Quality of life after myocardial re-vascularisation in patients with acute coronary syndrome during the coronavirus disease 2019 pandemic: a prospective observational study

<p><strong>Aim.</strong> To study the quality of life and how it is influenced by different factors in the long term after myocardial re-vascularisation in patients with coronary artery disease who had acute coronary syndrome during the coronavirus disease 2019 (COVID-19) pandemic.</p><p><strong>Methods.</strong> We examined 658 patients with coronary artery disease and acute coronary syndrome (mean age 66.4 ± 4.3 years). Percutaneous coronary intervention (600 patients) and coronary artery bypass grafting with cardio-pulmonary bypass (58 patients) were performed. Six months after myocardial re-vascularisation, we assessed patients' quality of life using the SF-36 questionnaire. We identified factors that affect the quality of life using multivariate regression analysis.</p><p><strong>Results.</strong> After myocardial revascularisation, the patients had a reduced overall indicator of physical health (&lt; 40 points). The overall indicator of psycho-emotional health was higher than physical (p &lt; 0.002) but did not exceed 50 points. We noted the adverse effect of COVID-19 (regardless of disease severity) on the assessment. Also, COVID-19 was associated with increased anxiety. A history of concomitant diabetes mellitus, obesity, stroke and percutaneous coronary intervention had a negative effect on the overall indicators of physical and mental health.</p><p><strong>Conclusion. </strong>Patients with coronary artery disease who had acute coronary syndrome after myocardial re-vascularisation are characterised by reduced indicators of physical and average indicators of mental health in the long term. COVID-19, regardless of disease severity, has a negative impact on patients' general state of health, social activity and emotional background. A history of diabetes mellitus, obesity, stroke and percutaneous coronary intervention adversely affects the physical and mental health indicators.</p><p>Received 4 August 2021. Revised 31 August 2021. Accepted 1 September 2021.</p><p><strong>Funding:</strong> This work was carried out within the framework of the state task of the Ministry of Health of the Russian Federation (No. 121031300225-8).</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Conception and study design: O.V. Kamenskaya, V.V. Lomivorotov<br /> Data collection and analysis: A.S. Klinkova<br /> Statistical analysis: A.S. Klinkova<br /> Drafting the article: A.S. Klinkova, I.Yu. Loginova<br /> Critical revision of the article: O.V. Kamenskaya, A.M. Chernyavskiy<br /> Final approval of the version to be published: A.S. Klinkova, O.V. Kamenskaya, I.Yu. Loginova, A.M. Chernyavskiy, V.V. Lomivorotov</p>

Results of the early and mid-term postoperative period after correction of total anomalous pulmonary venous connection

<p><strong>Aim.</strong> To compare complications and outcomes in the postoperative period with two different methods for correcting total anomalous pulmonary venous connection.</p><p><strong>Methods. </strong>In this pilot, two-centre, simple, blind, prospective randomised study, the patients’ quality of life after correction of total anomalous pulmonary venous connection in infancy was evaluated using the sutureless (n = 20) and conventional repair methods (n = 20) in 40 patients. The overall mortality and complications in the mid-term were evaluated.</p><p><strong>Results.</strong> The average follow-up was 15 (13; 16) months. Mortality was noted only in the conventional repair group, amounting to 5 (25%) patients (p = 0.018). Severe obstruction of the pulmonary veins anastomosis was also noted only in the conventional repair group (n = 8, 40%; p = 0.0013). Infectious endocarditis was observed in one (6.6%) patient in the conventional repair group (p = 0.42). Arrhythmias were present in 4 (26.6%) patients in the conventional repair group (p = 0.02).</p><p><strong>Conclusion.</strong> The rates of obstruction of the pulmonary vein anastomosis, arrhythmias and death depend on the method of total anomalous pulmonary venous connection correction. The sutureless repair reduces the incidence of early and mid-term postoperative complications compared to conventional repair.</p><p>Received 16 March 2021. Revised 8 June 2021. Accepted 11 June 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Conception and study design: Yu.N. Gorbatykh, A.V. Bogachev-Prokophiev, M.V. Plotnikov<br /> Data collection and analysis: M.V. Plotnikov, M.G. Galstyan, D.G. Tarasov<br /> Statistical analysis: M.V. Plotnikov<br /> Drafting the article: M.V. Plotnikov, Yu.N. Gorbatykh<br /> Critical revision of the article: I.A. Soynov<br /> Final approval of the version to be published: M.V. Plotnikov, Yu.N. Gorbatykh, A.N. Аrkhipov, M.G. Galstyan, A.V. Bogachev-Prokophiev, D.G. Tarasov, I.A. Soynov</p>

