<p><strong>Aim.</strong> The study looks at the results of clinical testing of the first Belarusian aortic stent graft system developed and manufactured by a team of specialists from RSPC "Cardiology", Minsk, Belarus, and Belarusian Technical University.<br /><strong>Methods.</strong> The original system of aortic stent graft includes a delivery system and an aortic stent graft itself. It is used in surgical treatment of complicated and common aneurysms of the thoracic aorta, as well as in cases of concomitant thoracic aneurysms and heart pathology to be treated under cardiopulmonary bypass. Clinical testing of the stent graft was carried out according to the requirements of Ministry of Health of the Republic of Belarus on the basis of three different cardiac hospitals of the country. <br /><strong>Results.</strong> All the three hospitals treated one patient each. The first patient underwent implantation of the stent graft into the descending thoracic aorta, with the thoracic aorta aneurysm isolated and the aortic valve replaced with bioprosthesis. The second patient underwent ascending aorta and aortic valve replacement with a conduit and implantation of aortic stent graft into the descending thoracic aorta. In the third patient the domestic aortic stent graft was implanted into the descending thoracic aorta with isolation of the thoracic aneurysm; aortic valve and ascending aorta were replaced with ‘MedEng' conduit and the aortic arch was also replaced, with the brachiocephalic arteries re-implanted in place. All the patients were followed-up for both early and long-term outcomes for more than 1 year and were examined by using CT angiography in the early postoperative period and after 1 year. Uncomplicated postoperative course was observed in all the patients. There were no complications in the long-term follow-up as well. CT angiography data confirmed good positioning of the stent graft and good isolation of the aneurysm lumen. Preoperative and postoperative СТ data of one patient are presented in the article.<br /><strong>Conclusion.</strong> The Belarusian system of aortic stent graft successfully passed clinical testing and may be certified and used in clinical practice at a later time on the territory of Belarus.</p><p>Received 21 June 2016. Accepted 11 November 2016.</p><p><strong>Funding:</strong> The research was financed by Ministry of Health Care of Republic of Belarus.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Conceptualization and study design: Shket A.P.<br />Material acquisition and analysis: Shket A.P., Nizhnikova O.G. <br />Statistical data processing: Glybovskaya T.V.<br />Article writing: Shket A.P., Krutov V.G.<br />Review &amp; editing: Ostrovskii Y.P.</p>

<p><strong>Aim:</strong> The study was designed to summarize short-term results of aortic valve reimplantation (David procedure) in patients suffering from thoracic aorta aneurysm and aortic valve insufficiency. <br /><strong>Methods:</strong> 132 patients were operated for various types of aorta pathology and aortic valve insufficiency, including 56 patients with acute and subacute aortic dissection and 76 patients with chronic aortic aneurysm with or without dissection. Different types of surgical interventions were offered to patients: ascending aorta replacement with aortic valve reimplantation (88 cases), hemiarch replacement (11 cases), Borst procedure (17 cases), stent-graft implantation (16 cases) and other concomitant interventions including CABG, valve repair or replacement. The efficacy of aortic valve functioning was evaluated by using intraoperative transoesophageal ultrasound imaging in 129 cases and transthoracic ultrasound imaging in immediate postoperative period in 119 cases. <br /><strong>Results:</strong> Satisfactory hemodynamic parameters of aortic valve functioning were recorded in the majority of patients: Grade 0 aortic insufficiency - 10 patients, Grade 1-1+ - 100 patients and Grade 2-2+ was registered in 10 patients. Despite the fact that functional parameters of the aortic valve following the David procedure were positive in most patients, overall hospital mortality ran to 12.1% (16 patients). Hospital mortality depended on the nature of intervention (emergency or elective surgery), as well as on the general complexity related with the extent of the intervention. In the group of patients who underwent emergency and elective interventions, hospital mortality accounted for 19.6% (11 patients) and 6.5% (5 patients) respectively. <br /><strong>Conclusion:</strong> David procedure in patients suffering from ascending aorta aneurysm is an effective treatment option in terms of aortic valve functional recovery in cases of acute or chronic aortic valve insufficiency.</p>

