Background: Thoracoscopic ablation is an effective treatment of patients with atrial fibrillation. Nowadays, 2 types of ablative devices are available in clinical practice allowing one to perform the thoracoscopic procedure Medtronic and AtriCure. However, the contemporary clinical literature does not have enough data that would compare these two approaches. Aims: to perform a comparative analysis of the short-term results of two minimally invasive strategies in thoracoscopic ablation for atrial fibrillation. Methods: 232 patients underwent thoracoscopic ablation for atrial fibrillation in two clinical centers for the period from 2016 to August 2021. The patients were divided into 2 groups. The first group was represented by those patients to whom a Medtronic device was applied (n=140), the second group was treated with an AtriCure device (n=92). The patients were comparable in their age, gender, initial severity of the condition. The follow-up consisted of laboratory tests, chest Х-ray, electrocardiography, 24-hour Holter monitor, echocardiography. The structure and prevalence of postoperative and intraoperative complications, specifics of the postoperative period were compared between the two groups. Results: According to the structure and prevalence of intraoperative complications the 2 groups are comparable to each other: 4.3% and 1.1% for the 1st group and 2nd group, respectively (p 0.05). The postoperative complications had developed in 6 (4.3%) and 5 (5.4%) patients in groups 1 and 2, respectively (p 0.05). At the time of discharge from hospital, a sinus rhythm was registered in 93.6% of patients (1st group), and 85.9% (2nd group) (p 0.05). Conclusions: Both strategies have demonstrated comparable short-term results in patients with lone atrial fibrillation. A further research is needed to evaluate the effectiveness of this strategy in a long-term period.

Aim. Assessment of lung volume status and oxygen transport system in patients with coronary artery disease (CAD) with different clinical types of comorbidity before and after coronary artery bypass grafting (CABG).Material and methods. The observational controlled study included 66 patients with CAD with a median age of 67 years (95% confidence interval [59; 74]), admitted to the Far Eastern Federal University Hospital for elective CABG. Depending on the prevalence of clinical manifestations of comorbidities, CAD patients were ranked into 3 groups of comorbidity: cardiovascular, respiratory and metabolic. The first of them was represented by a combination of CAD and peripheral artery disease, the second — CAD and chronic obstructive pulmonary disease (COPD),the third — CAD and metabolic syndrome. All patients underwent isolated CABG under cardiopulmonary bypass (CPB). Volume and hemodynamic monitoring was carried out by transpulmonary thermodilution using the Pulsion PiCCO Plus (Germany) technology and the following indices: cardiac function index (CFI), extravascular lung water (EVLW), pulmonary vascular permeability index (PVPI). Pulmonary blood volume and oxygen transport indices were determined: oxygen delivery (DO2I) and consumption (VO2I) indices, oxygen-utilization coefficient, and pulmonary shunt fraction (Qs/Qt). The study was carried out in three stages: before the onset of CABG, after its completion and one day after CABG.Results. The analysis of volume and hemodynamic monitoring data demonstrated the heterogeneity of their changes during CABG and one day after with different comorbidity profile. A more noticeable inhibition of the circulatory component of oxygen transport was revealed in patients with COPD, which was illustrated by the lowest CFI (3,2-3,4 ml/min) in relation to other groups of patients. The imbalance of cardio-respiratory interactions in this cohort after withdrawal from cardiopulmonary bypass was manifested by lower DO2I and VO2I and a maximum increase in Qs/Qt, exceeding 1,6 times the comparison groups. The respiratory and metabolic comorbidity of CAD was characterized by a significantly larger volume of extravascular lung water due to the higher permeability of the pulmonary vessels, which was documented by EVLW values, which exceeded the upper reference limit by 1,8-2 times and an increase in PVPI. In patients with cardiovascular comorbidity, lung volume violation was less noticeable.Conclusion. A comprehensive analysis of lung volume status and oxygen transport makes it possible to more accurately assess the functional status of patients with CAD, to increase the effectiveness of risk stratification and to prevent possible complications during CABG and in the early postoperative period.

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Цель исследования -сравнить эффективность защиты миокарда при использовании кардиоплегии по del Nido и кардиоплегии Buckberg у пациентов с ишемической болезнью сердца. Материал и методы. Проспективное одноцентровое нерандомизированное исследование. В исследование включены 150 пациентов (del Nido -75 человек, Buckberg -75 человек). В каждой группе 57 пациентам выполнено коронарное шунтирование (КШ), 18 -сочетанное КШ с протезированием/пластикой одного из клапанов сердца. Результаты. Среднее общее число шунтов (2,7±0,09 в группе del Nido и 2,7±0,09 в группе Buckberg, р=0,95) и среднее число артериальных шунтов (1,05±0,06 в группе del Nido и 1,12±0,08 в группе Buckberg, р=0,59) значимо не различались. В группе del Nido время пережатия аорты (63,8±26 против 74,6±37 мин, p=0,02), общее время искусственного кровообращения (98,7±34 против 115,3±46 мин, p=0,008), время искусственного кровообращения после пережатия аорты (30,4±11 против 34,4±10 мин, p=0,007) и общее время операции (221,8±45 против 251,7±65 мин, p=0,008) были статистически достоверно ниже, чем в группе Buckberg. Показатели спонтанного восстановления нормального ритма (90,7 против 84%), развития фибрилляции желудочков (12 против 14,7%) и интраоперационной дефибрилляции (9,3 против 14,7%) достоверно не различались (p>0,05). В послеоперационном периоде продолжительность инотропной/вазопрессорной поддержки, пребывания в отделении реанимации и интенсивной терапии и общего срока госпитализации достоверно не различались (p>0,05). Зависимость от искусственного водителя ритма в послеоперационном периоде (2,7 против 13,5%, p=0,01) и пароксизмы фибрилляции предсердий чаще наблюдались в группе Buckberg (14,7 против 26,7%, p=0,07). Уровень КФК-MB через 12-16 ч после операции был ниже в группе del Nido (26,3±17 против 45,1± 60 ед/л, p=0,0002). Заключение. Кардиоплегия по del Nido безопасна и эффективна у пациентов с ишемической болезнью сердца. По сравнению с холодовой кровяной кардиоплегией по Buckberg использование кардиоплегии по del Nido позволяет уменьшить время искусственного кровообращения, время пережатия аорты и общее время операции. В группе del Nido значения КФК-MB были достоверно ниже в раннем послеоперационном периоде, что положительно характеризует протективные свойства данного метода. В группе del Nido отмечена меньшая частота зависимости от искусственного водителя ритма в раннем послеоперационном периоде.Финансирование. Исследование не имело спонсорской поддержки.Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.