Ukrainian Journal of Cardiovascular Surgery

Amosov Readings: Challenges of Modernity and the Memory of History

2025-12-25T16:40:39+02:00

Amosov Readings: Challenges of Modernity and the Memory of History

Advantages of Minimally Invasive Coronary Artery Bypass Grafting in Wartime Conditions

2025-12-25T16:53:16+02:00

Minimally invasive direct coronary artery bypass (MIDCAB) is a promising surgical method for myocardial revascularization in coronary artery disease, performed via a mini-thoracotomy without cardiopulmonary bypass. In wartime conditions, the application of minimally invasive technologies gains special significance due to the need to optimize the use of limited resources, reduce blood loss, and shorten rehabilitation time. MIDCAB enables effective revascularization with minimal surgical trauma, which is critically important for military personnel requiring rapid functional recovery.

Aim. To justify the feasibility of implementing minimally invasive coronary artery bypass technologies to improve myocardial revascularization outcomes under resource-limited conditions during military operations.

Materials and Methods. The study included 42 patients divided into two groups: the main group (mini-access) – 16 patients (100 % military personnel) who underwent coronary artery bypass through a mini-lateral approach, and the control group (sternotomy) – 26 patients who underwent traditional CABG through median sternotomy. All operations in the main group were performed on the beating heart (off-pump). Analysis of intraoperative and postoperative parameters was conducted.

Results. The minimally invasive approach was associated with a statistically significant reduction in intraoperative blood loss (140±17 ml vs. 200±50 ml, p=0.041), need for blood transfusion (6.2 % vs. 30.8 %, p=0.048), duration of mechanical ventilation (3.5±1.2 h vs. 6.5±2.8 h, p=0.001), ICU stay (1.0±0.2 days vs. 2.2±0.9 days, p<0.001), and total hospitalization (9.2±3.5 days vs. 13.8±5.2 days, p=0.003). The rate of postoperative complications was statistically significantly lower with the mini-access approach (6.2 % vs. 42.3 %, p=0.015). In wartime conditions, the off-pump MIDCAB technique allows procedures to be performed during power outages and in hospitals without full-service cardiac surgery departments, which is critical for decentralizing specialised care. Additionally, the reduced need for blood products preserves limited supplies for patients with massive combat trauma. No hospital mortality was observed in either group.

Perioperative Glycaemic Dynamics in Type 2 Diabetes Mellitus: Comparison of Minimally Invasive and Conventional Coronary Artery Bypass

2025-12-25T17:00:30+02:00

Aim. To compare perioperative glycaemic dynamics and the need for inotropic support in patients with type 2 diabetes undergoing minimally invasive versus conventional coronary artery bypass grafting.

Materials and Methods. The study included 60 patients with multivessel coronary artery disease and type 2 diabetes mellitus not treated with insulin. All underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass. Group 1 (prospective, n=30) underwent minimally invasive CABG (MICS CABG) via left anterior thoracotomy; Group 2 (retrospective, n=30) underwent conventional CABG via sternotomy. Glycaemic levels were assessed perioperatively at six time points, and integral indices (mean AUC, AUC>10) were calculated. Statistical analyses included the Friedman test with post-hoc Wilcoxon comparisons and Spearman correlation for associations with clinical parameters.

Results. Completeness of revascularisation was comparable between groups: the completeness index was 0.95±0.138 in Group 1 and 0.94±0.127 in Group 2 (p=0.811). Operative (Group 1: 341.9±31.6 min; Group 2: 258.4±27.9 min) and perfusion times were longer in the minimally invasive group (p<0.001), reflecting greater technical complexity. However, the sternotomy group showed significantly higher postoperative glucose levels and a greater overall glycaemic load. Mean AUC was 8.3 (7.4-8.9) in Group 1 and 9.7 (8.4-11.1) in Group 2 (p<0.001), along with a longer time in clinically significant hyperglycaemia (AUC>10, p=0.01). These patients also required more frequent (p=0.021) inotropic support with dobutamine, with significantly higher dosing (p=0.018) and longer infusion duration (p=0.037). AUC>10 correlated positively with the mean dobutamine dose (p=0.42, p=0.01).

Conclusions. Minimally invasive CABG, while technically more demanding, provided equivalent revascularisation with reduced metabolic and haemodynamic stress compared with sternotomy. Integral glycaemic indices, particularly AUC>10, emerged as sensitive markers of metabolic stress and potential predictors of inotropic dependence, supporting their role in personalised perioperative management

Surgery of the Aortic Valve Using a Minimally Invasive Approach

2025-12-25T17:04:30+02:00

Aim. The aim of this study is to present and analyze the technique of isolated aortic valve replacement (AVR) or repair via a minimally invasive approach – right anterior thoracotomy in the second intercostal space.

