Vladlen V. Bazylev

Introduction. Modern advances in bicuspid aortic valve (BAV) reconstructive surgery, despite their significance, have significant limitations. Neocuspidization using autologous pericardium (Ozaki technique) is considered as an alternative approach to correcting BAV pathology. Up to 50% of patients with BAV have associated aortopathy, which can involve the proximal aorta and mid-portion of the ascending aorta. In this article, we present a comparative analysis of the results of Ozaki neocuspidation and mechanical prosthesis implantation in patients with bicuspid aortic valves and concomitant ascending aortic valve replacement (AVR). Aim: To compare the immediate outcomes of Ozaki neocuspidization and mechanical prosthesis implantation in patients with bicuspid aortic valves and concomitant ascending aortic valve replacement. Material and Methods. The study included 137 patients who underwent surgery at the clinic between January 2017 and January 2025. A retrospective observational comparison of surgical outcomes of two groups was performed: Group 1 – the study group, consisting of 63 patients who underwent neocuspidization using the Ozaki technique combined with ascending aortic replacement; Group 2 – the control group, consisting of 74 participants who underwent AVR with a mechanical prosthesis and ascending aortic replacement. Results. A statistically significant difference was observed based on postoperative ultrasound data: the effective orifice area in Group 1 was 4.7 ± 1.1 versus 2.3 ± 0.4 in Group 2 ( p = 0.04). The mean gradient was 4.5 ± 2.1 in Group 1 and 10.6 ± 2.2 in Group 2 ( p = 0.04). The maximum gradient was 9.5 ± 2.8 and 17.6 ± 2.9 in Groups 1 and 2, respectively ( p = 0.04). In-hospital mortality and the incidence of postoperative complications did not differ significantly between the two groups. Conclusion. No statistically significant differences were observed in in-hospital comparisons of intraoperative characteristics and early postoperative complications. However, significantly better hemodynamic parameters were observed in the study group.

Aim. to evaluate the results of pulmonary vein isolation (PVI) and spatio-temporal dispersion (STD) radiofrequency ablation (RFA) and the recurrence rate of atrial fibrillation (AF) in patients with non-paroxysmal AF after intraoperative intravenous administration of novocainamide. Methods. The study included 67 patients with persistent and long-standing persistent AF who underwent the primary RFA PVI and STD procedure. Stages of the operation: coronary sinus catheterization, interatrial septum puncture twice, PVI, administration of novocainamide in the right atrium, mapping and RFA of STD zones in the left atrium, ifnecessary, in the right atrium and in the coronary sinus. The final goal of RFA was conversion to sinus rhythm (SR) or transformation into atrial flutter (AFl)/regular atrial tachycardia (AT) with subsequent mapping and RFA. If AF/AFl/AT persisted, an electrical cardioversion (ECV) was performed. Then, PVI and linear blocks were evaluated/restored. An electrocardiogram and Holter monitoring were recorded at 3 and 6 months later to analyze the effectiveness. Results. PVI was achieved in each case. Acute conversion of AF to SR occurred in 7 patients (10.4%), in sustained AFl/AT in 26 (38.8%). In 18 of 26 patients (69.2%), AFl/AT were ablated with SR restoration. 42 patients (62.7%) required ECV. After 3 months, there was no recurrence of AF in 40 patients (88.9%), AF/AFl/AT in 31 (68.9%), 6 months later in 32 (80%) and 24 (60%) respectively. There were no differences in freedom from AF/AFl/AT 6 months later between the AF and ECV group at the end of the procedure and the SR/AFl/AT group (log-rank=0.333), while the latter had significantly fewer AF recurrences (log-rank=0.004). In patients who converted to SR/AFl/AT during RFA, the probability of AF recurrence during the 6-month follow-up period was 10 times lower than in patients with persistent AF and ECV (OR 10.4 (95% CI 1.351-81.120), p=0.025. Conclusion. In 49.3% of cases, AF was stopped during RFA PVI and STD. The probability of AF recurrence in this case was 10 times lower than in the case of persistent AF and ECV at the end of the operation. There were no differences in the absence of AF/AFl/AT recurrence between patients with intraoperative conversion to SR/AFl/AT and persistent AF.

