[Effectiveness of the Cox Maze-IV Procedure in Cardiac Surgery Patients With Atrial Fibrillation].

Aim Analyzing a 5-year experience of surgical treatment of cardiosurgical patients with atrial fibrillation (AF).Material and methods The study analyzed results of surgical treatment with extracorporeal circulation in 132 patients with AF who underwent the Maze-IV procedure using a radiofrequency ablator with transmurality feedback from 2013 through 2018.Results Two fatal outcomes were observed in the study group. These outcomes took place in the early postoperative period and were associated with progressive acute heart failure in patients with repeated surgery for mitral valve restenosis. 61.2% of the patients had no AF. Recurrent AF was observed during the first three years after surgery in association with withdrawal of the antiarrhythmic medication, which confirmed a need for long-term antiarrhythmic therapy. Analysis of risk factors for AF relapse identified significant predictors, including left ventricular dilatation larger than 5.5 cm at baseline and more than two-year duration of a history of arrhythmias.Conclusion The Maze-IV procedure proved an effective and safe method of surgical treatment in AF patients with acquired heart defects and ischemic heart disease, which allowed maintaining sinus rhythm in 61.2% of patients for 5 years. Preventive amiodarone saturation reduced the risk of AF relapse by 24.2 % (p=0.038) and incidence of postoperative arrhythmic complications by 34.9 % (p=0.008) in cardiosurgical patients.

[Decision-making while implantation of biodegradable vascular scaffolds ABSORB based on methods of intravascular visualization]. / Priniatie reshenii pri implantatsii biodegradiruemykh sosudistykh karkasov ABSORB na osnove metodov vnutrisosudistoi vizualizatsii.

A series of studies demonstrated comparability of the incidence rate of major adverse cardiac events (MACE) in the middle-term postoperative period following implantation of last-generation drug-coated stents and biodegradable intravascular scaffolds. It was noted observed that these complications may be associated with malposition and inadequate inappropriate preparation of the lesion. We carried out a total of 16 percutaneous coronary interventions (PCI) with implantation of absorbable vascular scaffolds (Absorb, Abbott Vascular) under the guidance of optical coherent tomography. Besides, a further 16 PCIs were performed without intravascular visualization (control group). As experience was gathered, the algorithm of carrying out optical coherent tomography was subjected to changes, resulting in proposal of an optimal algorithm for choice of intraoperative policy based on the findings obtained in optical coherent tomography.

[Prophylactic use of VFS in patients with coronary artery disease in the perioperative coronary artery bypass grafting].

Tachyarrhythmias (TA) - dangerous postoperative complications of coronary artery bypass grafting, threatening the lives of patients and found, according to different authors, in 13-40% of cases. VFS - an antiarrhythmic drug that belongs to a class 1C, is effective in the treatment and prevention of a variety of cardiac arrhythmias. The aim of the work was to study the clinical efficacy of VFS CHD patients with a history of tachyarrhythmias during the perioperative period of coronary bypass surgery, as well as its comparison with other antiarrhythmic drug (amiodarone). Clinical efficacy was evaluated in 218 patients with coronary heart disease at baseline with a history of tachyarrhythmia (paroxysmal atrial fibrillation or premature ventricular high grade (IV and V class on classification of Lown B. and Wolf M. in the modification of Ryan M.). Shown that the VFS is more effective than amiodarone, both in paroxysmal atrial fibrillation and ventricular arrhythmias when high gradation.

[Portacaval anastomoses in the basin of the left internal spermatic vein in patients with varicocele].

The article deals with the findings obtained in a roentgenological examination of the left renal vein and left internal spermatic vein in a total of one hundred and eighty-three 16-to-46-year-old patients presenting with varicocele. Analysing the roentgenograms revealed that four patients had portacaval anastomoses in the basin of the left internal spermatic vein (ISV), with the blood flow being directed from the system of the portal vein into the system of the venae cavae. Retrograde contrasting of the inferior mesenteric veins showed a sharp deceleration of the contrast medium to the portal vein with an apparent obstacle to the blood flow in the projection of the intersection of the inferior mesenteric vein, lower contour of the pancreas and the aorta. In two cases, the "mesentericospermatic" venous shunt into the system of the left ISV was the only visible cause of varicocele.

[Prophylaxis of complications at the surgery of postintubation and posttracheostomy tracheal stenoses].

Overall 42 patients aged 16 to 56 years with non-tumor stenosis of trachea were treated. Tracheostomia, endoscopic bougienage with endografting, circular resection of trachea with end-to-end anastomosis were performed. Original method of circular resection with allotransplantation was used at 4 patients with large tissues defect. There were no complications, the clinical results was good. The examination of trachea in 6 and 12 months after operation didn't revealed any pathological changes.

[High epidural anesthesia as a component of anesthetic support for cardiosurgical interventions in infants].

The aim of the study was to determine whether it was expedient to include epidural anesthesia into a complex of anesthetic support of surgical correction of ventricular septal defect in infants. This was a prospective, nonrandomized, monocenter case-control study. Seventy-nine infants met the inclusion criteria. A control group included 41 patients in whom total intravenous anesthesia was based on the infusion of propofol and fentanyl; a study comprised 38 patients in whom anesthetic support was potentiated by high prolonged epidural anesthesia. In the study group patients, the total dosage of anesthetics and the duration of inotropic support decreased intraoperatively and there was a reduction in the duration of postoperative artificial ventilation.

[Optimization of radiosurgical treatment for varicocele].

The topographic radiological anatomy of the left internal spermatic vein was studied in 95 patients with varicocele, of them 76 had secondary impaired spermatogenesis. Recurrent varicocele after Ivanissevich's operation was observed in 23 patients. The left internal spermatic vein has been found to empty as one trunk into the renal vein in 97.8% of cases. The renal capsular vein always falls into the proximal segment of the left internal spermatic vein. Intersystemic overflows, if present, also empty into the latter. A unified procedure for double-level occlusion of the left internal spermatic vein is described. The proposed procedure was used to operate on 46 patients. Long-term results were studied in periods of 3 months to 2 years. Recurrent varicocele was not revealed.

[Laparoscopic treatment of peritoneal adhesions].

Based on experience of treatment of 3000 patients with peritoneal comissures, new methods of diagnosis, prevention and treatment of this disease were developed and used. Exact verification of location and degree of comissures permits carrying out minimally invasive surgical procedures. A new variant of membranous allo-abdominal graft with anti-infective and anti-adhesive properties was developed and used for prevention of comissures. This approach leads to reduction of the number of ...

[Surgical treatment of postoperative abdominal hernia]. / Khirurgicheskoe lechenie posleoperatsionnykh gryzh zhivota.

After surgical treatment of 664 patients with postoperative abdominal hernias (PAH) within the period of from 1972 to 1983, the incidence of recurrences was 48.4%. On the basis of studying microcirculation at the area of hernioplasty and its dependence on tissue tension force in the experiment on animals and at operations by means of radiometry, rheometry and fluorimetric analysis, the technique for surgical treatment of PAH with regard to location of a defect, including the method of plasty, system of preoperative preparation and prophylaxis of the postoperative wound complications, has been developed. From 1984, 200 patients with PAH were operated on, the incidence of recurrences decreased to 2.4%.