<p><strong>Aim.</strong> Endoscopic surgery demonstrates promising results of treatment in patients with non-paroxysmal atrial fibrillation. Minimally invasive thoracoscopic ablation contributes to the growing interest in such operations all over the world. Nowadays totally thoracoscopic ablations are available for patients in Russian Federation. Emphasis in our study was placed on the collection and analysis of data on thoracoscopic ablation procedures used for treating patients with lone atrial fibrillation.</p><p><strong>Methods.</strong> The study covered the operations performed by Russian cardiac surgeons over a period up until January 1, 2018. Data collection was based on emailed registration forms containing information about the date of procedures, type of ablation pattern, previous catheter procedures, used devices, methods of left atrial appendage closure and safety profile information. 30-day mortality, conversion to sternotomy/thoracotomy, stroke/ transient ischemic attack, reexplorations, cardiac tamponade and phrenic nerve damage were considered as major complications.</p><p><strong>Results</strong>. The study encompassed 10 cardiosurgical centers in Russian Federation where totally thoracoscopic ablations had been carried out between 2011– 2018. Six hundred fifty-two procedures were registered. Most patients were ablated in Dallas and Box Lesion patterns. Left atrial appendage exclusion was performed in 90,4% patients. Major complications were observed in 27 (4%) patients, mostly during the “learning curve” period.</p><p><strong>Conclusion.</strong> The given study is the first attempt to collect and systematize the data on a new surgical procedure for treatment of patients with atrial fibrillation. The data obtained allow for making a conclusion that thoracoscopic ablation is becoming a wide-spread surgical technique to treat patients with lone atrial fibrillation in Russia. The quantity of procedure increases annually. Introducing thoracoscopic procedures in clinical practice may be accompanied by complications at any center. Nevertheless, according to our investigation the rate of complications is low, which enables us to recommend thoracoscopic ablation to treat a numerous cohort of atrial fibrillation patients in Russia.</p><p>Received 13 June 2018. Revised 22 July 2018. Accepted 23 July 2018.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>
The aim of the study was to assess the effectiveness of modified mitral valve repair in comparison with traditional methods of correcting ischemic mitral regurgitation.Materials and Methods. The results of surgical treatment of 80 patients with coronary artery disease complicated by ischemic mitral regurgitation were analyzed. The mean age of the patients was 58.95±8.36 years; the ratio of men and women was 67:13. Heart failure of FC II (according to the NYHA classification) was detected in 6 patients (7.50%), FC III -in 69 (86.25%) patients, FC IV -in 5 (6.25%) patients.Echocardiographic examination was used to determine the significance and genesis of mitral regurgitation in the preoperative period. 57 patients (71.25%) were detected with grade II mitral regurgitation, 23 (28.75%) had grade III.Annuloplasty was chosen as the operation for the correction of the valve apparatus. The patients of group 1 (n=23) underwent reconstructive surgery on the mitral valve using an autopericardial strip according to the technique, which we have developed, in combination with coronary artery bypass grafting (CABG), the patients of group 2 (n=26) underwent plastic surgery using a support ring in combination with CABG, patients of group 3 (n=31) had myocardial revascularization without correction of the valve apparatus.Results. The patients of group 2 underwent restrictive mitral annuloplasty performed with rigid support rings, group 1 -with an autopericardial strip as a soft support ring, the patients of group 3 underwent CABG alone.One patient from group 2 died in the early postoperative period due to acute perioperative myocardial infarction. The most common complications were pleurisy, acute cardiovascular failure, acute respiratory failure, and cardiac arrhythmias. The smallest number of complications was noted in the group 3, where patients underwent CABG alone. After surgery, all the patients showed a decrease in mitral regurgitation, which was most pronounced in the groups with annuloplasty.When analyzing the immediate results of the operations, it was revealed that the patients of groups 1 and 2, who underwent combined interventions, had a higher percentage of complications, and the length of their stay in the ICU increased. However, these groups showed a significant improvement in mitral valve functioning. Plasty of the mitral valve with an autopericardial strip according to the technique, which we have developed, demonstrated a good hemodynamic effect, the absence of significant regurgitation in the postoperative period.
The aim of the study was to develop tactics of surgical treatment of postinfarction interventricular septal (IVS) ruptures. Materials and Methods. Eighteen patients with the diagnosis of "postinfarction interventricular septal rupture" have been examined and operated on. The majority of them were men, 14 in number (77.7%), and only 4 women (22.3%). The average age was 55.6±6.4 years. The time of hospitalization from the IVS rupture onset varied from 4 days to 3.5 months. Clinically, there was noted left ventricular (4 cases) or biventricular (14 cases) failure of different degree with edema of lower extremities and/or uni-or bilateral hydrothorax. Patients were performed intra-aortic balloon counterpulsation in order to stabilize clinical state and support hemodynamics. Results. The assessment of the initial clinical state of the patients with postinfarction rupture of the IVS showed an extremely severe course of ischemic heart disease. Symptoms of severe heart failure (III-IV FC according to NYHA) were noted in all patients. Besides, 14 patients had angina pectoris (III-IV FC according to CCS) being evidence of a heavy damage of the coronary arterial bed. The expected mortality risk for our patients was 12.43±3.0% according to the EuroSCORE. Coronography demonstrated that the anterior descending artery (100%) and right coronary artery (62%) were the most commonly injured territories. Our own experience and the data obtained from the literature enabled us to develop the tactics of surgical treatment of these patients.
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