Objectives: Current national registries are lacking detailed pathology-driven analysis and long-term patients outcomes. The Heart Valve Society (HVS) aortic valve (AV) repair research network started the Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) to evaluate long-term patient outcomes of AV repair and replacement. The purpose of the current report is to describe the AVIATOR initiative and report in a descriptive manner the patients included. Methods:The AV repair research network includes surgeons, cardiologists, and scientists and established an online database compliant with the guidelines for reporting valve-related events. Prospective inclusion started from January 2013. Adult patients (18 years or older) who were operated on between 1995 and 2017 with complete procedural specification of the type of repair/replacement were selected for descriptive analysis.Results: Currently 58 centers from 17 countries include 4896 patients with 89% AV repair (n ¼ 4379) versus 11% AV replacement (n ¼ 517). AV repair was either isolated (28%), or associated with tubular/partial root replacement (22%) or valve-sparing root replacement (49%) with an in-hospital mortality of 0.5%, 1.7%, and 1.2%, respectively. AV replacement was either isolated (24%), associated with tubular/partial root replacement (17%) or root replacement (59%) with an in-hospital mortality of 1%, 2.6%, and 2.0%, respectively. Conclusions:The multicenter surgical AVIATOR registry, by applying uniform definitions, should provide a solid evidence base to evaluate the place of repair versus replacement on the basis of long-term patient outcomes. Obtaining data completeness and adequate representation of all surgery types remain challenging. Toward the near future AVIATOR-medical will start to study natural history, as will AVIATOR-kids, with a focus on pediatric disease.

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Highlights. Maze V significantly reduces the recurrence of AF compared to bipolar RFA for PVI in the short and mid-term period.Aim. To assess the effectiveness and safety of pulmonary vein isolation (PVI) in comparison with Maze V for treating paroxysmal atrial fibrillation (AF) concomitant to coronary artery bypass grafting (CABG).Methods. Medical records of 139 patients with coronary artery disease and concomitant paroxysmal AF were retrospectively analyzed. All patients were divided into two groups: Group 1 patients (n = 71) underwent CABG + bipolar radiofrequency ablation for PVI, and Group 2 patients (n = 68) underwent Maze V + CABG. Propensity score-matched (PSM) analysis with a 1:1 nearest-neighbor matching was done. 30 patients were selected from each group. The exclusion criteria were as follows: emergent CABG, concomitant valvular heart disease, non-paroxysmal AF, decompensation of chronic diseases, and cancer. On-pump CABG was performed at normothermia with warm blood hyperkalemia cardioplegia. RFA for PVI and Maze V were performed before CABG under parallel perfusion without aortic cross-clamping. The primary and secondary endpoints included recurrent AF/atrial flutter, sinus rhythm at discharge and in the long-term period, permanent pacemaker implantation, major cardiovascular and cerebrovascular events.Results. After the PSM analysis, the CABG+Maze V group and CABG+RFA for PVI differed significantly in the duration of surgery (330 [310; 375] vs. 255 [225; 270] min, p = 0.0001), cardiopulmonary bypass time (131 [113; 144] min vs. 89 [74; 98] min, p = 0.0001), duration of AF treatment (53 [44; 59] min vs. 10 [9; 12] min, p = 0.0001). The structure and rate of complications in both groups were comparable. There were no in-patient deaths. Recurrent AF/atrial flutter significantly reduced in the CABG+Maze V group compared to the CABG+RFA for PVI group (13.3% vs. 33.3%, respectively; p = 0.044). Sinus rhythm was restored in all cases. The rate of transient sinus node dysfunction (no more than 5 days) was 6.7% in the Group 1 and 16.6% in the Group 2. The difference did not reach statistical significance (p = 0.128). The 12-months cumulative freedom from AF/atrial flutter without antiarrhythmic drug therapy was significantly higher in the CABG+Maze V group compared to the CABG+RFA for PVI group (97% vs. 83.5%, respectively; p = 0.020). The freedom from MACE in both groups was 96.7%.Conclusion. Maze V for treating concomitant paroxysmal AF prolonged the duration of cardiopulmonary bypass and the surgery itself, but did not affect the postoperative period, indicating its safety and effectiveness. Maze V procedure concomitant to CABG significantly reduced the recurrence of AF compared to RFA for PVI both in the short- and mid-term period. Thus, it is reasonable to perform Maze V+CABG in patients with paroxysmal AF and a high risk of disease progression.

