[First serial transcatheter implantation of pulmonary valve using MedLab-KT prosthesis]. / Pervaia seriinaia transkateternaia implantatsiia klapana legochnoi arterii pri pomoshchi proteza (MedLab-KT).

BACKGROUND: Surgical treatment of 'blue' congenital heart defects frequently implies various interventions on the outlet portion of the right ventricle or pulmonary artery trunk. Most often used are various conduits, reconstructing the outlet portion of the right ventricle and pulmonary artery. Most patients having previously endured the mentioned interventions, would in the remote terms require repeat operative procedures for stenosis or insufficiency on the pulmonary valve or the implanted conduit. Taking into account complexity and the risk of open interventions, the current trends are towards more frequent use of transcatheter implantation of the pulmonary valve. AIM: The purpose of this work is to present the first serial experience with hybrid transventricular implantation of an original Russian-made valve into the position of the pulmonary artery. PATIENTS AND METHODS: We retrospectively studied a series of 5 clinical cases who from July 2019 to May 2020 at the Federal Centre of Cardiovascular Surgery (Penza) had underwent hybrid transventricular implantation of the first Russian-made valve-containing stent (MedLab-KT) into the position of the pulmonary valve, with the stent's closing component consisting of leaflets made of polytetrafluoroethylene. RESULTS: 3 patients underwent implantation of valve # 25 and 2 subjects received valve # 23, with all cases yielding good immediate results. The haemodynamic parameters of the implanted prosthesis were optimal. In all cases, the significant gradient was absent and regurgitation did not exceed grade I. There was no in-hospital mortality. The method of hybrid prosthetic repair of the pulmonary valve via the transapical right-ventricular access from the left lateral mini-thoracotomy was aimed at reducing potential risks of artificial circulation, also contributing to a significant decrease in the traumatic nature of surgical treatment of patients requiring a repeat intervention for pulmonary valve pathology.

[Effect of the degree of stenosis of the right coronary artery on remote results of bypass grafting]. / Vliianie stepeni stenoza pravoi koronarnoi arterii na otdalennye rezul'taty shuntirovaniia.

AIM: The purpose of this study was to assess the long-term results of right coronary artery bypass grafting and identify predictors of coronary artery bypass graft occlusion. PATIENTS AND METHODS: Our retrospective single-centre study included a total of 245 patients subjected to isolated coronary artery bypass graft operations during the follow up period from 2010 to 2015. All patients endured bypass grafting of the right coronary artery (RCA) with either autovenous or autoarterial conduits. Control coronary bypass angiography was performed in all patients in connection with a relapse of angina pectoris. The duration of the follow up period amounted to 43.7±20.2 months. The patients were divided into two groups depending on the type of the conduit used to bypass the RCA. Group One patients (n=106) endured bypass grafting of the RCA and its branches using the internal thoracic artery. Group Two patients (n=139) underwent autovenous coronary artery bypass grafting of the RCA basin. By the main clinical, demographic and intraoperative parameters the groups were statistically homogeneous (p>0.05). The effect of the degree of proximal stenosis, the diameter of the grafted artery on the viability of bypass grafts was assessed. RESULTS: During the follow-up period up to 84 months, 19 (17.9%) occluded arterial and 29 (20.9%) venous conduits were revealed. The Kaplan-Meier analysis showed that the probability of the absence of venous graft occlusion during the follow-up period up to 84 months was significantly lower than that of arterial grafts (log rank=0.012). The Cox regression analysis results revealed that shunt occlusion was influenced by the degree of proximal stenosis and the diameter of the shunted artery. CONCLUSION: When shunting a moderate stenosis of the RCA (up to 70%), an advantage of autovenous conduits was revealed. When shunting the RCA with a critical stenosis and occlusion, advantages were revealed for the internal thoracic artery.

[Remote results of myocardial endovascular revascularization in patients with low ejection fraction]. / Otdalennye rezul'taty éndovaskuliarnoi revaskuliarizatsii miokarda u bol'nykh s nizkoi fraktsiei vybrosa.

