Oleg Olegovich Ognev

Highlights We present the first case of successful simultaneous surgical treatment of a patient with breast cancer and a left atrial myxoma. The single-stage surgery, which included a right mastectomy and myxoma removal via a right thoracotomy, was justified by the high embolic risk and allowed for the complete elimination of both life-threatening conditions. The results demonstrate the feasibility of this approach with careful multidisciplinary patient selection and highlight the need for routine echocardiographic screening in the preoperative evaluation of cancer patients. Abstract Cardiovascular diseases remain the leading cause of death worldwide. Current data indicate a shift in the patient population, with malignant tumors increasingly common among them. Optimal surgical management for this comorbidity remains unclear, and the feasibility and safety of simultaneous radical treatment have been insufficiently studied. This clinical case demonstrates the feasibility and effectiveness of a simultaneous surgical approach after careful multidisciplinary patient selection. Simultaneous cardiac surgery and oncological intervention allowed for the resolution of both conditions and avoided the risks associated with delayed treatment of left atrial myxoma, particularly embolic complications.

Introduction: One of the main trends in modern cardiac surgery is the reduction of the invasiveness of surgical procedures. Robotic technologies enable a broad range of operations to be performed without sternotomy, thereby accelerating patient recovery andreducing the risk of postoperative complications. Objective: To describe the essential steps and technical considerationsof robot-assisted coronary artery bypass grafting (CABG) that ensure the convenience, safety, and reproducibility of this myocardial revascularization technique. Methods: The technique of robot-assisted CABG described in this article is based on experience with 50 minimally invasive CABG procedures performed using robotic technology in the Cardiac Surgery Department of University Clinical Hospital No. 1. Most patients were men – 47 (94%). The median age was 63 years [59–66], with the largestproportion of patients belonging to the 60–69-year age group (52%). The mean body mass index was 28.6 ± 5.6 kg/m². All procedures were performed electively, and no conversions were required. Results: All surgical procedures were completed successfully. In three cases, the internal thoracic artery (ITA) was injured during mobilization. At the current stage of our program, we have adopted a strategy of limiting the robotic stage to ITA harvesting without performing the distal anastomosis. The modular structure of the learning process for totally endoscopic coronary artery bypass grafting (TECAB) allowseach component of the procedure to be practiced sequentially. As our experience has accumulated, we have gradually expanded the scope of the intervention. Conclusion: Robot-assisted CABG, in which the ITA is harvested robotically and the anastomosis is constructed through a thoracotomy, provides a reliable foundation for mastering and subsequently implementing complete TECAB. It is important to recognize thatoutcomes improve as the surgical team gains relevant experience. Stepwise acquisition of robotic coronary surgery skills makes it possible to perform these procedures during the early stages of the learning curve without exposing patients to undue risk. Received 26 November 2025. Revised 15 April 2026. Accepted 5 May 2026. Informed consentThe patient’s informed consent to use the records for medical purposes is obtained. FundingThe study did not have sponsorship. Conflict of interestThe authors declare no conflict of interest. AcknowledgementsThe authors express their gratitude to Polina A. Kovaleva, an operating room nurse in the Department of MinimallyInvasive and Robotic Cardiovascular Surgery, University Clinical Hospital No. 1, Sechenov University, for her highlevel of professionalism and outstanding performance of her duties during high-technology surgical procedures. Contribution of the authorsConception and study design: R.N. Komarov, I.V. Lutsenko, O.O. Ognev Data collection and analysis: I.V. Lutsenko, O.O. Ognev, L.Z. Faradzheva, S.S. Kazakova Statistical analysis: I.V. Lutsenko, A.A. Romanovskii Drafting the article: all authors Critical revision of the article: R.N. Komarov, O.O. Ognev, A.N. Dzyundzia, N.O. Kurasov Final approval of the version to be published: all authors

Highlights Contemporary trends in global cardiac surgery are characterized by a growing number of operations performed using various minimally invasive techniques. Since 2024, we have been utilizing the da Vinci Si robotic system for cardiac surgical interventions. The results of the performed operations have demonstrated the reproducibility and safety of robot-assisted coronary artery bypass grafting during the initial phase of the learning curve. The phased mastery of robot-assisted coronary artery bypass grafting ensures the safe integration of robotic cardiac surgery into routine clinical practice.   Aim. To demonstrate the feasibility, efficacy, and safety of robotic technology in cardiac surgery based on our own results of robot-assisted coronary artery bypass grafting. Methods. Between June 2024 and June 2025, 30 robot-assisted coronary artery bypass grafting procedures were performed in the Department of Cardiac Surgery at University Clinical Hospital № 1. Intraoperative parameters and patient outcomes within the first 30 postoperative days were evaluated. Results. In-hospital mortality, conversion rate to sternotomy, and incidence of postoperative bleeding were 0%. The mean operative time was 293 ± 63 minutes. 10 (33.3%) procedures were performed using parallel cardiopulmonary bypass, while the remaining 20 (66.7%) were performed off-pump. The mean number of distal anastomoses was 1.7 ± 0.7. Conclusion. The path to realizing the full spectrum of benefits of robot-assisted coronary artery bypass grafting – be it minimal invasiveness or rapid patient recovery – lies in overcoming the inevitable learning curve. In the initial phase of mastering this technique, the true clinical advantages may remain obscured by technical challenges, highlighting the importance of a systematic approach to integrating robotic technology into routine practice.

