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Aortic valve replacement is the second most common cardiac surgery procedure. Prosthesis-patient size mismatch can increase the incidence of adverse events postoperatively, it also leads to increased left ventricular load. Some studies describe the higher mortality in this group of patients. It is also proved that patients with severe aortic stenosis usually have impaired platelet aggregation and low von Willebrand factor causing bleeding disorders. We report a case of successful aortic valve replacement and aortic root enlargement (Nicks technique) combined with coronary artery bypass grafting (left internal mammary artery to the left anterior descending artery) and left atrial appendage resection in 73-y.o. obese female patient. Postoperative course was uneventful.

Background: Patients with heart failure with preserved ejection fraction account for more than half of all hospitalizations because of heart failure. On the other hand, atrial fibrillation and heart failure are quite often diagnosed together and one disease influences the development of the other. Timely and accurate diagnosis of heart failure with preserved ejection fraction is the basis for effective treatment of this category of patients. In 2019, the HFA-PEFF algorithm of diagnosis heart failure with preserved ejection fraction (including patients with atrial fibrillation) was proposed. However, the algorithm implies cardiac catheterization in patients at intermediate risk, which involves certain difficulties and cannot be used in routine practice. As an alternative to cardiac catheterization in the diagnosis of heart failure with preserved ejection fraction, we proposed a noninvasive diagnostic method cardiopulmonary test. However, the value of cardiopulmonary test technique has not been conclusively studied, especially in patients with a combination of chronic heart failure and atrial fibrillation. Aim: The aim of the study was to evaluate the role of the cardiopulmonary test in the diagnosis of heart failure with preserved ejection fraction in patients with atrial fibrillation. Methods: 138 patients with atrial fibrillation were included in our study. Using HFA-PEFF algorithm (algorithm for diagnosis of heart failure with preserved left ventricular ejection fraction) all patients were initially divided into 3 groups: low probability of heart failure 23 patients, intermediate probability 96 and high probability 19 patients. The stress-test allowed to precisely assess of patients at intermediate risk and finally form the groups: Group 1 without heart failure, 85 patients (61.6%); Group 2 patients with heart failure and preserved ejection fraction, 53 patients (38.4%). The next diagnostic stage was cardiopulmonary test. Results: During cardiopulmonary test, the anaerobic exercise threshold was 6.8 and 4.85 METs for the first and second groups, respectively (p 0.001), reflecting lower exercise tolerance in the second group of patients. Analysis of variance (ANOVA) demonstrated a statistically significant increase in pro-BNP levels with a decrease in peak VO2 (p 0.001). Also, analysis of variance demonstrated a significant statistical difference with respect to systolic pulmonary artery pressure in the subgroups with severely, moderately reduced oxygen consumption and in the group with normal peak VO2 (p=0.01). ROC analysis determined a peak VO2 of 20 ml/kg/min, above which the HFA-PEFF algorithm was unlikely to detect heart failure (AUC 0.73; confidence interval 0.650.82; p=0.043; sensitivity 85%; specificity 51%). Conclusion: The cardiopulmonary test is a reliable instrumental non-invasive method in the diagnosis of heart failure with preserved ejection fraction.

Background: Atrial fibrillation (AF) and coexistent typical atrial flutter (AFL) interventional treatment strategy remains unresolved in cardiology and cardiovascular surgery. Results of this approach remain suboptimal. There are several approaches to the interventional treatment of patients with coexistent AF and AFL: simultaneous pulmonary vein isolation (PVI) and cavotricuspid isthmus (CTI) radiofrequency catheter ablation (RFCA), PVI or CTI RFCA only and two-stage approach. To our knowledge, cumulative efficacy of two-stage approach has not been previously reported. The aim. This study aimed to evaluate the efficacy of two-stage approach for interventional treatment of coexistent AF and AFL for sinus rhythm maintenance in long-term. Methods: Patients (pts) (n=34) with AF and AFL aged 4182 years (11 women) were divided into two groups (1:1): One-stage Approach (group 1; n=17): PVI+СTI RFСA and Two-stage approach (group 2; n=17): first stage CTI RFCA (group 2.1); second stage PVI in case of AF recurrence after RFCA (group 2.2). Primary endpoint (PEP) was defined as any recurrent atrial tachyarrhythmia at the end of follow-up; group 2 events have been considered after PVI. Secondary endpoint (SEP) recurrent any atrial tachyarrhythmia in groups 1 and 2 after CTI RFCA in group 2. PEP and SEP were evaluated at the end of the blind period (3 months after procedure). Results: Registered recurrent atrial tachyarrhythmia in pts who reached PEP or SEP was AF. AFL has not been detected in any cases. PEP was noted in 8 (47.06%) pts in group 1 and 1 (5.88%) pts in group 2. Further, SEP was observed in 3 pts (17.65%) in group 1 and in 4 (23.53%) pts in group 2 (p=0.671). The probability of long-term maintenance of sinus rhythm was significantly higher in Two-stage approach than in One-stage approach (94.12% and 52.94%, respectively, p=0.001). Significant differences in procedure length and fluoroscopy time have been found. Those were longer in group 1 compared to group 2.1 (p 0.001) and in group 2.2 compared to group 2.1 (procedure duration p 0.001; fluoroscopy time p=0.013). No differences were noted in length of procedure and fluoroscopy time between groups 1 and 2.2 (p=0.374 and p=0.028, respectively). Conclusion: The two-stage approach for interventional treatment of coexistent AF and AFL results in better long-term arrhythmia-free survival than one-stage approach (94.12% and 52.94%, respectively, p=0.001). CTI RFCA alone in pts with coexistent AF and AFL cause 23.53% AF recurrence rate and associated with shorter procedure duration and fluoroscopy time compared to simultaneous PVI and CTI RFCA (p 0.001).

