Aim. To evaluate intraoperative doses of administered heparin to achieve the target value of activated clotting time (ACT) in patients receiving preoperative anticoagulant therapy with warfarin or one of the non-vitamin K antagonists oral anticoagulants (NOAC).Materials and methods. The study was of a retrospective. Inclusion criteria: patients with atrial fibrillation (AF) who have indications for catheter ablation in accordance with national clinical guidelines; age 18-75 years; absence of thrombus and the effect of echocontrasting 3-4 stage in the left atrium cavity according to transesophageal echocardiography or computed tomography with contrast enhancement; regular intake of anticoagulants prescribed at least 3 weeks before hospitalization. Exclusion criteria: additional intake of antiplatelet drugs; contraindications to the anticoagulant therapy, including intolerance to the components of drugs; weight more than 100 kg. According to the criteria for inclusion in the study 279 patients were included (211 of them received warfarin and 68 received one of the NOAC). The mean age of the patients was 59.2±8.9 years, the body mass index was 59.2±8.9 kg/m2. Among them, men accounted for 155 (55,6%), diabetes mellitus was diagnosed in 28 (10%), arterial hypertension - in 224 (80.3%), coronary heart disease - in 103 (36.9%). Paroxysmal AF was observed in 185 (66.3%) of patients, persistent AF - in 77 (27.6%), and long-standing persistent AF - in 17 (6.1%). To ensure maximum comparability of the groups pseudorandomization was performed with the formation of 67 pairs of patients.Results. A group of patients taking warfarin for preoperative preparation required lower doses of heparin to achieve the target AСT and amounted to 14.8±5.1 thousand ME compared to 17.9±4.4 thousand ME in the NOAC group (p=0.0001). Despite the lower dose of heparin the ACT level in the warfarin group was significantly higher than in patients taking NOAC (441.5±203.4 sec. and 345.4±148.8 sec. accordingly, p=0.0001).Conclusions. A significantly lower dose of heparin was required in the warfarin group to achieve the target ACT (>300) than in the group of NOAC, while the maximum ACT value was higher. Thus, with the standard starting dose of heparin, the target anticoagulation was achieved faster in patients receiving warfarin.

Objective: To analyze outcomes of 4 transcatheter aortic valve replacements using a polytetrafluoroethylene leaflet valve in patients with a history of the Bentall–De Bono procedure.Methods: We retrospectively analyzed a series of 4 cases. From February 2019 to March 2022 in Federal Center for Cardiovascular Surgery (Penza, Russia), patients with a history of the Bentall–De Bono procedure underwent transaortic aortic valve implantation of the MedLAB-CT balloon-expandable valve under cardiopulmonary bypass and cardioplegia. Valve No. 25 was implanted in 3 patients, and 1 patient received valve No. 23.Results: According to echocardiography, valve hemodynamic performance improved in the postoperative period: mean and peak pressure gradients were 11.5 and 24 mm Hg, respectively; the median value of effective orifice area was 1.9 cm2, while mitral regurgitation in all cases did not exceed grade 1. Median cardiopulmonary bypass and myocardial ischemia times were 59 and 31 minutes, respectively. There was no immediate and remote mortality. No complications were reported in the postoperative period.Conclusion: The proposed replacement of the valved conduit’s compromised part after the Bentall–De Bono procedure can significantly reduce the extent of surgery, cardiopulmonary bypass and myocardial ischemia times, as well as simplify the procedure. Received 1 December 2022. Revised 10 February 2023. Accepted 16 February 2023. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interests: The authors declare no conflict of interest. Contribution of the authorsLiterature review: V.A. Karnakhin, I.D. PotopalskiyDrafting the article: V.V. Bazylev, A.B. Voevodin, I.D. Potopalskiy, V.A. KarnakhinCritical revision of the article: A.A. Kuznetsova, M.P. PatelSurgical treatment: V.V. Bazylev, A.B. VoevodinFinal approval of the version to be published: V.V. Bazylev, A.B. Voevodin, I.D. Potopalskiy, V.A. Karnakhin, M.P. Patel, A.A. Kuznetsova

Purpose of the study To evaluate the mid-term clinical and hemodynamic results of open transaortic implantation of the balloon-expandable prosthesis "MedLab-CT" in patients with high surgical risk. Materials and Methods The study included 41 patients who underwent open implantation of the MedLab-CT aortic valve prosthesis under cardiopulmonary bypass (EC) and cardioplegia (mean age 65.711.7 years), belonging to the cohort of high surgical risk according to the data EuroSCORE II scale, with critical symptomatic aortic stenosis (AS), high functional class according to the New York classification (FC NYHA). All studied patients had clinical indications for transcatheter aortic valve replacement, however, given the concomitant surgical pathology of the heart (critical multivessel coronary artery disease unsuitable for endovascular treatment and/or damage to other valves), as well as the morphological features of the aortic root ("low" location coronary artery ostia relative to the annulus fibrosus of the AC, large calcifications of the coronary cusps according to CT, with a high risk of ostium occlusion), they were denied a minimally invasive procedure. The incidence of adverse clinical events and hemodynamic parameters of the AV prosthesis in the medium-term period were assessed. Results The average follow-up period was 13.1 months, the maximum was 3 years. Mortality - 2.4% (1 patient), there were no cases of stroke. The average gradient in the long-term period on AK "MedLab-CT" is 8.53.1 mm Hg. Paravalvular regurgitation above grade II and transvalvular regurgitation were not detected. Thus, no cases of dysfunction of the aortic prosthesis were noted. Conclusion In the medium term, satisfactory clinical and hemodynamic results of open implantation of the MedLab-CT balloon-expandable prosthesis were obtained in high surgical risk patients.