Impact of atrial fibrillation on long-term outcomes in patients with coronary artery bifurcation lesions undergoing percutaneous coronary intervention

<p><strong>Background.</strong> Atrial fibrillation is one of the most common types of cardiac arrhythmias. The frequent combination of atrial fibrillation and coronary artery disease in clinical practice can be attributed to common risk factors and relationships among pathogenetic mechanisms.</p><p><strong>Aim. </strong>This study aims to evaluate the impact of atrial fibrillation on immediate and long-term clinical outcomes in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions.</p><p><strong>Methods.</strong> This study included 709 patients who underwent percutaneous coronary intervention for coronary bifurcation lesions. All patients were divided into two groups: those with and without atrial fibrillation.</p><p><strong>Results.</strong> This multicentre registry showed that the incidence of atrial fibrillation was 11.7%. Compared to patients without a history of atrial fibrillation, those that did were older (66.8 ± 8.5 vs. 62.9 ± 9.0 years, p = 0.0002) and more often had cerebrovascular (22.9% vs. 10.4%, p = 0.003) and peripheral artery disease (18.1% vs. 7.2%, p = 0.002). The overall incidence of major adverse cardiovascular events at the hospital stage was 1.8%. The average follow-up duration was 476 ± 94 days. No difference in long-term major adverse cardiovascular events (15.0% vs. 13.1%, p = 0.6) was observed between patients with and without atrial fibrillation. Patients with atrial fibrillation were more likely to have adverse events, such as bleeding (13.8% vs. 9.3%, p = 0.22), stroke (2.5% vs. 1.0%, p = 0.23) and myocardial infarction (7.6% vs. 5.0%, p = 0.28), although differences between the groups were insignificant.</p><p><strong>Conclusion.</strong> Atrial fibrillation was not associated with mortality and major adverse cardiovascular events in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions.</p><p><strong>ClinicalTrials.gov Identifier: </strong>NCT03450577</p><p>Received 4 August 2021. Revised 27 September 2021. Accepted 28 September 2021.</p><p><strong>Funding: </strong>The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Conception and study design: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov<br /> Data collection and analysis: D.A. Khelimskii, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov<br /> Statistical analysis: D.A. Khelimskii, A.G. Badoian, I.S. Bessonov<br /> Drafting the article: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov<br /> Critical revision of the article: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov<br /> Final approval of the version to be published: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov</p>