IN-HOSPITAL OUTCOMES OF MYOCARDIAL REVASCULARIZATION USING AN I-CONDUIT AND NO-TOUCH SAPHENOUS VEIN GRAFTING: RESULTS OF A RANDOMIZED CONTROLLED TRIAL | Makaev | Complex Issues of Cardiovascular Diseases ГОСПИТАЛЬНЫЕ РЕЗУЛЬТАТЫ РЕВАСКУЛЯРИЗАЦИИ МИОКАРДА С ПРИМЕНЕНИЕМ I КОНДУИТА И АУТОВЕНОЗНОГО ШУНТИРОВАНИЯ NO-TOUCH: РЕЗУЛЬТАТЫ РАНДОМИЗИРОВАННОГО КОНТРОЛИРУЕМОГО ИССЛЕДОВАНИЯ | Макаев | Комплексные проблемы сердечно-сосудистых заболеваний

Introduction . Trisomy 21, or Down syndrome (DS), is the most common chromosomal abnormality worldwide and is often considered a risk factor for complications and adverse outcomes in surgical treatment of congenital heart defects (CHD). Materials and methods . This was a retrospective single-center comparative study that included 440 children who underwent surgery for CHD. Patients with DS constituted the first (study) group (n = 57), while the second (control) group included patients without genetic disorders (n = 383). Results . Patients with DS had lower body weight – 4.8 kg versus 5.9 kg in patients in the control group (p = 0.017). The most frequently performed procedure in both groups was ventricular septal defect repair, in 33.0% and 39.6% of cases for the first and second groups, respectively (p = 0.61). Radical correction (RC) of the atrioventricular canal was more often performed in patients of the main group (p < 0.001). In patients with DS, staged treatment of CHD was more often performed, since pulmonary artery narrowing as the first stage of hemodynamic correction was performed in 22.8% of patients in the first group (p < 0.01). Conotruncal defects (tetralogy of Fallot (TOF) and double outlet right ventricle) were less common in patients with trisomy 21 than in patients with a normal chromosomal set (p = 0.031). Among the postoperative complications, respiratory failure (RF) was the most common in both groups, but developed more frequently in patients with trisomy 21 – in 26.3% of cases (p = 0.029). Patients with DS required longer duration of mechanical ventilation (MV) (p = 0.019), non-invasive respiratory support (p = 0.007), and inotropic support (p = 0.012). The duration of intensive care in the intensive care unit (ICU) (p = 0.023) and mortality (p = 0.01) were also higher in patients in the study group. Systemic inflammatory response syndrome (SIRS) was not a frequent complication, but its incidence in patients with trisomy 21 was twice as high – 12.2% versus 6.5% in the control group (0.004). Mortality in the first group was higher, at 5.3% versus 2.1% in patients without chromosomal abnormalities (p = 0.011). Conclusion . The postoperative period after cardiac surgery in children with trisomy 21 is more often complicated by respiratory failure, which requires longer periods of mechanical ventilation and more frequent use of non-invasive respiratory support. Respiratory failure is the most common postoperative complication in children with DS after cardiac surgery. Patients with trisomy 21 require a longer intensive care unit (ICU) stay compared to their peers without chromosomal abnormalities.

