According to continuous ECG monitoring data, freedom from AF was significantly higher after the concomitant LAM procedure than after PVI in patients with paroxysmal AF who underwent mitral valve surgery.

BackgroundWe aimed to compare the outcomes of mitral valve repair with flexible band (FB) versus complete semirigid ring (SR) in degenerative mitral valve disease patients.MethodsFrom September 2011 to 2014, 171 patients were randomized and underwent successful mitral valve repair using a SR (n = 85) or FB (n = 86). There were no significant between-group differences at baseline.ResultsThere were no early mortalities. The mean follow up was 24.7 months. The 2-year survival was 96.0 ± 2.3% (95% confidence interval [CI], 88.6–98.7%) and 94.3 ± 2.8% (95% CI, 85.5–97.9%) in the SR and FB groups, respectively (p = 0.899). The left ventricle remodeling was similar between the groups. Higher transmitral peak (8.5 [3.9–17] vs. 6 [2.1–18] mmHg, p < 0.001), mean pressure gradients (3.7 [1.3–8] vs. 2.8 [0.6–6.8] mmHg, p = 0.001), and systolic pulmonary artery pressure (34.5 [20–68] vs. 29.5 [8–48] mmHg, p < 0.001) was observed in the SR group. The 2-year freedom from recurrence of significant mitral regurgitation was significantly higher in the FB group than the SR group (p = 0.002). Residual mitral regurgitation was an independent prognostic factor of recurrence of mitral regurgitation. The 3-year freedom from reoperation was significantly higher in the FB group than the SR group (p = 0.044).ConclusionPatients with degenerative mitral valve disease may benefit from valve repair with FBs. Residual mitral regurgitation before discharge is an independent risk factor of late insufficiency recurrence.Trial registrationClinicalTrials.gov NCT03278574, retrospectively registered on 06.09.2017.Electronic supplementary materialThe online version of this article (10.1186/s13019-017-0679-0) contains supplementary material, which is available to authorized users.

No abstract

Background We aimed to evaluate early outcomes of septal myectomy in patients with hypertrophic cardiomyopathy. Methods We retrospectively analyzed data collected over a 9-year period from 583 patients who underwent septal myectomy for hypertrophic cardiomyopathy at our institution. Results The mean age was 55.7 ± 13.1 years, and 338 (58%) patients were in New York Heart Association class III or IV. There were 11 (1.9%) early deaths, including 3 (0.5%) intraoperative deaths. Early mortality was lowest after isolated septal myectomy (0.8%) and highest after concomitant mitral valve replacement (6.1%). There were 4 (0.7%) and 9 (1.5%) patients with left ventricular wall rupture and ventricular septal defect, respectively, after myectomy. New pacemaker implantation caused by atrioventricular disturbances was required in 29 (5.0%) patients, and was associated with previous alcohol septal ablation (odds ratio 3.34, 95% confidence interval 1.02–11.0, P = 0.047). Left ventricular wall rupture, intraoperative residual (15.5% moderate, 0.3% severe) mitral regurgitation, and pre-discharge residual outflow tract gradient >30 mm Hg (4.6%) occurrences were surgeon-dependent. Conclusions The early results are consistent with example targets reported in the 2020 American College of Cardiology/American Heart Association guidelines for septal reduction therapy outcomes. Septal myectomy safety and efficacy are surgeon-dependent. Previous alcohol septal ablation increases the risk of permanent pacemaker implantation due to postoperative complete atrioventricular block. Therefore, continuous education, mentoring, and learning by doing may play an important role in achieving reasonable septal myectomy safety and efficacy.

The CardiaMed mechanical heart valve prostheses meets world standards of safety and efficacy.

No abstract

Surgical treatment of atrial fibrillation (AF) in patients with valvular heart disease remains one of the most pressing problems in cardiac surgery. The purpose of the study was to determine the dynamics of proANP and myocardial damage markers depending on a modification of the radiofrequency (RF) Maze procedure used. The study involved 86 patients operated over a period from November 2007 to December 2010. A concomitant RF Maze procedure during mitral valve (MV) surgery was performed in two groups of the cohort; in group 1 it was the standard Maze IV scheme, in group 2 it was the modified one. In both groups we assessed the levels of proANP and myocardial damage markers. In group 1 a more significant decrease in proANP (by 4 times) was seen as compared to group 2 (by half). In group 1, the pleural effusion rate was 46.2%, and thoracocentesis rate reached 25.6%. In group 2, the corresponding rates were lower,14.9% and 27.7%. During the first postoperative day there was an increase in creatine phosphokinase MB fraction and Troponin T in both groups, and the rise was significantly higher in group 1. It should be noted that modified Maze IV RF ablation results in 80% freedom from AF, which is consistent with that of the standard Maze IV scheme. In patients with left atrial ablation the proANP secretion is less prominent early after surgery, and myocardial damage is lower in comparison with biatrial ablation.

