V. A. Karnakhin

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.

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: In modern cardiac surgery, the Ozaki procedure is one of the preferred methods for treating aortic valve diseases.This study examines histological changes in the pericardium associated with comorbidities, addressing a gap in the literature regarding the impact of ischemic heart disease (IHD) and myocardial infarction (MI) on the structure of the human pericardium. Objective: To evaluate the influence of IHD and MI on the human pericardium, evaluate the impact of comorbidities on pericardial structure, and compare the histological properties of glutaraldehyde-treated pericardium with untreated samples. Methods: Pericardial samples from 98 patients who underwent cardiac surgery were analyzed. Patients were divided into two groups based on their IHD status. Histological examination evaluated mesothelial integrity, collagen fiber organization, and inflammatory changes. Statistical analyses, including chi-square tests and ROC analysis, assessed the prognostic role of IHD and MI in pericardial destruction. Artificial neural networks further analyzed the prognostic significance of these comorbidities. Results: Histological analysis revealed significant structural deterioration in the pericardium of patients with IHD and MI, including mesothelial changes, collagen necrosis, and inflammatory infiltration. ROC analysis demonstrated high prognostic sensitivity of IHD and MI in pericardial destruction (AUC 0.915 for IHD and 0.849 for MI). Notably, no histological differences were observed between glutaraldehyde-treated and untreated pericardium under light microscopy. Conclusions: IHD and MI significantly contribute to pericardial destruction, which may impact surgical outcomes after the Ozaki procedure. Glutaraldehyde treatment does not alter pericardial structure microscopically. Keywords: pericardium, aortic stenosis, Ozaki procedure.

Introduction. Aortic valve replacement (AVR) is one of the most frequently performed procedures in cardiac surgery, which significantly improves the quality of life and increases its duration. Recently, transcatheter aortic valve implantation (TAVI) has been actively used, which is especially important in patients with concomitant pathology, in particular coronary heart disease (CHD). In this article, we describe the experience of successful surgical treatment of patients who underwent TAVI in combination with coronary artery bypass grafting.Aim: To compare the results of open transaortic implantation of the “MedLAB–CT” prosthesis in combination with coronary bypass surgery, in comparison with similar indicators when replacing the aortic valve with a mechanical prosthesis with coronary artery bypass grafting, at the hospital stage.Material and Methods. Patients operated in the clinic from June 2020 to November 2023. A retrospective observational comparison of the results of surgical treatment of two groups of patients was performed: Group 1 study group, which consisted of 60 patients who underwent open transaortic implantation of the prosthesis “MedLAB-CT” in combination with CABG. Group 2 control group, it included 99 patients who underwent AVR with a mechanical prosthesis and CABG. Using the Propensity Score Matching (PSM) pseudorandomization method, 60 patients were selected from the comparison group.Results. Cardiopulmonary bypass time was significantly less in the “MedLAB-CT” + CABG group – 57.4 ± 8.3 min (p = 0.003). A statistical difference in the time of aortic clamping was revealed: in the study group had a value of 43.2 ± 5.2 min, in the comparison group 75.4 ± 9.2 min (p = 0.002). There were no statistically significant differences in the duration of surgery (p = 0.224), length of stay in the intensive care unit (p = 0.805) and hospitalization (p = 0.783).Conclusion. The proposed method of open transaortic implantation of the MedLAB-CT prosthesis in combination with coronary bypass surgery can significantly reduce the time of cardiopulmonary bypass and myocardial ischemia, which has a positive effect on the course of the postoperative period.

