Highlights. Conducting minimally invasive aortic valve neocuspidization using autologous pericardium is a difficult task due to pericardial harvesting. Thoracoscopic harvesting of the pericardium provides a pericardial patch of sufficient size under visual control. Thus, thoracoscopic pericardial harvesting can transfer all advantages of minimally invasive cardiac surgery to aortic valve neocuspidization using autologous pericardium.Abstract. Minimally invasive aortic valve (AV) replacement is associated with a decrease in the traumatic nature of the procedure, the length of hospital stay, severity of pain, and provides faster rehabilitation and better cosmetic look compared to the gold standard incision in cardiac surgery –median sternotomy. AV neocuspidization using autologous pericardium is safe, associated with excellent hemodynamic parameters in short- and medium-term follow up. However, this technique requires a large pericardial patch to later form new leaflets, thus complicating the use of minimally invasive approach with this type of intervention. We have addressed this issue by introducing thoracoscopic pericardial harvesting. We report two successful cases of minimally invasive AV neocuspidization using autologous pericardium harvested through a thoracoscopic approach with peripheral cardiopulmonary bypass.

Renal cell carcinoma with inferior vena cava (IVC) thrombosis is a rare disease with a poor prognosis without surgical treatment. The presence of a tumor thrombus in the cavity of the main vessel in most cases is accompanied by massive bleeding during thrombectomy. To reduce the volume of blood loss, it is possible to use cardiopulmonary bypassto reduce the potential risks associated with blood loss and unstable hemodynamics. Sometimes tumor thrombosis can be growth into the vein wall or lead to occlusion IVC, we consider that it’s indication for resection of the IVC. Thrombectomy with laparotomy access can be performed even with type IV tumor thrombosis, if the thrombus is not fixed to the wall of the suprarenal IVC and surgeon have enough view of suprarenal segment.This article presents a variant of surgical treatment of patients with right kidney cancer, type IV IVC thrombosis, occlusion infrarenal IVC and ileofemoral thrombosis. In both cases we made resection IVC – infrarenal segment in first case and suprarenal segment in second case.

The BioBentall procedure has many options, but the optimal approach is still not determined. Alternative options for aortic root surgery include Ross procedure and modification of the Bentall – De Bono procedure using autologous pericardium leaflets. This literature review showed topical issues of surgical technique and the results of various modifications of the BioBentall operation, as well as methods of the aortic root repair using autologous materials. The search strategy included the analysis of international (PubMed, Scopus, Embase) and Russian’s databases (Russian Science Citation Index). The BioBentall procedure demonstrates satisfactory early and long-term results comparable to both the classic Bentall – De Bono procedure and valve-sparing techniques. Composite grafts containing frameless bioprostheses seem to be more promising and durable in comparison with stent-grafts, however, given the minimal amount of publications directly comparing these techniques, further study of this hypothesis is necessary. Total xenopericardial conduits have demonstrated higher rates of degradation and are currently not recommended for use, as demonstrated in most foreign studies. Modified Ross procedure shows excellent hemodynamic outcomes in the long-term follow-up, however, the literature data regarding its applicability in a cohort of patients with proximal aortic aneurysms are limited. The combination of the Bentall – De Bono procedure and autopericardial neocuspidization seems to be a promising and cost-effective method, however, this approach requires a clinical assessment, which results have not been yet published. Received 26 February 2022. Revised 20 April 2022. Accepted 21 April 2022. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: R.N. Komarov, A.M. IsmailbaevDrafting the article: A.N. Dzyundzya, A.O. Danachev, O.O. Ognev, M.V. LencovetsCritical revision of the article: S.V. CherniavskiiFinal approval of the version to be published: R.N. Komarov, A.M. Ismailbaev, S.V. Cherniavskii, A.N. Dzyundzya, A.O. Danachev, O.O. Ognev, M.V. Lencovets

Over the past 30 years, minimally invasive cardiac surgery has progressed from single case reports of operations via thoracotomy and various procedures of partial sternotomy to routine use of mini-accesses as well as fully thoracoscopic and robotic techniques. It is aortic valve surgery that implemented minimally invasive technologies most widely. The objective of this systematic review is to present state-of-the-art approaches to minimally invasive aortic valve surgery including patient selection criteria as well as evolution and state-of-the-art of the main surgical approaches. The search strategy covered international databases, such as PubMed, Scopus, Embase, and Web of Science. We used following queries: ‘minimally invasive surgery of the aortic valve’, ‘alternative surgical approaches in aortic valve surgery’, ‘minimally invasive autologous pericardium neocuspidization’. Selection of patients for minimally invasive aortic interventions should consider both the anatomy of the mediastinum and the aortic root as well as cardiac and other comorbidities. Minimally invasive approaches in aortic valve surgery include thoracotomy, partial sternotomy, and endoscopic techniques. Of particular interest is minimally invasive neocuspidization with autologous pericardium. Partial sternotomies are the most routinely used approaches in aortic valve surgery. Their cumulative outcomes allow to compare their efficacy and safety with those of classic sternotomy access within large meta-analyses. Minimally invasive autopericardial neocuspidization and endoscopic interventions on the aortic valve require further surgical experience and clinical outcomes. Received 17 January 2022. Revised 6 April 2022. Accepted 8 April 2022. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: R.N. Komarov, S.V. Cherniavskii, A.N. DzyundzyaDrafting the article: O.O. Ognev, M.V. LenkovetsCritical revision of the article: A.M. IsmailbaevFinal approval of the version to be published: R.N. Komarov, O.O. Ognev, A.M. Ismailbaev, S.V. Cherniavskii, A.N. Dzyundzya, M.V. Lenkovets

Highlights. The main approaches to the aortic root valve-sparing surgery of are reimplantation and remodeling;The literature review demonstrates either the relative identity of the reimplantation and remodeling clinical outcomes, or the advantage of reimplantation in relation to long-term results.Abstract. In recent decades, valve-sparring methods of aortic root replacement, including reimplantation and remodeling, as well as their modifications, have been developed and put into widespread practice. The effectiveness and durability of these two approaches is the subject of discussions in the modern cardiac surgery community. The global experience in performing remodeling and reimplantation procedures allows  for a comprehensive literature review to compare the results of these approaches.  The presented review is devoted to the comparison of surgical aspects and clinical outcomes of reimplantation and remodeling techniques, the analysis of the feasibility of restoring the physiological architectonics of the aortic root in valve-sparring operations using Valsalva grafts, as well as the assessment of risk factors for residual aortic insufficiency after such interventions. The search strategy included the analysis of international (PubMed, Scopus, Embase) databases for the following keywords: “reimplantation versus remodeling for aortic root valve-sparring procedures”, “David procedure versus Yacoub procedure”, “Valsalva graft for aortic root valve-sparring procedures”, “Valve-sparing aortic root repair with an anatomically shaped sinus prosthesis”. Literature analysis demonstrates either the relative identity of early and long-term results of reimplantation and remodeling procedures, or the advantage of reimplantation in terms of freedom from late mortality and residual aortic insufficiency. Preservation of the physiology of the aortic root by implantation of Valsalva grafts or remodeling provides better hemodynamics and reduces stress on the leaflets, however, these postulates run counter to the data of clinical studies analyzing postoperative outcomes and demonstrating the lack of advantages of Valsalva grafts over linear prostheses in terms of freedom from aortic valve surgery. Residual postoperative regurgitation of a mild degree, a decrease in the effective height below 9 mm and additional interventions on the leaflets are reliable factors of significant aortic insufficiency in the long-term period after valve-sparring operations on the aortic root.