Early results of optimal septal myectomy using 3-dimensional printed models.

INTRODUCTION: The completeness of septal myectomy (SM) is the key to surgery of hypertrophic obstructive cardiomyopathy (HOCM), but its planning is still based on echocardiographic findings. The need to perform radical SM requires the development of new cardio-visualisation techniques for monitoring myectomy quality. AIM: To improve results in centres treating few patients with HOCM using a new method of optimal SM with the help of 3-dimensional models to achieve an 'ideal' interventricular septum (IVS) thickness of 10-11 mm. MATERIAL AND METHODS: Between 2017 and 2018, 30 patients underwent optimal SM after computed tomography angiography, creation of a virtual 3-dimensional model of the IVS, computer-aided mapping, virtual SM and 3-dimensional printing of models of the 'ideal' IVS and the fragment to be removed. RESULTS: Initial isolated extended SM (n = 29, 97%) was effective in 23/29 (79%) patients. Four non-fatal complications were observed. A permanent pacemaker was implanted in three patients. No patients required mitral valve replacement. The mean postoperative left ventricle (LV) resting systolic gradient was 7.5 ±4.4 mm Hg, and at the latest follow-up this value was 7.1 ±4.2 mm Hg. The average weight of the excised myocardium was 12.0 g (range: 5.8-22.5 g). At follow-up both volumetric and dimensional LV echocardiography parameters increased compared with preoperative values (p ≤ 0.007). CONCLUSIONS: The proposed optimal SM provides intraoperative monitoring of the shape and volume of the myocardium resected to achieve the 'ideal' IVS, true radicality and an increase in the volumetric and dimensional parameters of the LV.

Multi-vessel small thoracotomy coronary artery bypass using in situ bilateral internal thoracic arteries and right gastroepiploic artery.

We present an innovative method of minimally invasive total arterial revascularization on a beating heart, using in situ bilateral internal thoracic arteries and laparoscopically harvested in situ right gastroepiploic artery. The safety and feasibility of this technique have been established.

Surgery for massive malignant tumors of the left atrium - one center's experience.

INTRODUCTION: Surgery for primary non-resectable malignant tumors of the left atrium is controversial. Today heart autotransplantation as a method of surgical treatment for patients suffering primary massive malignant tumors of the left atrium is still not sufficiently studied. MATERIAL AND METHODS: We provide information on our single-center 5-year experience in performing surgical interventions for massive malignant tumors of the left atrium and including cases of 5 patients (3 males - 60%, 2 females - 40%). One case (1/5, 20%) involved debulking surgery with partial resection of the left atrial (LA) wall and its reconstruction using a xenopericardium patch. Orthotopic heart transplantation was performed in 1 patient (1/5, 20%) and heart autotransplantation (HA) in the 3 other cases (3/5, 60%). RESULTS: Mean myocardial ischemia duration was 165.6 ±12.0 minutes (range: 137-198), cardiopulmonary bypass (CPB) duration was 248.6 ±36.6 minutes (range: 188-392), and intervention duration was 498.0 ±77.4 minutes (range: 330-780). Mean total blood loss was estimated to be 2432 ±616.5 ml (range: 1610-4880). Major in-hospital complications were registered in 4 patients (4/5, 80%). In-hospital mortality was registered in 3 patients (3/5, 60%). Survival time in 2 (2/5, 40%) patients discharged from the hospital was 29 and 9 months, respectively. Both died because of disease progression. CONCLUSIONS: Surgery in patients with massive resectable primary malignant tumor of the left atrium is associated with high incidence of major hospital complications and mortality. Heart autotransplantation with radical tumor resection is the treatment of choice for these cases. The surgical approach implies thorough primary hemostasis and selection of a proper surgical approach, allowing revision of all the regions of intervention during each step. The possibility of excessive tension and bleeding in the area of bicaval anastomosis should be considered when performing heart autotransplantation, and appropriate preventive measures should be applied.