Aim: to evaluate the immediate and mid-term outcomes of transapical and transfemoral aortic valve replacement using the MedLAB CT stent-valve prosthesis.

Methods: a total of 319 patients with aortic valve disease admitted for elective cardiac surgery to the Federal Center for Cardiovascular Surgery (Penza) were enrolled in a prospective single-center study. The mean patient age was 73.3±4 years. All patients were considered at high or intermediate surgical risk with a mean EuroSCORE II of 6.27%. All procedures were performed in a hybrid operating room under general endotracheal anesthesia without planned cardiopulmonary bypass. The prosthesis size was selected by the surgeon based on echocardiography (EchoCG), aortic root computed tomography (CT), and intraoperative aortography. The primary endpoints were all-cause mortality and clinically significant stroke. Hemodynamic parameters assessed echocardiography included mean aortic valve (AV) gradient, the effective orifice area (EOA), the severity of postoperative regurgitation.

Results: a total of 450 transapical and 8 transfemoral MedLAB CT prosthesis implantations were performed. In-hospital mortality was 29 (6%). Clinically significant stroke occurred in five patients (1%). There were no cases of myocardial infarction. Acute kidney injury was diagnosed in eight (2%) patients. Permanent pacemaker implantation was required in 11 cases (2.4%). There were no cases of clinically significant aortic regurgitation in the early postoperative period. Four patients required repeat open aortic valve surgery within the same hospitalization. The mean postoperative AV gradient was 5.55±2.24, the peak gradient –11.29±4.46 mm Hg and the EOA was 2.27±0.60 cm2. During the follow-up period of up to 8 years, 80 patients died, resulting in a mortality rate of 18.3%. The survival rate at 84 months was 71.3%.

Conclusion: the key clinical outcomes following TAVR with the Russian-made MedLAB CT prosthesis with PTFE leaflets are not inferior and, in some parameters, even superior to those reported in major international studies. Transapical and transfemoral TAVR using MedLAB CT prosthesis is a safe and effective procedure with favorable immediate and mid-term outcomes.

Background: сoronary artery perforations following minimally invasive diagnostic and therapeutic procedures require 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. One of the options for perforation closure is the implantation of a coronary stent‑graft — a device that seals the damaged vascular wall by means of an external membrane.

Aim: to perform numerical and experimental evaluation of several promising experimental polymer materials that could be used as such a membrane in the development of a domestic stent‑graft for coronary arteries.

Materials and methods: the study was conducted in two consecutive stages: assessment of the physical and mechanical characteristics of candidate polymers (polytetrafluoroethylene, styrene‑isobutylene‑styrene copolymer, polyvinyl alcohol) and numerical simulation of the coronary stent‑graft biomechanics during its expansion to the working diameter. The first stage — investigation of polymer properties — was performed on a Zwick/Roell‑2.5H universal testing machine (Zwick/Roell, Germany) under uniaxial tensile testing conditions. Numerical simulation was carried out using the finite element method in Abaqus/CAE software (Dassault Systemes, France), with the stent‑graft model diameter increased by 50% relative to the initial one.

Results: during the first stage, it was shown that the styrene‑isobutylene‑styrene copolymer experienced the greatest tensile strain, reaching an elongation at break of 744.9 [737.0–837.8]% relative to the initial size. The other polymers demonstrated significantly lower, though still satisfactory, values of this parameter: polytetrafluoroethylene samples failed at an elongation of 274.4 [270.9–280.4]%; polyvinyl alcohol — at 384.9 [313.4–390.6]%. Numerical simulation for all materials revealed moderate von Mises stress amplitudes not exceeding the tensile strength. The maximum stress values were 7.50 MPa for polytetrafluoroethylene, 2.80 MPa for styrene‑isobutylene‑styrene copolymer, and 0.08 MPa for polyvinyl alcohol.

Conclusion: overall, all investigated materials showed satisfactory results in terms of their suitability as a membrane for a stent‑graft; however, the styrene‑isobutylene‑styrene copolymer appeared to be the most promising. Further prototyping of the device should primarily focus on the use of this material.

Aim: to analyze changes in modern approaches to the surgical treatment of atherosclerotic lesions of the brachiocephalic trunk.

Materials and methods: this article analyzes current literature on the treatment of atherosclerotic lesions of the brachiocephalic trunk. Data on surgical treatment of asymptomatic lesions of the brachiocephalic trunk are presented, issues of access during brachiocephalic trunk surgery are discussed, and the results of endarterectomy and extrathoracic reconstruction are shown. The role of endovascular surgery in the treatment of atherosclerotic lesions of the brachiocephalic trunk is separately discussed.

Results: the analysis of literature data indicates that endovascular intervention is currently the surgical treatment of choice for stenotic lesions of the innominate artery. However, the average follow-up period after these procedures is limited to 5 years, and even then within this timeframe, they are inferior to open reconstructions in terms of patency of the reconstructed arteries. In cases of occlusive lesions, technical failure, and the development of restenosis or stent occlusion, open interventions remain relevant, with intrathoracic reconstruction being the most preferable.