Surgical management of biatrial myxoma: case report

<p>Heart tumours account for approximately 0.2 % of all tumours: of these, approximately 75 % of all primary heart tumours are benign and 50 % of them are myxomas. Further, myxomas make up 0.0017 % of the general population of patients with cardiovascular disease. Biatrial myxomas, i.e. tumours in both the left and right atria, can be in the form of a ‘butterfly’ or a ‘dumbbell’, and account for &lt; 1 % of all cardiac myxomas. Here we describe the successful surgical management of a rare case of a large biatrial myxoma and concomitant atrioventricular valve insufficiency. Briefly, 2D transthoracic echocardiography findings included an end-diastolic volume of 90 ml, an end-systolic volume of 40 ml and a left ventricular ejection fraction of 55 % (according to Simpson). The fibrous ring of the mitral valve measured 36 mm with a regurgitation degree of 2 while the fibrous ring of the tricuspid valve was 42 mm in size and the regurgitation grade was 3. Lesion size in the cavity of the left and right atrium were 73 × 38 mm and 80 × 42 mm, respectively. These neoplasia were surgically removed under peripheral cardiopulmonary bypass, hypothermia and cold cardioplegia (Custodiol). The myxomas were accessed through the right atrium, according to Giradon and were resected without defragmentation. Next, mitral valve plasty using a soft support ring and annuloplasty of the tricuspid valve were performed according to de Vega. The duration of artificial circulation was 150 minutes and that of myocardial ischaemia was 100 minutes. The patient was extubated 11 hours after surgery, spent 22 hours in the intensive care unit and was discharged on the 14th day after surgery. Surgical resection of biatrial myxomas before the development of serious irreversible or life-threatening complications can provide rapid symptomatic relief in congestive heart failure.</p><p>Received 30 May 2021. Revised 22 August 2021. Accepted 23 August 2021.</p><p><strong>Funding: </strong>The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Literature review: T.A. Simonyan<br /> Drafting the article: T.A. Simonyan, I.M. Tsiskaridze<br /> Critical revision of the article: T.A. Simonyan, I.Yu. Farulova, E.A. Babajanyan<br /> Surgical treatment: I.I. Scopin, I.M. Tsiskaridze<br /> Final approval of the version to be published: T.A. Simonyan, I.I. Scopin, I.M. Tsiskaridze, I.Yu. Farulova, E.A. Babajanyan</p>

Carotid endarterectomy for atherosclerotic occlusion of the contralateral internal carotid artery

<p><strong>Aim.</strong> To analyse perioperative and long-term results of carotid endarterectomy for occlusion or stenosis of the contralateral internal carotid artery.</p><p><strong>Methods.</strong> This study included 184 patients who underwent carotid endarterectomy for either occlusion (group 1, n = 74) or stenosis (group 2, n = 110) of the contralateral internal carotid artery. Carotid endarterectomy with eversion was performed in 97% of the patients while the conventional procedure with a patch was used in the remaining 3%.</p><p><strong>Results.</strong> The incidence of perioperative stroke / transient ischemic attack (TIA) in groups 1 and 2 was 1.35% and 1.82%, respectively (p = 0.806). Stroke / TIA within 30 days after surgery occurred in 2 patients in group 1 and in 1 patient in group 2 (p = 0.346); however, none were associated with death. In contrast, 3 cases of myocardial infarction (MI) were seen in group 1, two of which resulted in death. No instances of MI were seen in group 2. Long-term freedom from stroke and myocardial infarction, estimated using the Kaplan-Meier method, was not significantly different between the groups (p = 0.240 and p = 0.657, respectively). Long-term survival was similar in both groups (p = 0.281). An analysis of the risk factors for major cardiovascular events, both immediate and in the long-term, showed that plaque instability was the most significant (p = 0.004), followed by lesions in the arteries of the lower extremities (p = 0.002).</p><p><strong>Conclusion.</strong> Short-term and long-term cerebral complications were not significantly different between patients with occlusion or stenosis of the contralateral internal carotid artery. However, patients with occlusion were significantly more likely to experience MI, necessitating a detailed diagnosis of coronary artery disease. Instability of the atherosclerotic substrate and multifocal atherosclerosis were identified as independent risk factors for major cardiovascular events.</p><p>Received 18 May 2021. Revised 30 July 2021. Accepted 11 August 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors:</strong> The authors contributed equally to this article.</p>

Successful delayed endovascular correction of migration of transcatheter aortic valve prosthesis in left ventricle outflow tract: case report