Introduction. In 2003, at the Annual Congress of the American Heart Association in Orlando, L. Menicanti and M. Di Donato proposed an original morphofunctional classification of postinfarction left ventricular aneurysms based on the silhouette and segmental contractility of the LV wall. According to this classification, 4 types of aneurysms are distinguished. Type 4 is akinesis of the anterolateral, apical and posterobasal segments, the presence of residual contractility of the anterobasal and inferoapical segments («double scar»). The combination of anterior and posterior LV aneurysms is one of the rarest complications, and the incidence rate of less than 1 % is due to high mortality in the acute period of MI [2–4]. Objective. To evaluate the results of surgical treatment of patients with post-infarction left ventricular aneurysm type IV according to the classification of L. Menicanti. Materials and methods. In this retrospective single-center study, we examined the medical records of 37 patients who underwent simultaneous reconstruction of the anterior and posterior LV aneurysm, coronary artery bypass grafting and mitral valve plastic surgery from 2010 to 2024 at the Federal Center for Cardiovascular Surgery in Penza. The main inclusion criteria were: coronary heart disease and the presence of an aneurysm type IV (a combination of anterior and posterior aneurysms) according to the classification of L. Menicanti. Results. In the period from January 2010 to 2024, 37 operations were performed, which consisted of geometric remodeling of post-infarction LV aneurysm type IV. The follow-up period was up to 120 months. The long-term results of patients were assessed. An increase and preservation of LV contractility was revealed, despite the reverse LV remodeling in the long-term period (p=0.01). According to the univariate Cox regression analysis, it was revealed that MV plastic surgery reduces the likelihood of fatal outcome in the long-term period (HR=0.306, p=0.027). Conclusions. 1. Combined correction of anterior and posterior aneurysms is not associated with perioperative risk of death. 2. Combined correction of anterior and posterior aneurysms is accompanied by a significant increase and preservation of LV contractility both in the early and late follow-up periods. 3. MV plastic surgery reduces the likelihood of death in the late period (HR=0.306, p=0.027).

BACKGROUND: Aortic stenosis (AS) itself is a common disease in patients of older populations, and its combination with a narrow aortic root puts the surgeon in front of choosing the most optimal option. The advantages of Ozaki's operation include hemodynamics close to the native aortic valve (AV) and the absence of the need for lifelong anticoagulant therapy. AIM: To evaluate the hospital and long-term results of surgical treatment of patients with AS and a narrow fibrous ring who underwent Ozaki surgery or AV prosthetics with a biological prosthesis. MATERIALS AND METHODS: In total, 836 isolated Ozaki operations or combined interventions of this kind were performed at the Federal Center for Cardiovascular Surgery (Penza). This retrospective single-center study included 150 patients with critical AC (effective opening area ≤1 cm2) in whose surgical treatment tactics Ozaki surgery or prosthetics with a biological prosthesis were used. RESULTS: In the early postoperative period, group 1 patients had significantly lower values of the average and maximum gradients on the aortic valve and a larger area of the effective opening of the aortic valve. Also, in group 1 patients, the postoperative period of stay in intensive care is significantly higher, which is a consequence of the longer duration of the operation, the time of artificial circulation and myocardial ischemia. Long-term mortality is higher in the group with prosthetics of AV (Log Rank=0.006). Freedom from re-operation according to the analysis, there was no significant difference between the groups (Log Rank=0.226). CONCLUSION: Ozaki surgery demonstrates the best hemodynamic characteristics on AV in comparison with a biological prosthesis in patients with a narrow fibrous ring of AV in the early and long-term follow-up periods.

Aim. To evaluate immediate outcomes of the Ozaki procedure in patients with coronary artery bypass grafting (CABG).Material and methods. This retrospective study included 416 patients operated on at the Federal Center of Cardiovascular Surgery (Penza). The patients were divided into two groups. The first group included 139 patients who underwent the AVNeo procedure in combination with CABG. The second group included 277 patients who underwent a single AVNeo procedure.Results. The median time of cardiopulmonary bypass and myocardial ischemia in the AVNeo+CABG group was 146 (134-165) and 115 (104-125), respectively, while in the AVNeo group — 117 (102-136) and 96 (82-109), respectively. The mean aortic valve pressure gradient immediately after surgery in the AVNeo+CABG group was 5,9±3,3, while in the AVNeo group — 6,4±3,1. Mortality in the AVNeo+CABG group was 2,8% (n=4), while in the AVNeo group — 0,3% (n=1). Inhospital survival in the AVNeo+CABG group was 97,1%, while in the AVNeo group — 99,6%. In the AVNeo+CABG group, there were following death causes: perioperative myocardial infarction (n=2), pneumonia (n=1), multiple organ failure (n=1). In the AVNeo group, the cause of the only fatal outcome was multiple organ failure. Only one predictor of inhospital mortality was identified — resternotomy for bleeding. In the case of resternotomy, inhospital death risk increases by 1,3 times for each day of the postoperative period. Cardiopulmonary bypass time, myocardial infarction, and operation duration do not affect mortality. The combination of AVNeo with CABG also does not affect inhospital mortality (p=0,1).Conclusion. The combination of the AVNeo procedure with CABG is an effective and safe procedure in the immediate period.