Despite the present-day level of the development of cardiac surgery, a low left ventricular ejection fraction (LLVEF) is an important independent predictor of high complication rates and increased in-hospital mortality related to open surgical interventions. The method of myocardial endovascular revascularization is associated with the lowest rates of both intraoperative and early postoperative complications. However, percutaneous coronary intervention (PCI) does not always make it possible to perform anatomically complete myocardial revascularization. Comparisons of the remote results of anatomically complete and incomplete revascularization of the myocardium in the world literature seem to be extremely scarce and ambiguous, with a low ejection fraction in the majority of cases being an exclusion criterion. In order to elucidate these problems we carried out a prospective, single-centre study, including a total of 151 patients suffering from ischaemic heart disease with a left ventricular ejection fraction of less than 35%, who were subjected to myocardial endovascular revascularization. The patients were divided into 2 groups: those with complete (n=87) and incomplete (n=64) revascularization, followed by comparing the alterations in the echocardiographic parameters, assessing the incidence of repeat myocardial revascularization due to a relapse of the clinical course of angina pectoris, and the survival rate in the remote period. The obtained findings were suggestive of efficacy of both complete and incomplete endovascular revascularization of the myocardium in patients with a low left ventricular ejection fraction (LLVEF), with no statistically significant differences between the patients of both groups in the examined parameters revealed.

[Analysis of cases of repeat hi-tech medical care for non-ST-segment elevation acute coronary syndrome]. / Analiz sluchaev povtornogo okazaniia vysokotekhnologichnoi meditsinskoi pomoshchi pri ostrom koronarnom sindrome bez pod''ema segmenta ST.

Despite implementation of antiproliferative drug-eluting stents (DES) and intention to perform maximally full myocardial revascularization during a single hospital stay even in acute coronary syndrome (ACS) the frequency of repeat interventions after endovascular revascularization remains at a sufficiently stable level. In order to examine the causes of repeat hi-tech medical care rendered by means of endovascular myocardial revascularization for acute coronary syndrome without ST-segment elevation we carried out a retrospective single-centre study. It included a total of 93 patients suffering from ischaemic heart disease (IHD), who in 2017 endured this type of medical care twice. The cases of repeat revascularization were analysed based on medical history taking, physical examination, ECG pattern, ultrasonographic examination, laboratory findings, data of electronic case report forms and video recordings of the previous and latest coronary angiographies (CAG). The obtained findings revealed the main causes of repeat hi-tech medical care rendered within 1 year by means of endovascular myocardial revascularization for acute coronary syndrome without ST-segment elevation, which were as follows: progression of atherosclerosis in the previously non-revascularized arteries, the emergence of the clinical course of ACS in borderline stenosis; the development of acute coronary syndrome in patients with a significant lesion of the coronary bed, who were scheduled for this or that reason to undergo elective staged transcutaneous coronary intervention (TCI); restenosis in the previously implanted stents.

[Comparative results of using coronary drug-eluting stents 'NanoMed' and Orsiro]. / Sravnitel'nye rezul'taty ispol'zovaniia koronarnykh stentov s lekarstvennym pokrytiem 'NanoMed' i Orsiro.

The purpose of the present study was to compare mid-term results of using drug-eluting stents 'NanoMed' and Orsiro. Within the framework of an ongoing randomized prospective study we carried out an intermediate analysis of clinical and angiographic data of 520 patients after coronary artery stenting. The duration of the follow-up period amounted to 6.8±0.2 months. The patients were randomly assigned to the study and control groups each consisting of 260 patients with implanted stents 'NanoMed' and Orsiro, respectively. The obtained findings demonstrated that the main baseline clinical, demographic, and angiographic parameters had no statistically significant differences. The primary endpoint was achieved in 6.1 and 5.3% of cases in the study and control group, respectively (p=0.7). One case of acute in-stent thrombosis was revealed in each group. Cardiac mortality amounted to 0.7% and 0.3% in the study and control group, respectively (p>0.9). Repeat interventions on the target lesion were performed in 2.7 versus 3.4% of cases in the study and control group, respectively (p=0.6). Hence, the comparative analysis of using 'NanoMed' and Orsiro stents in the mid-term period revealed no statistically significant differences.

[Incomplete endovascular myocardial revascularization in patients with low ejection fraction]. / Nepolnaia éndovaskuliarnaia revaskuliarizatsiia miokarda u bol'nykh s nizkoi fraktsiei vybrosa.

Despite obvious progress of cardiac surgery, a low left ventricular ejection fraction is an important independent predictor of a high rate of complications and increased in-hospital lethality in open surgical interventions. On this ground, promising seems to be a method of endovascular myocardial revascularization, which is associated with a minimal number of intraoperative and postoperative complications. However, by means of transcutaneous coronary intervention (TCI) it is not always possible to perform complete anatomical myocardial revascularization. The subject concerning the necessity of complete myocardial revascularization, changes of anatomy and physiology of the heart, clinical state of patients with a low left ventricular ejection fraction after endovascular intervention has not been sufficiently explored. In order to clear up these problems we carried out a prospective single-centre study including a total of 151 patients suffering from ischaemic heart diseases with a left ventricular ejection fraction of less than 35%, who were subjected to endovascular myocardial revascularization. The patients were divided into two groups: with complete (n=87) and incomplete (n=64) revascularization. All patients before and 6 months after the intervention underwent echocardiographic examination with the measurement of the left ventricular ejection fraction, stroke volume, end-diastolic volume and assessment of the functional class of angina pectoris. The obtained findings are indicative of efficacy of both complete and incomplete endovascular myocardial revascularization in patients with a low left ventricular fraction. No statistically significant difference by the examined parameters between the patients of both groups was revealed.

