Objective Minimally invasive multivessel coronary artery bypass grafting (MIM CABG) has demonstrated its safety, effectiveness and high rate of reproducibility. However, minithoracotomy CABG is still rarely performed. In this study, we retrospectively analyze the CT‐angiographic graft patency rates for the patients subjected to this operation. Methods A total of 245 patients were subjected to MIM CABG by a left minithoracotomy approach between 2014 and 2018. The left internal thoracic artery (LITA) harvesting, proximal, and distal anastomoses were performed under direct vision. The patients then underwent 128‐slice computed tomography coronary angiography (CTA). The angiographic results were obtained for 127 (51.8%) patients (the follow‐up period of 31.1 ± 7.8 months, from 15 to 45 months). Of the total patients, 204 (83.2%) were followed clinically during the time period from 12 to 56 months. Results Complete revascularization was performed for all the patients. The mean number of grafts was 2.6 ± 0.5. The perioperative mortality was 0.4% (1 patient). There were two conversions to sternotomy (0.8%), four reopenings for bleeding (1.6%), three myocardial infarctions (1.2%), and one stroke (0.4%). Twenty‐two patients (9.0%) received transfusions. The long‐term mortality was 4.4% (nine patients). Three patients (1.5%) suffered from a stroke during the follow‐up period. For five patients (2.4%), repeat revascularization was necessary. For the examined patients, the overall graft patency rate was 89.8%, the LITA graft patency rate was 98.4%, the radial artery patency was 100%, and the saphenous vein graft patency was 84.0%. Conclusions MIM CABG allows complete surgical revascularization with excellent clinical outcomes and promising angiographic graft patency rates.

The OBJECTIVE was to demonstrate clinical outcomes of minimally invasive aortic valve replacement (MIAVR).MATERIAL AND METHODS. We retrospectively analyzed surgical results of treatment of patients underwent isolated AVR in our Institution between 2006 and 2018. Overall number of operations was 122; 56 of patient were operated via upper ministernotomy approach. Preoperative characteristics were similar in both groups.RESULTS. In our series MIAVR procedures had prolonged CPB and aortic cross clamping time, what significantly contributed to the increase in manifestations of heart failure in the early postoperative period, but didn’t affect the perioperative mortality and major morbidity rates. MIAVR led to reduction in postoperative blood loss and perioperative red blood cell transfusion rate. Most severe complications occurred in frail patients older than 75 years, and in those with extensive aortic annular calcification.CONCLUSION. MIAVR was the safe and reproducible surgical intervention and rarely led to significant complications in low-risk patients. Prolonged CPB time adversely affected the frequency of significant complications, especially in elderly patients. Although, selected high risk patients might benefit with MIAVR.

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Background. Ventricular aneurysms develop after transmural myocardial infarctions and can significantly worsen clinical outcomes. We report an unusual case of the giant inferior wall aneurysm, successfully treated by surgical resection. Case presentation. The 65-year-old male was diagnosed with a giant inferior wall left ventricular aneurysm after worsening of his dyspnoea. Four months prior to the admission, he had ST-elevation inferior myocardial infarction, complicated by pericarditis. During the 4-month follow-up period, the aneurysm has significantly increased in size. Unrecognized ventricular wall rupture was supposed.The precise anatomy of the aneurysm was established by cardiac MRI. Surgical resection of the aneurysm was performed with uneventful patient's recovery. Conclusion. Timely surgical treatment of the rapidly growing aneurysms is recommended. In such cases cardiac MRI can specify anatomy and coordinate surgical strategy.

Background Minithoracotomy avoids the complications specific to sternotomy access, which in turn creates the conditions for early activation and rehabilitation of patients, especially elderly, with diabetes mellitus, obesity, disorders of the musculo-skeletal system. Purpose To assess the patency of grafts after minimally invasive coronary artery bypass grafting (MICS CABG). Methods We analyzed the results of 50 MSCT- angiography made to patients with MICS CABG operated between 2014 and 2016 (28,5±13,5 months after surgery). Totally 132 conduits were used, 47 (35.6%) of them – arterial, 85 (64.4%) – venous. In all cases left internal mammary artery (LIMA) was used for revascularization of the left anterior descending artery (LAD). The great saphenous vein was used as a conduit for revascularization of: diagonal branch (DA) – 10 (11.7%) cases, left circumflex artery (LCx) – 44 (51.8%), right coronary artery (RCA) – 12 (14.1%), posterior interventricular branch – 19 (22.4%). Assessment of the patency of grafts were performed: 1–2 years (33 conduits: 13 arterial, 20 venous), after 2–3 years (51 conduits: 19 arterial, 32 venous) and after 3–4 years (48 conduits: 15 arterial, 33 venous). Results Assessment of coronary grafts patency in the first period revealed occlusion of 3 (15%) venous conduits. In 2 cases, the venous conduit was anastomosed with the LCx, in 1 case with the RCA. The cumulative patency of the grafts was as follows: arterial – 100%, venous – 85%. In the second point of the study occlusion and stenotic changes of LIMA has not been revealed. Determined occlusion 5 (15,6%) venous grafts. In all cases, the occluded venous conduits revascularized the RCA. Total permeability of conduits: arterial – 100%, venous-84.4%. In the third time interval it was revealed: in 1 case of LIMA occlusion and 7 venous grafts, in 4 cases in the area of the LCx, in 2 – DA and in 1 case – in the area of the RCA. Total patency of grafts: arterial – 93.3%, venous – 78.8%. Total permeability of conduits: arterial – 97.9%, venous – 82.4%. Conclusion The analysis shows good long–term results of the functioning of grafts after MICS CABG and their comparability with the results of patency of the conduits after CABG performed by the traditional Funding Acknowledgement Type of funding source: None

