interventricular septal defect not differ in researched groups (p = 0.242, p = 0.191 and p = 1.0). Blood transfusions and resternotomies were performed significantly more in group of standard access (p = 0.007 and p = 0.024). Operating time was statistically longer in mini-J sternotomy, but without a significant differ in CPB time (p < 0.001 and p = 0.729). Mean follow-up period for groups mini-J sternotomy with BMI ≥ 31 and standard approach was 61.1 months (95% CI 51.6 -66.4) and 62.1 months (95% CI 54.6 -67.4) , respectively. Survival rates at 12.36 and 60 months were 99.2%, 94.4%, 89.3% and 92.7%, 94.8%, 87.3% (Logrank test = 0.745). Freedom from thromboembolic complications at 12.36 and 60 months was 100%, 95.5%, 92.3% and 100%, 95.6%, 88.4% (Log-rank test = 0.745).

Conclusion: Applying mini-J sternotomy in patients with BMI more then 31 for surgical treatment of aortic valve, allows effective and safe treatment of this group patients and shows good immediate and long-term results.