Assessing the effect of endoprosthetic repair of the thoracic portion on aortic remodelling after surgical correction for DeBakey type I dissection. / Otsenka vliianiia éndoprotezirovaniia grudnogo otdela na remodelirovanie aorty posle khirurgicheskoi korrektsii rassloeniia 1 tipa po De Beki.

OBJECTIVE: The purpose of the study was to evaluate the influence of endoprosthetic repair of the aortic thoracic portion on remodelling of the descending aorta in patients after the surgical stage of correction for DeBakey type I aortic dissection. PATIENTS AND METHODS: The authors retrospectively analysed a group of 12 patients (9 men and 3 women) subjected to endoprosthetic repair of the aortic thoracic portion after previously performed surgical correction of the ascending aorta and its braches. The average age of the patients amounted to 48 (43-56.7) years. All patients underwent multispiral computed tomography (MSCT) first performed at admission, then immediately after implantation of the stent graft and at 6, 12 and 24 months after discharge. The Control Group consisted of nine patients with a previous history of DeBakey type I aortic dissection, who had endured only surgical correction of the ascending aorta and arch. RESULTS: The success rate of the intervention amounted to 100%. There were no signs of ischaemia of the spinal cord, visceral organs or lower limbs. The diameter of the implanted stent grafts varied from 28 to 40 mm and the length ranged from 140 to 204 mm. Seven (58%) patients of the Study Group as early as during a year were found to have no blood flow along the false channel. The false channel remained patent in 100% of the Control Group patients. Over a two-year period of follow up, in patients after endoprosthetic repair, the diameter of the false channel did not increase. In the Control Group patients during the same period of follow up, there was a tendency towards an increase in the aortic diameter at the expense of dilatation of the false channel, with an enlargement of the false channel of the descending aorta at the level of the diaphragm from 1.8 (1.57-2.1) to 2.05 (1.7-2.31) cm (p=0.4) and at the level of the renal arteries from 1.5 (1.32-1.8) to 1.8 (1.58-1.97) cm (p=0.4). There were no lethal outcomes during follow up. CONCLUSION: Endoprosthetic repair of the thoracic portion after surgical correction was in the remote period accompanied and followed by stabilization of the diameter of the descending aorta, as well as contributed to closure of the false channel.

[Possibility of endovascular correction of defects after carotid endarterectomy]. / Vozmozhnost' éndovaskuliarnoi korrektsii defektov posle karotidnoi éndarteréktomii.

Carotid endarterectomy is a method of choice in treatment of patients with pronounced atherosclerotic lesions of carotid arteries. However, the incidence rate of perioperative complications according to the findings of some authors varies within the limits of 1.5-9%, with up to 60% of unfavourable cerebrovascular events being associated with residual defects such as intimal detachment, kinks, lesions from vascular clamps, etc. The incidence of forced secondary interventions amounts to 2.3-16%, with the complications rate equalling 9-17%. Surgical correction of technical defects is traumatic and associated with high risk. Stenting of carotid arteries as a faster and less invasive method may be an alternative. Taking into consideration small world experience, we have found it appropriate to present two case reports of successful endovascular correction of intimal detachment following carotid endarterectomy previously performed.

[Comparative study of the results of using stagewise open interventions and single-step hybrid operations in patients with coronary artery disease accompanied by lesions of carotid arteries].

The authors describe herein the technique of a hybrid single-stage intervention performed in patients presenting with coronary artery disease (CAD) combined with carotid artery atherosclerosis, as well as comparing the outcomes of using similar operations with the results of stagewise open interventions within a 30-day postoperative period. High risk for the development of severe and not uncommonly fatal complications both in the carotid basin and coronary bed determines difficulty of therapeutic decision-making regarding this patient cohort. This problem has been the subject of study and discussion in both Russian and foreign literature for more than two decades. However, none of the currently existing techniques has yet been accepted as an optimal one. The hybrid approach is a relatively novel technique, with the number of publications describing its application being only sporadic. The present article demonstrates significantly better immediate results of using the hybrid technique, thus suggesting that it may well be considered as an alternative to the classical approaches, requiring however further studies.