Цель исследования: проанализировать технические преимущества и эффективность коронарного шунтирования по методике TECAB по сравнению с операциями MIDCAB/MICS-CABG на основе данных литературных источников. Материалы и методы: отбор литературных источников производился при помощи поисковой системы PubMed по запросам «minimally invasive coronary bypass», «MIDCAB», «robot-assisted coronary bypass», «totally endoscopic coronary bypass», «TECAB». Литературный обзор проведён на основании данных, представленных в 33 оригинальных статьях за период с 2004 г. по 2024 г. Результаты: согласно представленным в отобранных публикациях данным TECAB операции по сравнению с методиками MIDCAB и MICS-CABG в большинстве случаев имеют преимущество по следующим показателям: частота конверсии на стернотомный доступ, частота развития раневой инфекции, длительность послеоперационного пребывания в стационаре. В то же время методика TECAB уступает MIDCAB/MICS-CABG по длительности оперативного вмешательства. Выводы: методика TECAB характеризуется более низкой частотой послеоперационных осложнений по сравнению с MIDCAB/MICSCABG операциями. Длительность госпитализации и частота развития раневой инфекции при выполнении TECAB по литературным данным ниже, чем при MIDCAB/MICS-CABG операциях

HighlightsPulmonary embolism is a life–threatening complication caused by surgery on the heart and blood vessels. This case report describes a case of a 60-year-old patient diagnosed with pulmonary artery thrombosis after minimally invasive multiple coronary artery bypass grafting according to MSCT angiography. Thrombectomy of the right pulmonary artery was performed with cardiopulmonary bypass and Calafiore cardioplegia along with thrombectomy of the common femoral, common iliac and large subcutaneous veins on the left, and crossectomy. Constant monitoring, stabilization and improvement of the patient's condition demonstrated the effectiveness of the selected diagnostic method and treatment strategy. AbstractMassive pulmonary embolism (PE) is a serious life-threatening complication in the postoperative period of cardiovascular surgery. This case describes the treatment strategy in a 60-year-old patient after minimally invasive multiple coronary artery bypass grafting. The massive PE that occurred in the postoperative period required simultaneous open surgery – thrombectomy of the right pulmonary artery with cardiopulmonary bypass and thrombectomy of the vena femoralis communis (VFC), vena saphena magna (VSM), and crossectomy. One-stage approach is justified in order to reduce the risk of recurrent PE, pulmonary hypertension and right ventricular failure in the long-term period. This clinical case demonstrates successful one-stage surgical treatment of massive PE using two different vessels after minimally invasive cardiac surgery - multiple coronary artery bypass grafting (MICSCABG).

Background. There was a trend towards valve-sparing techniques in aortic root surgery in recent decades. This approach can significantly improve the quality of life and do not require anticoagulation. There is a question on surgical strategy for patients with native aortic leaflets not suitable for reconstruction. We describe an alternative technique of aortic root replacement with certain advantages in mid-term period compared to standard Bio Bentall procedure. Material and methods. The study included 50 patients who underwent surgery for aortic root and ascending aorta lesions between 2014 and 2022. Mean follow-up was 31.0±17.9 months in the group «Russian conduit» and 39.2±22.7 months in the group 2 «BioBentall» (p=0.159). In the 1st group, patients (n=28) underwent a combined Bentall-De Bono procedure and aortic valve neocuspidization with autologous pericardium. In the 2nd group (n=22), surgery was performed using synthetic composite conduit containing biological aortic root stented prosthesis. Results. In the 1st group, there were no conversions to standard Bentall or BioBentall procedure. Cumulative freedom from MACE (delayed all-cause mortality, acute myocardial infarction, stroke, infective endocarditis) after 12, 24, and 48 months was similar (92.59±5.04% versus 100% (p=0.367), 88.7±6.1% versus 93.3±6.4% (p=0.534) and 88.7±6.1% versus 86.7±8.8% (p=0.864)). Freedom from redo surgeries throughout 48 months was 92.59±5.04% and 92.3±7.4%, respectively (p=0.734). Indexed effective orifice area in mid-term period was significantly larger in the 1st group (1.36±0.23 versus 0.93±0.1 cm2, p<0.01). Conclusion. Aortic root and ascending aortic replacement using Russian conduit technique demonstrates comparable results regarding freedom from redo surgeries compared to standard BioBentall technique and better hemodynamic parameters (mean pressure gradient and effective orifice area) in mid-term period. This approach may be successfully used for aortic root disease if reconstruction of native cusps is not possible.