Введение:транскатетерная имплантация клапана в легочную артерию является перспективной минимально инвазивной альтернативой традиционной хирургии для пациентов с заболеваниями легочной артерии, такими как стеноз или недостаточность легочного клапана. Эта процедура позволяет значительно снизить интраоперационную травматизацию и время восстановления, при этом обеспечивая улучшение клинических и гемодинамических показателей пациентов. Непосредственные результаты транскатетерной имплантации клапана в легочную артерию важны для оценки эффективности вмешательства, выявления возможных осложнений и оптимизации последующих подходов. Цель: оценить непосредственные и отдаленные результаты имплантации первого отечественного клапана МедЛаб-КТ со створками из политетрафторэтилена (ПТФЭ) в легочную артерию. Материал и методы: в одноцентровое ретроспективное исследование были включены 12 пациентов, которым в период с 2019 по 2025 гг. выполнялась операция: транскатерная имплантация клапана МедЛаб-КТ в легочную позицию. Среди пациентов было 4 (33%) мужчин и 8 (67%) женщин в возрасте от 18 до 52 лет (средний возраст 22 ± 9 лет). Их вес варьировал от 46 до 87 кг, в среднем 61 ± 17 кг. Первоначальные диагнозы включали: тетраду Фалло (n = 8; 67%), транспозицию крупных артерий после операции Растелли (n = 1; 8,3%), аортальный стеноз и обструкцию выходного тракта левого желудочка после операций Росса (n = 1; 8,3%), атрезию легочной артерии (n = 1; 8,3%) и изолированный стеноз легочного клапана (n = 1; 8,3%). Средний период наблюдения составил 35,2 месяцев, максимальный период наблюдения - 6 лет. Результаты:транскатетерная имплантация клапана легочной артерии была успешной во всех случаях. Градиент систолического давления снизился со среднего значения 32,9 ± 6 мм рт. ст. до среднего значения 14,4 ± 6,1 мм рт. ст. в раннем послеоперационном периоде. Снижение градиента было особенно выраженным у пациентов с преобладающим стенозом. В этой группе градиент снизился со среднего значения 48,0 ± 9,5 мм рт. ст. до значения 19,4 ± 5,2мм рт. ст. после процедуры. В группе с преобладанием регургитации градиент снизился со среднего значения 22,5 ± 5,7мм рт. ст. до среднего значения 10,9 ± 4,1мм рт. ст. В раннем послеоперационном периоде соотношение систолического давления ПЖ/ЛЖ снизилось с 0,41 ± 0,12 до среднего значения 0,26 ± 0,02 (p <0,02); у пациентов с преобладающим стенозом со среднего значения 0,37 ± 0,11 до среднего значения 0,23 ± 0,02; у пациентов со значительной регургитацией со среднего значения 0,47 ± 0,11до среднего значения 0,28 ± 0,03. При ангиографии незначительная послеоперационная легочная регургитация наблюдалась у 7 пациентов после имплантации клапана МедЛаб-КТ. Серьезных процедурных осложнений не наблюдалось. Выводы: результаты нашего исследования подтверждают эффективность транскатетерной имплантации клапана в легочную артерию как метода лечения пациентов с легочной гипертензией и заболеваниями клапанов. Процедура показала хорошие краткосрочные результаты, включая значительное улучшение гемодинамических показателей и снижение давления в легочной артерии. Однако для полного понимания долгосрочной эффективности и устойчивости результатов необходимо продолжить мониторинг пациентов в отдаленные сроки, особенно для пациентов с недостаточностью клапана. Introduction: transcatheter pulmonary valve implantation (TPVI) is a promising minimally...

Введение:транскатетерная имплантация клапана в легочную артерию является перспективной минимально инвазивной альтернативой традиционной хирургии для пациентов с заболеваниями легочной артерии, такими как стеноз или недостаточность легочного клапана. Эта процедура позволяет значительно снизить интраоперационную травматизацию и время восстановления, при этом обеспечивая улучшение клинических и гемодинамических показателей пациентов. Непосредственные результаты транскатетерной имплантации клапана в легочную артерию важны для оценки эффективности вмешательства, выявления возможных осложнений и оптимизации последующих подходов. Цель: оценить непосредственные и отдаленные результаты имплантации первого отечественного клапана МедЛаб-КТ со створками из политетрафторэтилена (ПТФЭ) в легочную артерию. Материал и методы: в одноцентровое ретроспективное исследование были включены 12 пациентов, которым в период с 2019 по 2025 гг. выполнялась операция: транскатерная имплантация клапана МедЛаб-КТ в легочную позицию. Среди пациентов было 4 (33%) мужчин и 8 (67%) женщин в возрасте от 18 до 52 лет (средний возраст 22 ± 9 лет). Их вес варьировал от 46 до 87 кг, в среднем 61 ± 17 кг. Первоначальные диагнозы включали: тетраду Фалло (n = 8; 67%), транспозицию крупных артерий после операции Растелли (n = 1; 8,3%), аортальный стеноз и обструкцию выходного тракта левого желудочка после операций Росса (n = 1; 8,3%), атрезию легочной артерии (n = 1; 8,3%) и изолированный стеноз легочного клапана (n = 1; 8,3%). Средний период наблюдения составил 35,2 месяцев, максимальный период наблюдения - 6 лет. Результаты:транскатетерная имплантация клапана легочной артерии была успешной во всех случаях. Градиент систолического давления снизился со среднего значения 32,9 ± 6 мм рт. ст. до среднего значения 14,4 ± 6,1 мм рт. ст. в раннем послеоперационном периоде. Снижение градиента было особенно выраженным у пациентов с преобладающим стенозом. В этой группе градиент снизился со среднего значения 48,0 ± 9,5 мм рт. ст. до значения 19,4 ± 5,2мм рт. ст. после процедуры. В группе с преобладанием регургитации градиент снизился со среднего значения 22,5 ± 5,7мм рт. ст. до среднего значения 10,9 ± 4,1мм рт. ст. В раннем послеоперационном периоде соотношение систолического давления ПЖ/ЛЖ снизилось с 0,41 ± 0,12 до среднего значения 0,26 ± 0,02 (p <0,02); у пациентов с преобладающим стенозом со среднего значения 0,37 ± 0,11 до среднего значения 0,23 ± 0,02; у пациентов со значительной регургитацией со среднего значения 0,47 ± 0,11до среднего значения 0,28 ± 0,03. При ангиографии незначительная послеоперационная легочная регургитация наблюдалась у 7 пациентов после имплантации клапана МедЛаб-КТ. Серьезных процедурных осложнений не наблюдалось. Выводы: результаты нашего исследования подтверждают эффективность транскатетерной имплантации клапана в легочную артерию как метода лечения пациентов с легочной гипертензией и заболеваниями клапанов. Процедура показала хорошие краткосрочные результаты, включая значительное улучшение гемодинамических показателей и снижение давления в легочной артерии. Однако для полного понимания долгосрочной эффективности и устойчивости результатов необходимо продолжить мониторинг пациентов в отдаленные сроки, особенно для пациентов с недостаточностью клапана. Introduction: transcatheter pulmonary valve implantation (TPVI) is a promising minimally...