Цель. Провести анализ результатов клапаносохраняющих операций на митральном клапане при дисплазии соединительной ткани. Материал и методы. С 2011 по 2014гг в исследование включены 171 пациен-тов с изолированной митральной недостаточностью. Пациенты были рандо-мизированы на две группы. Средний возраст пациентов в Группе D ring и Группе C flex составил 57 [42;65] и 54 [41;63] лет, соответственно (р=0,092). Доля мужчин в каждой из групп составила 69 и 67%, соответственно. Результаты. Случаев 30-дневной летальности в обеих группах не было. В сроки наблюдения 24 месяца в группах D ring и C flex выживаемость пациен-тов составила 96,0±2,3% (95% ДИ 88,6-98,7%) и 94,3±2,8% (95% ДИ 85,5-97,9%), соответственно (р=0,899); свобода от реоперации -97,0±2,1% (95% ДИ 88,4-99,3%) и 100%, соответственно (р=0,044); свобода от возврата значи-мой митральной недостаточности составила 80,8±6,5% (95% ДИ 64,0-90,3%) и 92,8±3,1% (95% ДИ 83,4-97,0%), соответственно (р=0,002). Заключение. Применение гибких C flex колец при выполнении клапаносохра-няющих операций позволяет получить более лучшие результаты в средне-отдаленном послеоперационном периоде по сравнению с использованием полужестких замкнутых опорных колец у пациентов с дисплазией соедини-тельной ткани и выраженной митральной недостаточностью. Афанасьев А. В.* -врач сердечно-сосудистый хирург, м. н.с., Желез-нев С. И. -д. м.н., профессор, врач сердечно-сосудистый хирург, в. н.с., Бога-чев-Прокофьев А. В. -д. м.н., руководитель центра новых хирургических тех-нологий, Назаров В. М. -д. м.н., врач сердечно-сосудистый хирург, в. н.с., Демин И. И. -к. м.н., врач сердечно-сосудистый хирург, с. н.с., Астапов Д. А. -д. м.н., зав. отделением приобретённых порока сердца, в. н.с., Карась-ков А. М. -академик РАН, профессор, д. м.н., директор института. ВЫБОР ИМПЛАНТИРУЕМЫХ ОПОРНЫХ КОЛЕЦ У ПАЦИЕНТОВ С ДИСПЛАЗИЕЙ СОЕДИНИТЕЛЬНОЙ ТКАНИ И ВЫРАЖЕННОЙ МИТРАЛЬНОЙ НЕДОСТАТОЧНОСТЬЮАфанасьев А. В., Железнев С. И., Богачев-Прокофьев А. В., Назаров В. М., Демин И. И., Астапов Д. А., Караськов А. М. was 57 [42;65] and 54 [41;63] year old, respectively (p=0,092). Part of males was 69 and 67% in the groups, respectively. Results. There were no cases of 30-day mortality. During 24 months of follow-up, in D ring and C flex groups, survival was 96,0±2,3% (95% CI 88,6-98,7%) and 94,3±2,8% (95% CI 85,5-97,9%), resp. (р=0,899); no re-operation -97,0±2,1% (95% CI 88,4-99,3%) and 100%, resp. (р=0,044); no return of significant mitral regurgitation 80,8±6,5% (95% CI 64,0-90,3%) and 92,8±3,1% (95% CI 83,4-97,0%), resp. (р=0,002). CHOICE OF THE IMPLANTABLE SUPPORT RINGS IN CONNECTIVE TISSUE DYSPLASIA AND SEVERE MITRAL REGURGITATION Conclusion.Application of flexible C flex rings in valve-securing operations makes it to achieve better results in middle-long-term post-operation period comparing to the usage of semi-hard support rings in patients with connective tissue dysplasia and severe mitral regurgitation. Russ