<p>We report the successful endovascular correction of the migration of a transcatheter aortic valve prosthesis in the left ventricle outflow tract (LVOT). A 72-old man was underwent transcatheter aortic valve implantation (TAVI) at Almazov National Medical Research Centre for severe aortic stenosis. During the procedure, the self-expanding prosthesis dislocated 10–12 mm into the LVOT. The frame was optimised with the use of a balloon catheter, and aortic regurgitation I-II degree was achieved. However, on day 17 of hospitalisation, acute heart failure with episodes of asystole occurred as a result of severe paravalvular regurgitation; cardiopulmonary resuscitation was necessary. The prosthesis malpositioning was corrected by traction with endovascular snare devices. The patient was stable during the postprocedural period and discharged on day 31. Dislocation of self-expanding prostheses into the LVOT is a complication specific to TAVI that may quickly aggravate a patient’s condition; therefore, correction of valve malpositioning should be performed as soon as possible. The case reported here in an illustration of successful endovascular correction of dislocation performed with the snare traction technique. This bail-out approach can be used by interventional cardiologists in similar situations.</p><p>Received 27 May 2021. Revised 29 July 2021. Accepted 30 July 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest: </strong>Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Literature review: A.D. Gorovaya, D.D. Zubarev, A.A. Prokhorikhin<br /> Drafting the article: A.D. Gorovaya, V.S. Krasnov, A.A. Prokhorikhin<br /> Critical revision of the article: A.D. Gorovaya, M.A. Chernyavskiy, A.A. Prokhorikhin<br /> Surgical treatment: D.D. Zubarev, V.S. Krasnov, A.A. Prokhorikhin<br /> Final approval of the version to be published: A.D. Gorovaya, D.D. Zubarev, V.S. Krasnov, M.A. Chernyavskiy, A.A. Prokhorikhin</p>

Three-year results of Ozaki surgery in patients aged ≥65 years: a multicentre study

<p><strong>Background.</strong> Currently, aortic valve stenosis is the most common disease of the native valve, which affects 5% of the elderly population. In symptomatic patients, aortic valve replacement is the ‘gold standard’. For patients aged ≥65 years, the use of biological prostheses is recommended. The Ozaki operation is an alternative to bioprostheses.</p><p><strong>Aim.</strong> The aim of this study was to evaluate the immediate and 3-year results of Ozaki surgery in patients aged ≥65 years.</p><p><strong>Methods.</strong> This was a prospective multicentre study conducted on 107 patients aged ≥65 years, who underwent the Ozaki procedure at three centres during 2016–2019. There were 46 (43%) men. The median age of the patients was 69 [67–74] years. Severe aortic stenosis was the major cause of aortic valve dysfunction (106 patients [99.1%]). Chronic heart failure III–IV functional class according to NYHA was diagnosed in 47 (43.9%) patients. The following complications were also registered: atrial fibrillation in 30 (28%) patients, a history of diabetes mellitus in 16 (15%) patients, chronic obstructive pulmonary disease in 14 (13.1%) patients and coronary artery disease in 42 (39.2%) patients. Bicuspid aortic valve was detected in 36 (34.6%) patients. There were 72 (67.2%) patients with a small annulus (≤21 mm) and 59 (55.14%) patients with a left ventricular ejection fraction of 64%. The median follow-up period was 23 [18–33] months. This study included all patients who underwent Ozaki surgery from 2016 to 2019.</p><p><strong>Results.</strong> No patient had any conversions. A total of 45 (42.1%) patients underwent combined interventions. The operation duration was 240 [214–300] min, cardiopulmonary bypass duration was 104 [93–120] min and aortic cross-clamp duration was 82 [72–95] min. The rate of hospital mortality was 1.9%, and the incidence rates of acute renal failure requiring haemodialysis, stroke, pacemaker implantation, sepsis and reoperation for bleeding were 1.9%, 0.9%, 1.9%, 0.9% and 0.9%, respectively. The hospitalisation duration was 14 [11–16] days. The gradients of peak and mean pressure on the aortic valve after surgery were 9 [7–13] and 4 [3–6] mmHg, respectively, and the effective valve opening area was 2.6 [2.3–2.9] cm². None of the patients had moderate and severe aortic regurgitation. The 3-year overall survival and freedom from reoperation were 88.6% and 97%, respectively.</p><p><strong>Conclusion.</strong> The Ozaki operation in patients aged ≥65 years has good immediate results, with a hospital mortality rate of 1.9%, excellent haemodynamic parameters with an average pressure gradient across the aortic valve of 4 [3–6] mmHg and a valve opening area of 2.6 [2.3–2.9] cm². The 3-year overall survival and freedom from reoperation were 88.6% and 97%, respectively. Further monitoring of these patients is required to evaluate long-term results, and there is also a need for randomised clinical trials comparing Ozaki operation with bioprostheses.</p><p>Received 4 February 2021. Revised 21 June 2021. Accepted 23 June 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Conception and study design: I.I. Chernov, R.N. Komarov, D.G. Tarasov, Yu.S. Sinelnikov, A.V. Marchenko, V.B. Arutyunayan, K.Yu. Zhigalov<br /> Data collection and analysis: B.K. Kadyraliev, A.M. Ismailbaev, B.M. Tlisov, D.A. Zorin, M.I. Tcheglov<br /> Statistical analysis: S.T. Enginoev<br /> Drafting the article: I.I. Chernov, S.T. Enginoev<br /> Critical revision of the article: I.I. Chernov, R.N. Komarov, D.G. Tarasov, Yu.S. Sinelnikov, A.V. Marchenko, V.B. Arutyunayan, K.Yu. Zhigalov<br /> Final approval of the version to be published: I.I. Chernov, S.T. Enginoev, R.N. Komarov, D.G. Tarasov, Y.S. Sinelnikov, A.V. Marchenko, V.B. Arutyunayan, B.K. Kadyraliev, A.M. Ismailbaev, B.M. Tlisov, D.A. Zorin, M.I. Tcheglov, K.Yu. Zhigalov</p>