Radiofrequency ablation of the pulmonary veins using a single-catheter method is as effective as the traditional approach in the treatment of paroxysmal atrial fibrillation | Bazylev | Journal of Arrhythmology Радиочастотная аблация легочных вен с использованием однокатетерного метода не уступает по эффективности традиционному подходу при пароксизмальной форме фибрилляции предсердий | Базылев | Вестник аритмологии

Objective. To compare clinical and hemodynamic outcomes of open transaortic implantation of balloon-expandable prosthesis with PTFE leaflets and Ozaki procedure (AV-Neo). Material and methods. A prospective study included 101 patients who underwent open transaortic aortic valve replacement with balloon-expandable prosthesis with polytetrafluoroethylene leaflets and 277 patients who underwent AV-Neo procedure. The primary endpoint was in-hospital mortality. Results. Significant differences were found in the incidence of blood transfusions (p=0.02), acute kidney injury (AKI) (p=0.018), and total number of complications (in-hospital mortality+myocardial infarction+AKI) (p=0.006). Significant differences were also found in characteristics of surgical interventions: duration of cardiopulmonary bypass (CPB) (p=0.02), aortic cross-clamping (p=0.002), and surgery (p=0.03). Conclusion. Transaortic implantation of balloon-expandable graft has a significant advantage over Ozaki procedure. Comparison of perioperative parameters (time of surgery, CPB and aortic cross-clamping) revealed significant differences in favor of transaortic implantation (p=0.03; 0.002; 0.03), as well as lower risk of in-hospital mortality.