Санкт-Петербургское государственное бюджетное учреждение здравоохранения «Городская больница ¹ 40 Курортного района», Санкт-Петербург, Россия Поступила в редакцию 02.04.19 г.; принята к печати 09.10.19 г. ЦЕЛЬ. Продемонстрировать периоперационные результаты и ангиографические показатели функционирования шунтов в среднесрочном периоде у пациентов, перенесших мини-инвазивное многососудистое коронарное шунтирование (МИКШ). МАТЕРИАЛ И МЕТОДЫ. В период с 2014 по 2019 г. оперированы 270 пациентов со стабильными формами ишемической болезни сердца (ИБС). Всем пациентам выполнено МИКШ из левосторонней мини-торакотомии с использованием левой внутренней грудной артерии и аутовенозных аортокоронарных шунтов. У 264 (97,8 %) пациентов операции выполнены без искусственного кровообращения. 127 пациентам была выполнена КТшунтография (КТ-ШГ) на 128-срезовом компьютерном томографе не ранее, чем через 12 месяцев с момента операции. Средний срок наблюдения составил (30,3±7,9) месяца. РЕЗУЛЬТАТЫ. Всем пациентам выполнена полная реваскуляризация миокарда. Среднее число шунтов составило (2,6±0,5). Периоперационная летальность составила 0,4 % (1 пациент). Периоперационный инфаркт миокарда и острые нарушения мозгового кровообращения наблюдались соответственно у 3 (1,1 %) и 1 (0,4 %) пациента. Общая проходимость шунтов составила 89,8 % (290 из 323). К моменту выполнения КТ-ШГ проходимость маммарных шунтов составила 98,4 % (124 из 126), венозных шунтов -84,0 % (163 из 194), а шунтов из лучевой артерии -100 % (3 из 3). ЗАКЛЮЧЕНИЕ. МИКШ является эффективной и безопасной операцией, выполняемой с минимальным числом периоперационных осложнений. МИКШ позволяет достичь полной реваскуляризации миокарда без выполнения стернотомии и в подавляющем большинстве случаев проводится на работающем сердце, без искусственного кровообращения и пережатия аорты. МИКШ обеспечивает хорошую отдаленную проходимость шунтов. Ключевые слова: мини-торакотомия, коронарное шунтирование, мини-инвазивное шунтирование, коронарная реваскуляризация, мини-инвазивная кардиохирургия, коронарное шунтирование, шунтография

The strategy of heart tissue engineering is simple enough: first remove all the cells from a organ then take the protein scaffold left behind and repopulate it with stem cells immunologically matched to the patient in need. While various successful methods for decellularization have been developed, and the feasibility of using decellularized whole hearts and extracellular matrix to support cells has been demonstrated, the reality of creating whole hearts for transplantation and of clinical application of decellularized extracellular matrix-based scaffolds will require much more research. For example, further investigations into how lineage-restricted progenitors repopulate the decellularized heart and differentiate in a site-specific manner into different populations of the native heart would be essential. The scaffold heart does not have to be human. Pig hearts carries all the essential components of the extracellular matrix. Through trial and error, scaling up the concentration, timing and pressure of the detergents, researchers have refined the decellularization process on hundreds of hearts and other organs, but this is only the first step. Further, the framework must be populated with human cells. Most researchers in the field use a mixture of two or more cell types, such as endothelial precursor cells to line blood vessels and muscle progenitors to seed the walls of the chambers. The final challenge is one of the hardest: vascularization, placing a engineered heart into a living animal, integration with the recipient tissue, and keeping it beating for a long time. Much remains to be done before a bioartificial heart is available for transplantation in humans.

Санкт-Петербургское государственное бюджетное учреждение здравоохранения «Городская больница ¹ 40 Курортного района», Санкт-Петербург, Россия Поступила в редакцию 30.09.19 г.; принята к печати 11.12.19 г. Мы демонстрируем клинический пример успешного лечения пациента с тяжелой аортальной недостаточностью, ранее перенесшего коронарное шунтирование и имеющего функционирующие коронарные шунты, в том числе маммарно-коронарный. Выполнено протезирование аортального клапана из верхней мини-стернотомии с периферическим (бедренно-бедренным) искусственным кровообращением. Ключевые слова: министернотомия, миниинвазивная кардиохирургия, протезирование аортального клапана, периферическое искусственное кровообращение, повторная операция Для цитирования: Снегирев М. А., Пайвин А. А., Денисюк Д. О. Протезирование аортального клапана у пациента с функционирующими коронарными шунтами.We report the clinical case of aortic valve replacement for severe aortic insufficiency in patient who previously was subjected to coronary bypass grafting, with functioning grafts, including internal thoracic artery graft. The procedure was performed from the upper ministernotomy with peripheral (femoral) cardiopulmonary bypass. Keywords: ministernotomy, minimally invasive cardiac surgery, aortic valve replacement, peripheral cardiopulmonary bypass, redo operation For citation: Snegirev M. A., Paivin A. A., Denisyuk D. O. Aortic valve replacement in patient with functioning coronary artery bypass grafts.