Acute kidney injury after cardiac surgery in children

<p>Acute kidney injury (AKI) after cardiac surgery in children remains a common clinical concern. The approaches developed recently and applied in clinical practice have sufficiently helped in clarifying the epidemiology, risk factors and pathophysiology of AKI in paediatric cardiac surgery. Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease criteria (pRIFLE), Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO), which are based on changes in serum creatinine levels and urine output rate, enable the identification and ranking of AKI according to severity. However, the diagnostic strategies for AKI have developed beyond creatinine levels and recommend the use of markers of renal tissue damage. Currently, two markers, neutrophil gelatinase-associated lipocalin and TIMP-2/IGFBP-7 (tissue inhibitor of metalloproteinase 2 and protein that binds insulin-like growth factor-7), can be used for the early diagnosis of AKI in paediatric cardiac surgery.<br />Various risk factors, both renal and extrarenal, can predict AKI after cardiac surgery, among which age, the duration of cardiopulmonary bypass and the need for mechanical ventilation and inotropic support before surgery, are the most significant. Strategies for addressing modifiable risk factors (maintaining appropriate perfusion pressure during cardiopulmonary bypass and avoiding nephrotoxic drugs and fluid overload) will reduce the risk of developing AKI. There has been a significant increase in survival rates due to the introduction of ultrafiltration techniques and the early initiation of renal replacement therapy in the postoperative period.<br />The purpose of this review is to analyse the current literature data on AKI in paediatric cardiac surgery. The review results demonstrate the differences in the incidence of AKI associated with cardiac surgery and the effectiveness of certain methods for prevention and treatment of this complication. Further comprehensive research on the issue of AKI in children, creation of medical electronic databases on patients, minimisation of the influence of possible risk factors and timely prevention and treatment of complications would prevent the development of AKI and reduce the possibility of complication progression to a more severe stage.</p><p>Received 12 April 2021. Revised 24 June 2021. Accepted 25 June 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest: </strong>Authors declare no conflict of interest.</p><p><strong>Contribution of the authors:</strong> The authors contributed equally to this article.</p>

Bentall–De Bono procedure for aortic regurgitation and intraoperative rupture of moderately dilated ascending aorta: A case report