Introduction. Given the high cost of cardiac resynchronization therapy (CRT) devices, the search for reliable preoperative predictors of response to optimize patient selection becomes critically important. One promising prognostic factor is right ventricular (RV) systolic function. However, existing data are contradictory, and echocardiography does not provide an accurate quantitative assessment of right ventricular ejection fraction (RVEF) due to the chamber's anatomical peculiarities. Cardiac magnetic resonance imaging (MRI) is the gold standard for assessing RV volumes and function, but its role in predicting response to CRT has been insufficiently studied due to the limited number of existing studies. Aim : To study the association between baseline RV EF, measured by cardiac MRI, and echocardiographic response to CRT. Material and Methods. A single-center retrospective study was conducted involving 368 patients who received a CRT-P or CRT-D (with cardioverter-defibrillator function) implant at the Federal Center for Cardiovascular Surgery (Penza, Russia) between 2014 and 2021 in accordance with current clinical guidelines and who underwent cardiac MRI immediately prior to implantation. A total of 113 patients were selected. CRT response criteria were defined as an increase in left ventricular ejection fraction (LVEF) by ≥ 5% and/or a reduction in left ventricular end-systolic volume (LVESV) by ≥ 15% from baseline. Based on response, patients were divided into two groups: responders and non-responders. Results. The formed groups were comparable in terms of key clinical and demographic characteristics, as well as heart failure functional class, LVEF, and QRS duration. The only difference was a higher frequency of ischemic cardiomyopathy (ICM) in the nonresponder group. When comparing baseline MRI parameters, the non-responder group had significantly lower RVEF values (46 [39; 51] vs. 32 [22; 43], p = 0.001), higher right ventricular end-diastolic and end-systolic volumes, and a higher frequency of moderate (grade 2) or greater tricuspid regurgitation (TR). In the postoperative period, the groups did not differ in paced QRS duration. As expected, the groups differed significantly in LVEF and left ventricular end-diastolic volume. Univariate regression analysis identified four indicators statistically significantly associated with the endpoint: ICM (OR 0.381, 95% CI 0.157–0.924, p = 0.033), LVESV (OR 0.994, 95% CI 0.990–0.999, p = 0.011), RVEF (OR 1.060, 95% CI 0.992–1.132, p = 0.083), and TR grade ≥ 2 (OR 0.696, 95% CI 0.233–0.992, p = 0.040). Multivariate regression analysis using these indicators revealed that only two maintained a statistically significant association with CRT response: ICM (OR 0.326, 95% CI 0.115–0.924, p = 0.035) and RVEF (OR 1.057, 95% CI 1.022– 1.094, p = 0.001). Conclusion. The study demonstrated that patients with standard indications for CRT and lower baseline RVEF measured by cardiac MRI are less likely to respond to therapy. RVEF and ICM were independently associated with CRT response: RVEF showed a direct relationship, while the presence of ICM showed an inverse relationship.

Introduction . Atrial fibrillation (AF) is a common and complex problem in patients with heart failure (HF). At the same time, AF and HF form a synergistic interaction. Cardiac resynchronization therapy (CRT) is an effective method of treating certain groups of patients with HF. In view of this fact, the negative dynamics of echocardiographic parameters in patients with effective CRT and nonparoxysmal AF is of interest for study. Aim : To assess impact of non-paroxysmal AF on clinical and echocardiographic parameters in CRT responders at the late postoperative period. Material and Methods . A single-center retrospective observational study was performed on 608 patients who underwent primary implantation of the CRT (-R / -D) between 2009 and 2022. The response to CRT was assessed at the time of the best dynamics of the parameters. 139 patients were selected. All patients with non-paroxysmal AF underwent radiofrequency ablation (RFA) of the atrioventricular node. Two groups of patients were formed based on this criterion. The primary endpoint was all-cause mortality in the long-term follow-up period. Results. Descriptive statistics did not reveal a significant intergroup difference in demographic and basic clinical characteristics (p > 0.05), with the exception of a higher incidence of TIA/He also has a lower functional status in the group with AF. The results of echocardiographic data in the preand postoperative periods differed in most linear and volumetric parameters, with the exception of finite diastolic volume (CDV) and LVEF. In the sinus rhythm group, there was a statistically significant decrease in the incidence of severe valvular insufficiency, as well as significantly lower atrial volume and size of the right heart (p < 0.05). Postoperative analysis revealed positive dynamics of most parameters in both groups, however, there was no significant dynamics in the size of the pancreas and the TP gradient. In the long-term period, intergroup differences in LVEF, CDOs, and MR degree did not reach statistical significance, however, patients after RF AB connection had large right heart chambers. A single-factor analysis revealed statistically significant associations of overall mortality with art. (OR = 6.0; 95% CI 1.1–32.5), TR 3 art. (OR = 8.7; 95% CI 1.3–57.0) and MR 3 art. (OR = 9.6; 95% CI 2.9–31.7). According to the results of multifactorial regression analysis, the presence of severe MR in the preoperative period was associated with an increased chance of mortality (OR = 7.2; 95% CI 1.7 – 30.1). The overall mortality rate was 19.4% (n = 27), and there was no intergroup difference in long-term survival (p = 0.202). Conclusion. Linear and volumetric parameters of the right heart chambers in CRT responders with nonparoxysmal AF were higher than those in patients with sinus rhythm. This group was more likely to have significant regurgitation of both AV valves, which persisted into the long-term follow-up. The association between AF and long-term all-cause mortality did not reach statistical significance.