The specifics of the anticoagulant therapy after radiofrequency ablation of the cavotricuspid isthmus have not been sufficiently studied, therefore, the recommendations for prescribing the anticoagulant therapy usually do not distinguish between atrial flutter and atrial fibrillation. In contrast to the case of atrial fibrillation, the effectiveness of the interventional treatment for typical atrial flutter reaches 90%. This procedure may save the patient from a long-term anticoagulant therapy in the absence of recurrence of typical atrial flutter. The decision to stop the anticoagulant therapy after successful radiofrequency ablation of the cavotricuspid isthmus should take into account the potential induction of atrial fibrillation in patients undergoing the interventional treatment. In addition to the CHA2DS2-VASc scale, which characterizes the patient's comorbidity, it is important to take into account the echocardiographic morphofunctional criteria to assess the risk of atrial fibrillation. Currently, this protocol is not regulated in the clinical guidelines. The analysis of the literature data and the authors' own experience allow us to conclude that the optimal time for stopping the anticoagulant therapy is a relapse-free period of 34 months after the radiofrequency ablation of the cavotricuspid isthmus, since it is at this time that the effectiveness of the interventional treatment can be objectified.

Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with an increased risk of death, progression of heart failure, and the development of cardiogenic thromboemboli. Despite the significant success in the management of AF in the paroxysmal form, the results of the treatment for patients with persistent forms of AF remain unsatisfactory. Though the surgical approach provides higher rates of efficiency regarding the restoration of a sinus rhythm, transmural lesions are not always attainable, as a result, the rate of AF recurrence in the long-term period remains fairly high. It is also impossible to create ablative patterns to the mitral and tricuspid valves during thoracoscopic epicardial ablation, which can cause the development of recurrent AF, perimitral and typical atrial flutter. Therefore, the development of hybrid approaches combining the advantages of catheter and thoracoscopic techniques is an urgent task of contemporary surgical and interventional arrhythmology. Aims: to estimate the immediate results of a hybrid approach in the management of patients with persistent AF. Methods: We report the first experience of a hybrid treatment of patients with persistent AF. 6 patients aged 53-64 years (1 female, 5 males) were included in the study. At the first stage, thoracoscopic epicardial bipolar ablation was performed (modified GALAXY protocol); the second stage (in 3 to 6 months after the thoracoscopic stage) included an intracardiac electrophysiological study with three-dimensional endocardial mapping followed by endocardial ablation. Results: The thoracoscopic stage of the hybrid treatment included ablation according to the box lesion scheme using a bipolar irrigation equipment. No lethal outcomes and severe, life-threatening complications were registered. The duration of the inpatient period was 510 hospital-days. The 2nd stage of the hybrid treatment was limited to intracardiac electrophysiological examination only in 2 patients. In 4 patients, epicardial radiofrequency ablation was complemented by endocardial radiofrequency exposure. In 3 of the 4 patients who underwent endocardial radiofrequency ablation, catheter ablation of the mitral and cavotricuspid isthmus was required because of the induction of perimitral and typical flutter, respectively. After the 2nd stage of the hybrid treatment, at the time of discharge all the patients maintained a stable sinus rhythm. There were no severe complications or lethal outcomes. Conclusion: a hybrid approach in the AF management is a safe and effective method of treatment, which combines the advantages of minimally invasive surgery and endocardial intervention in patients with persistent AF. The technique is safe and has acceptable short-term results.