Conclusions: there have been changes in the approach to the surgical treatment of atherosclerotic lesions of the innominate artery: performing surgical interventions at the asymptomatic stage, shifting the surgical approach in favor of partial sternotomy, performing prosthetic replacement of the brachiocephalic trunk as opposed to endarterectomy and extrathoracic interventions.

Aim: to analyze the technical advantages and efficacy of coronary artery bypass grafting using the TECAB technique compared to MIDCAB/MICSCABG, based on literature data.

Materials and methods: literature was selected using the PubMed search engine using the queries "minimally invasive coronary bypass," "MIDCAB," "robot-assisted coronary bypass," "totally endoscopic coronary bypass," and "TECAB." The literature review was conducted using data presented in 33 original articles from 2004 to 2024.

Results: according to the data presented in the selected publications, TECAB procedures, compared to MIDCAB and MICS-CABG, are generally superior in the following respects: conversion rate to sternotomy access, incidence of wound infection, and length of postoperative hospital stay. At the same time, the TECAB technique is inferior to MIDCAB/MICS-CABG in terms of surgical duration.

Conclusions: the TECAB technique is characterized by a lower rate of postoperative complications compared to MIDCAB/MICS-CABG procedures. according to the literature, the length of hospital stay and the incidence of wound infection with TECAB are lower than with MIDCAB/MICSCABG procedures.

Objective: to demonstrate the potential of combined treatment for arteriovenous malformations (AVMs) in cases of complicated disease progression where clinical results cannot be achieved with minimally invasive interventions alone.

Materials and methods: a clinical case of complicated spinal AVM following a session of endovascular occlusion of the afferent vessels is presented. Subsequent treatment included sequential embolizations, resection procedures, and wound closure.

Results: this combined approach allowed for the maximum possible removal of the AVM lesion, completely eliminating the risk of recurrent bleeding. Practical implementation of this approach requires collaboration between specialists from various surgical specialties at a highly specialized center.

Aim: to present the experience of surgical treatment of a giant thoracic aortic aneurysm that developed in the postpartum period in a patient who had previously undergone the David procedure.

Materials and methods: patient B., 20 years old, had previously undergone valve- sparing cardiac surgery - replacement of the ascending aorta and aortic root with a 30 mm Gelweave Valsalva vascular prosthesis with reimplantation of the aortic valve into the prosthesis (David procedure). Further examination revealed no abnormalities in the reconstruction area. Nine years after the child's birth, an examination revealed a giant aneurysm of the distal ascending aorta with chronic dissection and thrombosis. Echocardiography showed that the aortic root was not dilated, but at a distance of 50-55 mm from the aortic valve annulus, the distal ascending aorta up to the arch was dilated to 75-82 mm with intimal detachment. The true aortic lumen was 25 mm.

Results: the patient underwent a repeat operation: ascending aortic replacement and aortic arch replacement using the hemiarch repair technique with a 28 mm Polythese vascular graft. Considering the aneurysm size (10 cm) and false lumen thrombosis, the operation was performed without initial aortic cross-clamping, under conditions of circulatory arrest and with unilateral antegrade cerebral perfusion. Following thrombectomy and formation of a distal anastomosis between the vascular graft and a the aortic arch section, circulatory arrest was terminated (20 min). Aortic cross-clamp time was 62 min, and cardiopulmonary bypass time was 230 min. The postoperative course was uncomplicated. The patient was discharged in satisfactory condition.

Conclusions: this article presents a successful clinical case of surgical treatment of a giant thrombosed thoracic aortic aneurysm in a postpartum patient 9 years after the David procedure. Thorough patient examination and meticulous planning of the redo aortic surgery contributed to achieving a favorable clinical outcome.

Aim: to evaluate the effect of cardioneuroablation when using cryoballoon technology during pulmonary vein isolation in a patient with atrial fibrillation.

Materials and methods: a clinical case of the development of cardiac neuromodulation after cryoballoon ablation of pulmonary veins in a patient with atrial fibrillation and a history of vasovagal syncope.

Results: during the vascular access during the procedure of cryoballoon ablation of pulmonary vein in a patient with atrial fibrillation, the vasovagal mechanism of the syncope was verified. After the isolation of the right upper pulmonary vein, there was a significant acceleration of the rhythm, which indicates the modulation of the nervous system of the heart. In this regard, it was decided to refrain from the implantation of a pacemaker and dynamic observation. During the observation period of 6 months, the patient was not bothered by episodes of syncope or symptoms of bradycardia.

Conclusion: cryoballoon ablation for the purpose of cardioneuroablation has proven to be a reproducible and accessible technique for the prevention of vasovagal fainting.