Surgical treatment of atrial fibrillation: technique of thoracoscopic radiofrequency fragmentation of the left atrium. / Khirurgicheskoe lechenie fibrilliatsii predserdii: tekhnologiia vypolneniia torakoskopicheskoi radiochastotnoi fragmentatsii levogo predserdiia.

Presented in the article is a detailed description of a modified technique of minimally invasive surgical treatment of patients with atrial fibrillation - thoracoscopic radiofrequency fragmentation of the left atrium. This modification differs from the prototype GALAXY procedure by a significant increase of the 'quantitative' rather than 'qualitative' parameter of surgical aggression in relation to the left atrium. This technique results in creation of multiple transmural continuous closed lines of lesion to the left atrium and, consequently, a reduced risk of inadequate surgical treatment for atrial fibrillation. Besides the radiofrequency action on the wall of the left atrium, the protocol of the operation included destruction of the ligament of Marshall and resection of the left atrial appendage. An indication for performing this operation is the presence of various forms of atrial fibrillation.

[Aorta-associated complications after prosthetic repair of the aortic valve].

The authors analyzed dependence between the presence of preoperative predictors of aorta-associated complications and risk for the development of these complications in the remote period after prosthetic repair of the aortic valve. The study included a total of 231 patients subjected to aortic valve prosthetic repair with no additional intervention on the root and ascending portion of the aorta. The follow up duration varied from 12 to 62 months. As predictors of the development of aorta-associated complications we examined such factors as the bicuspid structure of the aortic valve, dilatation of the aortic ascending portion relative to the upper border of the individually calculated norm, disordered configuration of the complex "aortic root - ascending portion of the aorta", resistant arterial hypertension, diabetes mellitus. Depending on the number of predictors for the development of aorta-associated complications the patients were subdivided into 2 groups: Group One consisting of 105 patients with two and more predictors of the development of aorta-associated complications, and Group Two comprising 126 patients with not more than one predictor of the development of aorta-associated complications. It was determined that in the first group of patients the total number of aorta-associated complications in the remote period after prosthetic repair of the aortic valve amounted to 25.7% (27 of 105 patients). The total number of aorta-associated complications in the second group amounted to 1.6% (2 of 126 patients). All detected aorta-associated complications were divided into "critical" and "noncritical". The critical complications were those the detection of which required performing a second operation in the patient: formation of an ascending aortic aneurysm and type A aortic dissection. To the "noncritical" aorta-associated complications belonged dilatation of the ascending portion of the aorta progressing at a rate of 2 mm/year. Resulting from the performed study it was determined that each specific of the examined predictors exerted no influence on the risk for the development of aorta-associated complications in the remote period after prosthetic repair of the aortic valve (p>0.05). Any combination of two and more predictors in one patient considerably increased the risk for the development of complications (p<0.001). A conclusion was made that revealing two and more predictors of the development of aorta-associated complications in one patient it is appropriate to perform a simultaneous operation of prosthetic repair of the aortic valve and the ascending aortic portion.

[Single-stage correction of aortic coarctation combined with an aneurysm of the ascending portion of the aorta and/or intracardiac pathology in adults].

OBJECTIVE: the work was aimed at substantiating and studying the outcomes of single-stage correction of aortic coarctation combined with an aneurysm of the ascending portion of the aorta and/or intracardiac pathology in adult patients. MATERIAL AND METHODS: From August 2009 to September 2012, a total of nine patients were operated on for aortic coarctation combined with an aneurysm of the ascending portion of the aorta and/or intracardiac pathology. The patient s average age amounted to 35.6±15 years. The risk median according to the Euroscore scale equalled 9.35 % (7 points). Aortic coarctation was corrected by means of ascending-to-descending bypass grafting of the aorta, simultaneously accompanied by prosthetic repair of the ascending portion of the aorta and/or correction of cardiac pathology from the median sternotomy approach. RESULTS: The mean duration of artificial circulation amounted to 178.7±25.5 min, with that of myocardial ischaemia equalling 133.7±29.4 min. The average volume of blood loss was 616.6±325 min. The postoperative follow-up period ranged from two months to three years. No lethal outcomes were observed. The clinical manifestation of hypertension regressed in all patients. There were no cases of either dislocation of the ascending-descending bypass graft or compression of the surrounding formations thereby. CONCLUSION: The presented technique of single-stage surgical correction of aortic coarctation combined with an aneurysm of the ascending aorta and/or intracardiac pathology in adult patients makes it possible to perform all technical manipulations during a single-step surgical intervention from one approach, i. e. sternotomy. Placing the aorto-aortic graft behind the inferior vena cava toward the front of the right pulmonary veins makes it possible to minimize the risks associated with an extra-anatomical position of the prosthesis.