<p>We herein present a clinical case of root and ascending aortic replacement in a patient with borderline enlargement of the ascending aorta and aortic valve insufficiency. A 65-year-old man was admitted to our clinic with signs of heart failure. Subsequent echocardiography and contrast-enhanced computed tomography revealed hemodynamically significant aortic insufficiency, as well as expansion of the ascending aorta. Diameter at the levels of the sinuses of Valsalva, sinotubular junction and tubular portion of the ascending aorta were 48, 47 and 44 mm, respectively. Based on the aforementioned data, indications for isolated aortic valve replacement were determined. Although the main portion of the surgery was unremarkable, at its final stage, a rupture of a section of the ascending aorta occurred. The results of intraoperative express histological examination of the enlarged aorta revealed connective tissue dysplasia and cystic median necrosis. Replacement of the ascending aorta was performed using the modified Bentall–De Bono technique. This case demonstrated that a borderline aortic dilatation of 40–50 mm at the ascending aorta was associated with pathological changes in its wall, which can cause fatal complications (rupture and dissection) and may require a more aggressive approach during surgical correction. Intraoperative express histological examination of the wall of the ascending aorta in ambiguous situations can help determine the scope of the intervention.</p><p>Received 16 March 2021. Revised 14 September 2021. Accepted 15 September 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Literature review: S.Yu. Boldyrev, M.A. Marukyan<br /> Drafting the article: S.Yu. Boldyrev, M.A. Marukyan, V.N. Suslova<br /> Critical revision of the article: S.Yu. Boldyrev, V.A. Porkhanov<br /> Surgical treatment: S.Yu. Boldyrev, M.A. Marukyan<br /> Final approval of the version to be published: S.Yu. Boldyrev, M.A. Marukyan, V.N. Suslova, K.O. Barbukhatti, V.A. Porkhanov</p>

Aortic root prosthesis with pericardial cusps "Russian conduit": A hydrodynamic experiment

<p><strong>Aim.</strong> The study aimed to compare the hydrodynamic characteristics and durability of the aortic root prosthesis with pericardial cusps with various options for the formation of commissures.</p><p><strong>Methods.</strong> Nine conduits with pericardial valves were formed according to the technique described by Ozaki. The prostheses were divided into 3 groups of 3 specimens each: group 1 — without additional reinforcing seams on the top of the commissure; group 2 — with an additional U-shaped seam without gasket; and group 3 — with an additional suture with an opposite pericardial gasket. The prostheses were fixed on a stand for hydrodynamic testing of artificial heart valves. The hydrodynamic characteristics of the prostheses were evaluated. The hydrodynamics of the frame biological prosthesis was used for comparison. After assessing the hydrodynamic parameters of the aortic root prostheses, their work durability was tested. Defects of the pericardial cusps were studied macroscopically.</p><p><strong>Results. </strong>Two samples from group 2 were withdrawn from testing ahead of schedule at around 11 × 10⁶ cycles, which is approximately 3.5 months of normal heart function. The other prostheses remained competent and were removed for an examination at 32 × 10⁶ cycles, which is approximately 9.6 months of normal heart function.</p><p><strong>Conclusion. </strong>The hydrodynamics of the aortic root prosthesis with pericardial valves was comparable to the hydrodynamics of the frame biological prosthesis. Additional U-shaped sutures in the commissure area of the pericardial cusps did not increase the functional durability of the aortic root prosthesis with pericardial leaflets and served as additional risk factors for leaflet perforation. Implantation of pericardial leaflets into a vascular graft resulted in a different distribution of dynamic stress compared to the original aortic valve neocuspidisation, which preserved the aortic root.</p><p>Received 8 July 2021. Revised 30 August 2021. Accepted 7 September 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Conception and study design: V.V. Bazylev, P.A. Batrakov<br /> Data collection and analysis: P.A. Batrakov, D.M. Khadiev, A.A. Egorov, N.A. Eremin<br /> Drafting the article: P.A. Batrakov<br /> Critical revision of the article: V.V. Bazylev, P.A. Batrakov<br /> Final approval of the version to be published: V.V. Bazylev, P.A. Batrakov, D.M. Khadiev, A.A. Egorov, N.A. Eremin<strong> </strong></p>