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OBJECTIVES Pulmonary allografts (AG) are the gold standard for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure. However, there is limited availability of AG in some countries, and the use of alternative grafts for RVOT reconstruction remains controversial. This study aimed to compare the rates of freedom from RVOT graft dysfunction for AG and diepoxide-treated pericardial xenografts (DPXG). METHODS Between 1998 and 2015, 793 adult patients underwent the Ross procedure in our centre. Using propensity score matching, the clinical outcomes and echocardiographic results of AG and DPXG were compared. RESULTS Propensity score matching resulted in 2 groups (AG and DPXG) of 122 patients each. No difference was found in early mortality (2.5%) in both groups. The freedom from RVOT graft dysfunction curves were comparable between the AG and DPXG groups (P = 0.186) and the 8-year rates of freedom from graft dysfunction were 91.8% and 82.2%, respectively. The survival rates at 8 years were 90.5% and 90.1%, and the rates of freedom from RVOT reintervention at 8 years were 100% and 96.8% for the AG and DPXG groups, respectively. At discharge and follow-up, transprosthetic gradients were significantly higher in the DPXG group. The rate of the RVOT gradient progression was also higher in the DPXG group than in the AG group (1.80 ± 0.06 vs 1.39 ± 0.04 mmHg/year, P < 0.001). CONCLUSIONS There was no difference in freedom from RVOT graft dysfunction by 8 years when using AG and DPXG in adult Ross patients, nor in survival and freedom from RVOT conduit reintervention. Long-term results need further evaluation.

The persistence or appearance of atrial fibrillation (AF) after mitral valve (MV) surgery significantly decreases the quality and effectiveness of treatment, and also increases the risk of thromboembolic complications and stroke. Predictors of AF appearance after surgery are the initial size of the left atrium, stenotic lesion and rheumatic disease of mitral valve. The aim of our study was to evaluate freedom from AF in patients with left atrium enlargement and MV lesion in short-and long-term follow up, and to justify the feasibility of preventive ablation. Material and methods. A retrospective analysis of 100 patients operated in our clinic in 2010-2014 was conducted. All patients included in the study had MV lesion and left atrial enlargement more than 6.0 cm. They were divided into two groups depending on the presence of AF in the anamnesis. The 1st group included patients with sinus rhythm at the time of admission and the absence of paroxysms of AF in the anamnesis, the 2nd group included patients with paroxysmal AF. The mean age was 51.50 ± 3.43 (31-65) years. All patients were operated for MV lesion. In the 2nd group the concomitant ablation of left atrium was performed. Heart rhythm was evaluated after 12 months after surgery. Results. Patients who underwent AF ablation had greater freedom from AF in the long-term (12 months) follow up compared with patients without AF history and left atrial enlargement. Conclusion. Patients with mitral valve lesion and left atrial enlargement with no AF history are classified as extremely high-risk of AF in the postoperative period.

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We present a case report of successful transcatheter implantation of a Russian-made cardiac valve prosthesis in a patient with dysfunction of biological mitral valve prosthesis (valve-in-valve). A patient aged 78 years with a high surgical risk and severe heart failure due to mitral valve bioprosthesis dysfunction is described. Fluoroscopyand transesophageal echocardiography-guided transapical implantation of a MedLab-CT prosthesis (23 mm) was made. When a heart rate of 180 beats per minute, a stent prosthesis was implanted. Transcatheter implant valve functioned properly after surgery. The patient was discharged in satisfactory condition.