More than 2 million on-pump cardiac surgeries are performed worldwide each year. These procedures are associated with acute kidney injury. To date, many studies are devoted to nephroprotective measures. A comprehensive approach to pre-, intra- and postoperative management was formed. This review summarizes data from studies investigating (goal-directed fluid therapy (GDFT), target DO2 strategy, KDIGO Bundle of Care), non-pharmacological (filters for leukodepletion, remote ischemic preconditioning) and pharmacological (dopamine and phenoldopam, dexmedetomidine, glucocorticosteroids, antioxidants, atrial natriuretic peptide) methods of kidney protection. Prospective directions in this field are considered (haptoglobin, QPI-1002 molecule, lithium, nitric oxide, acetaminophen and intravenous infusion of amino acids).

Цель исследования: оценить результаты и провести сравнение методики аутоперикардиальной неокуспидизации аортального клапана при выполнении из мини-J стернотомии с торакоскопическим забором перикарда и полной срединной стернотомией. Материалы и методы: выполнен ретроспективный анализ результатов лечения 64 пациентов. 20 больным выполнена операция AVNeo из мини-J стернотомии с торакоскопическим забором перикарда (1 группа), 44 – классическая операция AVNeo (2 группа). Анализ коморбидной и сопутствующей кардиальной патологии не выявил разницы в исследуемых группах. В первой группе операция выполнялась с использованием искусственного кровообращения (ИК) по схеме «бедренная вена-бедренная артерия» у 14 (70%) больных, «бедренная вена-аорта» - 6 (30%) больных. Торакоскопический забор перикарда составлял 29,2±4,2 мин от постановки портов до полностью забранного перикарда и выполнялся на фоне искусственного кровообращения. Размер забранного перикарда не различался между двумя группами. Мини-J стернотомия выполнялась по III или IV межреберью, решение принималось на основании данных МСКТ. Результаты: анализ времени ИК и ишемии миокарда (ИМ) выявил достоверное увеличение длительности в группе мини-J стернотомии: в первой группе 175,5±11,6 мин и 102,5±7,8 мин, во второй – 114,4±40,6 мин и 84,4±19,9 мин (р>0,001 и p>0,001) соответственно. В первой группе отмечалось статистически значимое снижение объема кровопотери: 576±114,7 мл в I группе и 763,6±446,7 мл во II группе (р=0,027). Летальных исходов в первой группе не отмечено, во второй - 2 (4,5%) случая. При сравнении летальности между группами достоверная разница не получена (р=0,846). Длительность ИВЛ в послеоперационном периоде достоверно меньше в первой группе 2,85±2,3 часов, чем во второй – 5,18±3,9 часов (р>0,001). Интенсивность болевого синдрома по шкале ВАШ показала достоверное снижение в I группе (р>0,001). При оценке длительности пребывания в стационаре после операции отмечается достоверное уменьшение количества койко-дней в I группе (7,1±3 суток) против (13,9±5,5 суток) II группы (р>0,001). По результатам оценки эффективности операции не получено достоверной разницы между двумя группами. Выводы: торакоскопический забор перикарда позволяет применить преимущества миниинвазивного доступа к операции AVNeo. Методика миниинвазивной аутоперикардиальной неокуспидизации аортального клапана является безопасной и эффективной методикой.

Introduction. Some patients with aortic valve (AV) disease have small aortic annulus. This anatomical feature can lead to prosthesis-patient mismatch after AV replacement. Objective. To improve postoperative outcomes in patients with AV disease and small aortic annulus. Material and methods. We retrospectively analyzed 77 patients with small aortic annulus divided into 2 groups: group 1 (n=49) — autopericardial neocuspidization (AVNeo) of the aortic valve, group 2 (n=28) — aortic root enlargement and standard aortic valve replacement using mechanical or biological prostheses. Analysis of comorbidities found no differences between groups. Results. In-hospital mortality was similar (2.1% (n=1) and 7.1% (n=2), respectively, p=0.321). Survival rate was 96% and 74%, respectively (p=0.04), cumulative freedom from MACE — 95% and 53% (p=0.03), freedom from redo surgery — 95% and 80%, respectively (p=0.381). Duration of cardiopulmonary bypass and myocardial ischemia was similar: 113.84±36.03 vs 116.61±25.01 min, (p=0.71); 86.74±23.19 vs 91.04±22.71 min, respectively (p=0.404). The incidence of permanent pacemaker implantations was significantly higher in group 2: 6 (21.4%) vs 2 (4.1%) cases (p=0.039). In early postoperative period, transvalvular peak blood flow velocity (p<0.01) and pressure gradient (p<0.01) significantly decreased in the 1st group compared to the 2nd group. Mean transvalvular pressure gradient in mid-term period was significantly lower in the AVNeo group (p=0.001). Conclusion. AVNeo in patients with small annulus demonstrates the advantages over aortic root enlargement regarding mid-term results due to better hemodynamic parameters after surgery.