Aim. To examine the impact of late gadolinium enhancement (LGE) in the left ventricular myocardium on magnetic resonance imaging (MRI) on overall mortality and the phases of arrhythmic events in patients with ischemic cardiomyopathy and implantable cardioverter defibrillator (ICD).Methods. This was a single-center retrospective study. A total of 382 medical records of patients from the period between 2019 and 2022, who underwent ICD implantation as part of primary prevention of sudden cardiac death at National Centre of Cardiovascular Surgery, were analyzed. Seventy-four patients were selected for the study. Observation was conducted through in-person examinations and remote monitoring. Endpoints evaluated included overall mortality and arrhythmic events. The cause of death was determined based on the “Promed” medical database. Patients who reached a specific endpoint constituted the case group, while those who did not reach any endpoint formed the control group.Results. During the observation period, arrhythmic events were registered in 26 patients (35.1%), with a total of 27.1±13.2 events. Twenty-one patients (28.4%) deceased. In univariate regression analysis, the presence of LGE, the extent of LGE (%), and the number of segments with LGE served as predictors of ICD activation and overall mortality. Two multivariate logistic regression models were constructed. ROC curves were used to determine the quality of the regression model, with an area under the curve of 0.807 for ICD activation and 0.789 for mortality. The highest sensitivity and specificity of the method were observed with a LGE value equal to or greater than 14% for ICD activation (sensitivity 81%, specificity 75%) and 26% for overall mortality (sensitivity 89%, specificity 64%).Conclusion. Substantiated ICD activations (shock/antitachycardia pacing) were observed in 35.1% of cases, and the overall mortality rate was 28.4%. The association between ICD activation and the extent of LGE occurred when LGE was >14%. The association between overall mortality and the extent of LGE occurred when LGE was >26%.

Objective. To determine the predictors of aortic valve dysfunction after Ozaki procedure. Material and methods. A retrospective study included all patients (n=539) who underwent Ozaki procedure between 2015 and 2018. Isolated aortic valve replacement and concomitant procedures with coronary artery bypass grafting and/or mitral valve surgery were performed. All interventions were performed under cardiopulmonary bypass and normothermia through median sternotomy or J-shaped partial sternotomy (4%). Results. Redo surgery for aortic insufficiency was required in 16 (2.9%) patients. Infective endocarditis caused valve dysfunction in 3 (18%) cases. In other cases, recurrent aortic insufficiency was due to prolapse of the right coronary or non-coronary leaflets. Freedom from redo surgeries throughout 5 years was 97±1%. According to Cox regression, two predictors influencing long-term results were identified. For each millimeter of aortic annulus size, the risk of redo surgery increases by 60% with each month after surgery. Leaflet symmetry reduces the risk of redo surgery by 90% with each month. Multilayer perceptron allowed us to identify several significant predictors of redo surgery: leaflet asymmetry, size of sinotubular junction, sinuses of Valsalva and aortic annulus. The main predictor of long-term results is leaflet asymmetry. Other ones are twice as important and have the same effect on postoperative results.

BACKGROUND: An alternative to plastic surgery on the bicuspid aortic valve (BAV) can be replacement of the leaflets with autopericardium using the Ozaki technique. The procedure is characterized by excellent hemodynamic results in the short and long term in patients with tricuspid aortic valve (TAV). However, the question remains about the long-term results of the procedure and the frequency of reoperations in patients with BAV. OBJECTIVE: To analyze the midterm outcomes of the Ozaki procedure in patients with BAV. MATERIALS AND METHODS: Retrospective single-center, non-randomized, parallel-group study was conducted. Since January 2015 to October 1, 2023, the clinic performed 809 Ozaki procedures. The work included 540 patients with studied midterm and long-term outcomes for up to 5 years. Both isolated aortic valve replacement and combined operations with coronary artery bypass grafting and (or) correction of mitral and tricuspid valve defects were performed. RESULTS: Midterm mortality was 5.7% (n=3) in the group with BAV and 7.3% (n=36) in the group with TAV. Reoperation for aortic regurgitation was required in 16 patients (2.9%): 1 patient (1.9%) in BAV group and 15 (3.3%) in TAV group. Freedom from reoperations in patients with BAV after the Ozaki procedure for up to 5 years was 95.4%, in the group with TAV — 92.6%. The peak gradient on the aortic valve in the group with BAV was 16±7.3, in TAV group— 16.4±10.9. 5 years after surgery, the mean gradient on the aortic valve does not exceed 10 mm Hg. CONCLUSION: The Ozaki operation in patients with BAV is an effective and safe procedure in the midterm follow-up period.