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.

New variants of SARS-CoV-2 such as Omicron BA.2, BA.4/5, BA.2.12.1 and BA 2.75 are characterized by higher infectivity and the ability to escape virus-neutralizing antibodies against previous coronavirus variants. The S-trimer of BA.2 and its phylogenetic derivatives are characterized by a predominant Up-conformation, which facilitates the interaction with ACE2 on target cells and promotes the resistance to neutralizing antibodies. The immunity acquired from the infection with earlier strains is non-sterile for both early and later strains; the booster systemic immunization does not significantly affect the effectiveness of antiviral immunity, and its feasibility is currently being questioned. Studies of the mucosal immune response have shown that intranasal immunization with adenovirus vaccines provides more pronounced protective immunity than systemic reimmunization does. A promising approach is the creation of multivalent inhaled next generation vaccines containing immunoadjuvants that activate B- and T-cell mucosal immunity. Currently, a large number of intranasal vaccines are undergoing phase I/II trials, while the preclinical and preliminary clinical results indicate that this method of vaccination provides a better mucosal immune response at the entry site of the virus than systemic immunization does. This strategy may provide a long-term immune protection against the currently existing and yet unknown new strains of SARS-CoV-2.

Background: Adequate diagnosis of recurrent atrial fibrillation after the surgical treatment in patients with paroxysmal forms of the disease appears to be a difficult task. Aims: The manuscript is devoted to a comparative analysis of the results of subjective and objective assessment of atrial fibrillation recurrence after cryoballoon ablation of the pulmonary veins. Material and methods: 301 patients were included in the study. All of them consequentially underwent cryoballoon ablation of the pulmonary veins in the period of October, 2016 November, 2019. The inclusion criteria were as follows: symptomatic atrial fibrillation; confirmation of atrial fibrillation by instrumental diagnostic methods. The exclusion criteria were the following: a combination of atrial fibrillation and atrial flutter at the time of surgery; history of open-heart procedures and catheter procedures to cease atrial fibrillation; the presence of concomitant cardiac and "arrhythmogenic" pathology. Results: In the period of May 01-30, 2020, 100% (n=301) of the patients included in the study were assessed by the method of targeted survey. The median duration of the postoperative period to the time of a patient's survey was 21 (3; 43) months. The interviews have shown that 136 (45%) patients noted a return of complaints associated with atrial fibrillation recurrence in the postoperative period. There was a clear tendency towards a decrease in the total number of patients with complaints of the clinical recurrence of the disease, depending on the time elapsed since the surgical procedure. The longer the period from the moment of surgery, the lower the number of patients with recurrence. Of 136 patients with recurrent complaints associated with atrial fibrillation, 97 (71%) were able to conduct the daily electrocardiogram monitoring. Of these, the instrumental recurrence of atrial fibrillation was confirmed in 59 patients, which amounted to 20% of all the patients included in the study (n=301). Conclusion: To establish the true number of atrial fibrillation recurrence after cryoballoon ablation of the pulmonary veins, a targeted survey of patients is desirable for up to 12 months after the surgery. The patients with complaints which suggest atrial fibrillation recurrence, even if these complaints do not correspond to the preoperative ones, should be invited for the instrumental diagnostics of arrhythmia.

The article presents two clinical cases of delayed restoration of the sinus rhythm in patients with long-term persistent atrial fibrillation after the procedure of thoracoscopic radiofrequency fragmentation of the left atrium. The necessity of continuing attempts to restore the sinus rhythm up to the end of the "blind period" (90 days) is discussed.

Editorial board of the journal informs authors about the retraction of the article Short-Term Results of Two Strategies in Thoracoscopic Ablation for Lone Atrial Fibrillation published in Journal of Clinical Practice 13(3) 2022 by A.S. Zotov, O.Yu. Pidanov, I.S. Osmanov, A.V. Troitsky, A.A. Silaev, E.R. Sakharov, V.N. Sukhotin, O.O. Shelest, R.I. Khabazov, D.A. Timashkov. The reason for the retraction is the publication ethics violation in terms of authorship criteria. Not all authors whose names appear on the article made substantial contributions to the study drafted/revised the manuscript and approved the version to be published. Retraction made on January 09, 2023 with approve from the Editor-in-Chief.