Objective:Atrial fibrillation (AF) is the most formidable supraventricular tachyarrhythmia, which worsens the natural course of mitral valve disease. In this study, we evaluated early and long-term results and quality of life (QOL) after simultaneous surgical radiofrequency ablation (RFA) of AF, left atrial reduction and mitral valve repair or replacement.Methods:Overall, 147 patients with mitral valve diseases who underwent mitral valve surgery were included in this prospective cohort study. Patients were divided into two groups according to the type of operation: the study group—patients after mitral valve surgery with concomitant radiofrequency surgical ablation and left atrial reduction procedure (54 patients), and the control group—patients undergoing only mitral valve surgery (93 cases). We assessed AF recurrence and sinus rhythm restoration rates and mortality rates, QOL measures, postoperative complications rates, and left atrial size during follow-up.Results:In the study group, sinus rhythm restoration rate in the early postoperative period was 63%, but at the time of discharge it reduced to 29%; after 6 months, it significantly increased to 72% and after 3 years, to 81% (p=0.02). In the control group, the sinus rhythm restored only in 14% after 1 year, and at 3 years, it was 22%, although in the early postoperative period it, was 43%. Analysis of left atrial size before and after surgery showed that dimension significantly reduced in both groups (study group, p=0.013; control group, p=0.024). In addition, in patients undergoing surgical RFA procedure, there was a significant association between shorter heart disease history (p=0.02) and shorter AF history (p=0.074) with maintenance of sinus rhythm. The mortality rate in the study group was 4% (two patients) and in the control group 5% (five patients). Comparison of QOL measures between study and control groups after 1 year showed that patients undergoing concomitant atrial reduction surgery and RFA had significant improvement of QOL physical (p=0.03) and role (p=0.03) functioning, heartbeat (p=0.01), general (p=0.03) and mental health (p=0.01), vitality (p=0.007), and social role (p=0.02) functioning measures as compared to preoperative state, being higher than in patients who underwent only mitral valve surgery.Conclusion:Application of surgical RFA using irrigated cooling electrode and atrial reduction during mitral valve surgery is associated with higher restoration and maintenance of SR as compared to patients undergoing only mitral valve surgery. We did not observe complications related to AF surgery that required permanent pacemaker implantation. Performing concomitant surgery as surgical RFA, atrial reduction along with mitral valve surgery, improves QOL in the short- and long-term and reduces the feeling of heartbeat and discomfort. (Anatol J Cardiol 2016; 16: 797-803)

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Представлены результаты сравнения хирургической коррекции дефекта межпредсердной перегородки сердца. Пациенты разделены на 2 группы: 1 группа -оперированы полностью торакоскопическим доступом (n=93), во 2 группе использовалась полная срединная стернотомия (n=80). Полученные данные свидетельствуют об успешном применении двух доступов, однако в группе, где выполнялась торакоскопическая коррекция, срок пребывания в ОРИТ и в стационаре, величина кровопотери, потребность в проведении гемотрансфузии, длина кожного разреза были достоверно ниже, чем в группе со срединным доступом.

ObjectiveThe aim of our study was to define predictors of cardiac compression development including clinical, electrocardiographic, echocardiographic, chest-X-ray and perioperative parameters and their diagnostic value.MethodsOverall 243 patients with pericardial disease, among them 123 with compression (tamponade, constriction) and 120 without signs of compression were included in the study. Clinical, laboratory, electrocardiographic, chest-X-Ray, echocardiographic and perioperative data were included in the logistic regression analysis to define predictors of tamponade/constriction development.ResultsLogistic regression analysis demonstrated large effusion (> 20 mm) (OR 5.393, 95%CI 1.202–24.199, p = 0.028), cardiac chamber collapse (OR 31.426, 95%CI 1.609–613-914, p = 0.023) and NYHA class > 3 (OR 8.671, 95%CI 1.730–43.451, p = 0.009) were multivariable predictors of compression development. The model including these three variables allowed predicting compression in 91.7% of cases.ROC analyses demonstrated that all three variables had significant diagnostic value with sensitivity of 75.6% and specificity of 74.2% for large effusion, low sensitivity and high specificity for cardiac chamber collapse (35% and 92%) and NYHA class (32.5% and 94.2%).ConclusionThe independent predictors of compression development are presence of large effusion > 20 mm, cardiac chamber collapse and high NYHA class. The model including all three parameters allows correctly predicting compression in 91.4% of cases. The diagnostic accuracy of each parameter is characterized by high sensitivity and specificity of large effusion, high specificity of cardiac chamber collapse and NYHA class.

Objective: To compare the immediate outcomes of thoracoscopy and median sternotomy in patients undergoing ventricular septal defect repair. Materials and мethods. We analyzed 59 patients diagnosed with VSD who were operated on at the SCCCST from 2012 to 2021. All patients were divided into two groups: group 1 included patients in whom thoracoscopic access was used (n=27), group 2 included the method of complete median sternotomy (n=32). Results. There were no statistically significant differences in complications in the postoperative period and no in-hospital mortality. The duration of the procedure and the duration of cardiopulmonary bypass in the thoracoscopy group were longer than in the sternotomy group. Blood loss during and after surgery was lower in the thoracoscopy group than in the sternotomy group. Hence, less blood and plasma transfusion was required in the thoracoscopy group than in the sternotomy group. The length of stay in the intensive care unit, the time spent on mechanical ventilation, bed days after surgery, the use of analgesics were statistically lower in the thoracoscopy group than in the sternotomy group. It should be noted that the length of the skin incision in patients in the thoracoscopy group was significantly less than in the second group. Conclusion. Thoracoscopic approach for VSD correction is an effective and low-traumatic method that does not increase the risk of surgical complications. Routine use of this technique requires a study on a larger sample of patients.