Цель -оценить влияние исходной гемодинамической формы порока митрального клапана (МК) на эффективность радиочастотной абляции фибрилляции предсердий (ФП). Материал и методы. С января 2011 г. по декабрь 2017 г. в ФЦССХ (г. Челябинск) 180 пациентам при коррекции порока МК одномоментно была выполнена абляция ФП. Средний возраст пациентов составил 57,6±8,96 (29-79) лет, 66 мужчин и 114 женщин. До операции длительно персистирующая форма ФП была у 113 (62,8%) больных, пароксизмальная и персистирующая -у 34 (18,9%) и 33 (18,3%) соответственно. У 44 (24,4%) больных до операции был синусовый ритм. Исходя из клинико-морфологической формы поражения МК все пациенты были разделены на 2 группы: 1-я группа -93 (51,7%) пациента с преобладающим стенотическим поражением МК ревматической этиологии; 2-я группа -87 (48,3%) пациентов с преобладающей органической недостаточностью МК. Результаты. Госпитальная летальность -1,7% (3 пациента). Протезирование МК выполнено 148 (83,6%) пациентам, пластика МК -29 (16,4%). Процедура maze IV выполнена 129 (72,9%) пациентам, левопредсердный лабиринт -45 (27,1%) больным, изоляция легочных вен -3 (1,7%) пациентам. Имплантация постоянного электрокардиостимулятора (ЭКС) в послеоперационном периоде потребовалась 16 пациентам (9%). На момент выписки из стационара ФП отсутствовала у 145 пациентов, т.е. эффективность составила 81,9%. Данный показатель зависел от исходной формы ФП: наибольшая эффективность была при пароксизмальной форме (100%), чуть меньше -при персистирующей (81,3%) и наименьшаяу пациентов с длительно персистирующей формой (76,6%). В группе с исходным стенозом МК после операции ФП отсутствовала у 72 (80%) пациентов. В группе больных с недостаточностью МК ФП на этапе выписки отсутствовала у 73 (83,9%) больных (p=0,56). Заключение. Радиочастотная фрагментация предсердий -эффективный метод устранения ФП у пациентов, нуждающихся в хирургической коррекции патологии МК. Эффективность процедуры определяется исходной формой ФП и не зависит от анатомического варианта поражения МК. Финансирование. Исследование не имело спонсорской поддержки. Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Aims.To assess the outcomes of atrial fibrillation (AF) treatment by radiofrequency ablation for patients with mitral valve replacement, the analysis of short-term results of 128 patients was performed.Methods.Mean age of the patients was 56,7±9,6 (29 - 79) years, males - 39, females - 89. Most of the patients had longstanding persistent AF - 81 (63,3%), 28 (21,9%) had persistent AF and 19 (14,8%) - paroxysmal AF. The indications for surgery were: rheumatic mitral valve disease in 105 patients (82%), degerative mitral valve disease - in 21 (16,4%) and with treated infectious endocarditis - in 2 (1,6%). Maze IV procedure was carried out in all cases.Results.Hospital mortality was 0,8% (1 patient). Ten patients (7,9%) required pacemaker implantation. The indications were sinus node dysfunction in 7 patients, bradycardia AF - in 2 patients, AV node dysfunction - in 1. At the discharge 88 patients (69,3%) had a sinus rhythm, 10 (7,9%) - atrial rhythm, pacemaker rhythm with sinus node dysfunction patients - in 4 (3,1%) and AF - in 25 (19,7%). Thus, the rate of freedom from atrial fibrillation was 80,3% (102 patients). The effectiveness of ablation for paroxysmal AF was 100%, persistent - 74,1%, longstanding persistent - 77,8% (p=0,006). To reveal other predictors of freedom from AF at the discharge each ECHO parameter was included in the simple logistic regression analysis. Statistically significant p-value was obtained for the preoperative right atrial size (p=0,005), and close to it for the left atrial size, especially for the index left atrial volume/body surface area (p=0,052).Conclusion.Thus, the radiofrequency ablation is an effective method for treatment of AF in patients undergoing mitral valve replacement. The rate of freedom from AF at the discharge is 80,3%. The predictors of freedom from AF at the discharge are preoperative form of AF and preoperative size of atria.