Цель. Изучение результатов операций на открытом сердце у пациентов 70 лет и старше. Материалы и методы. В период с марта 2018 г. по апрель 2021 г. оперированы 222 пациента в возрасте 70 лет и старше. Из них 25 пациентов превысили возраст 80 и более лет. Изучение результатов лечения осуществлялось ретроспективно на основании анализа медицинской документации. Результаты операций в госпитальном периоде у пациентов 70 лет и старше подвергнуты сравнению с пациентами младше 70 лет (n=532). Результаты. Наиболее частыми этиологическими факторами заболеваний сердца у пожилых людей были атеросклероз и дегенеративный кальциноз - 46% и 44% соответственно. Пациентам выполнены следующие виды операций: АКШ - 85, коррекция клапанов сердца - 112, операции на грудной аорте - 25. Euroscore 2 (%), представленный через показатели медианы и межквартильного интервала - ME [МКИ], в указанных группах составил 1,7 [1,3; 2,7], 3,67 [2,1; 7], 4,46 [3,3; 7,85] соответственно и 2,76 [1,7; 5,3] для всей группы. Госпитальная летальность составила 0,4%, умер 1 пациент из подгруппы многоклапанной коррекции. ME [МКИ] Euroscore 2 (%) для пациентов моложе 70 лет составили в аналогичных группах операций 1,03 [0,9; 1,8] (n=301); 2 [1,4; 2,9] (n=172); 1,83 [1,49; 3,19] (n=59); 1,48 [1; 2,42] (n=532). Госпитальной летальности среди пациентов моложе 70 лет не было. Достоверной разницы в показателе госпитальной летальности между молодыми и пожилыми пациентами не обнаружено. Достоверная разница операционного риска выявлена только в группе операций на грудной аорте (p<0,05). Среди наиболее частых осложнений в госпитальном периоде среди пациентов 70 лет и старше были: А-В блокада - 7 (3,15%), ОСН - 6 (2,7%), пневмония - 6 (2,7%). Достоверной разницы с пациентами моложе 70 лет по частоте осложнений не наблюдалось. Заключение. Оперативные вмешательства на открытом сердце у пациентов 70 лет и старше могут выполняться так же успешно, как и у более молодых пациентов. Наиболее важным предиктором неблагоприятного исхода у пожилых пациентов следует считать вмешательство большого объема, когда требуется выполнение нескольких процедур. Также следует учитывать индивидуальные особенности анатомии пожилого пациента. Purpose. To study the results of open-heart surgery in patients aged 70 and older. Materials and methods. 222 consecutive patients aged 70 and older were operated on in our department in the period from March 2018 to April 2021. 25 patients among them have exceeded the age of 80 years. The study of surgical results was carried out retrospectively based on the analysis of medical records. Only in-hospital period was taken into consideration. The results of operations in patients aged 70 and older were compared with the results in younger patients aged less than 70 (n=532). Results. The most common etiological factors of heart disease in the elderly were atherosclerosis and degenerative calcification, 46% and 44%, respectively. The patients were divided into 3 groups according to the type of operations: CABG - 85, valve correction - 112, operations on the thoracic aorta - 25. Median and Interquartile Range (ME [IQR]) of Euroscore 2 (%) in these groups were 1.7 [1.3; 2.7], 3.67 [2.1; 7], 4.46 [3.3; 7.85] respectively and 2.76 [1.7; 5.3] for the entire group. Hospital mortality among patients aged 70 and older was 0.4%. One patient died after multivalve correction. ME [IQR] of Euroscore 2 (%) in patients under 70 years old were 1.03 [0.9; 1.8] (n=301); 2 [1.4; 2.9] (n=172); 1.83 [1.49; 3.19] (n=59); 1.48 [1; 2.42] (n=532) in the corresponding groups of operations. There was no hospital mortality among patients under 70 years. However, no significant difference was found in the hospital mortality rate between younger and older patients. Significant difference in surgical risk was found only between the thoracic aorta groups (p<0.05). Among the most frequent complications in the hospital period among patients aged 70 and older were: AV block - 7 (3.15%), АHF - 6 (2.7%), pneumonia - 6 (2.7%). There was no difference in the rate of complications between older and younger groups. Conclusion. Open heart surgery in patients aged 70 and older can be performed as successfully as in younger patients. The most important predictor of poor outcome in elderly patients is a high- volume intervention, when several procedures are required. It is mandatory to take into account individual features of the anatomy of the elderly patients.