Materials and Methods. From February 2020 to November 2025, 180 patients at our institution underwent isolated aortic valve interventions. Since July 2020, we have implemented the technique of minimally invasive aortic valve surgery via right anterior thoracotomy. Between 2020 and 2025, 177 patients were operated on using this approach: 165 underwent aortic valve replacement (AVR), and 12 underwent aortic valve repair. In 2 (1.1 %) patients with isolated aortic valve stenosis, AVR was performed through axillary access for a better cosmetic effect. Since the introduction of this technique, median sternotomy was used in only one case due to difficulties with peripheral cannulation or severe aortic calcification.

Results. Based on etiology and anatomical pathology, AVR was performed in 165 (91.6 %) patients – 90 (54.5 %) received biological prostheses, and 75 (45.5 %) received mechanical valves. Aortic valve repair was performed in 12 (8.4 %) patients. Aortic cross-clamp time ranged from 39 to 145 minutes (mean 89.4±19.5 min). Total cardiopulmonary bypass time ranged from 83 to 275 minutes (mean 150.9±29.4 min). Total operative time ranged from 165 to 435 minutes (mean 237.7±43.4 min). Intensive care unit (ICU) stay was 1.4±0.6 (1-3) days, and total hospital stay was 6.1±1.6 (3-16) days. There were no significant postoperative cardiac complications, mortality, or conversions to median sternotomy. Three cases (1.4 %) required surgical re-exploration due to bleeding.

Conclusions. Right anterior mini-thoracotomy is a safe approach for aortic valve surgery. The use of exposure maneuvers during aortic valve replacement via mini-thoracotomy allows the operation to be performed without patient selection and yields good perioperative results.

Risk Factors and Complications Structure in Patients After Surgical Treatment of Combined Aortic and Mitral Valve Disease with Concomitant Coronary Artery Disease

2025-12-25T17:11:58+02:00

Introduction. Combined aortic and mitral valve lesions on the background of coronary artery disease require complex surgical correction and are associated with high perioperative risk and frequent complications. Local data on such interventions remain limited.

Aim. To determine the structure of complications following combined aortic and mitral valve replacement with concomitant coronary artery bypass grafting (AVR+MVR+CABG).

Materials and Methods. A retrospective single-center study included 57 patients operated in 2018-2023. Clinical, laboratory, and echocardiographic parameters were analyzed; operative risk was assessed using EuroSCORE II and STS models. Intra- and postoperative parameters were recorded; complications were classified as acute kidney injury (AKI, KDIGO), bleeding (BARC≥3), infectious, neurological, cardiac, pericarditis, rethoracotomy, and in-hospital mortality. Uni- and multivariate logistic regression was used to identify predictors of the composite endpoint (mortality / major complications) with ORs and 95 % CI (p<0.05).

Results and discussion. Patients were high-risk: EuroSCORE II Me 7.0 % [4.3-10.9], STS mortality 12.2 % [8.7-17.3], STS mortality/morbidity 61.3 % [49.9-69.0]. In-hospital mortality was 10.5 % (6/57). The main causes of death were acute kidney injury progressing to multiorgan failure (n=2), acute cerebrovascular accident (n=1), pneumonia with septic shock (n=1), mediastinitis with sepsis (n=1), and acute graft thrombosis resulting in myocardial infarction (n=1). Major postoperative complications included: AKI 38.0 % (dialysis-dependent 15.8 %), infectious complications 47.4 % (mediastinitis 7.0 %), neurological disorders 43.9 % (delirium/encephalopathy), stroke 7.0 %, rethoracotomy for bleeding 12.3 %, and pericarditis 10.5 %. Typical hyperlactatemia peaked at 6 hours and normalized within 48 hours. Postoperative valve gradients remained within expected ranges; left ventricular ejection fraction at discharge was Me 50 % [41-56]. Preventive priorities include KDIGO-based AKI prevention, neuroprotection and delirium/stroke prevention strategies, strengthened infection control, blood conservation programs, and refined perioperative risk stratification.

Conclusions.

The combined valve–coronary cohort demonstrated high surgical risk, with elevated EuroSCORE II and STS indices and hospital mortality of 10.5 %. Functional results were satisfactory: prosthetic valve gradients remained within expected limits, and LVEF at discharge (Me 50 % [41-56]) indicated stable systolic performance.
The postoperative course was dominated by an organ-dysfunction–driven complication structure, including renal complications (AKI 38.0 %, dialysis-dependent 15.8 %), infectious events (47.4 %, mediastinitis 7 %), neurological disorders (delirium/encephalopathy 43.9 %, stroke 7 %), and additional cardiac/bleeding complications (re-thoracotomy 12.3 %, pericarditis 10.5 %).
The findings support the need for standardized perioperative pathways, emphasizing KDIGO-based renal protection, neuroprotection, infection control, and blood-conservation strategies, with combined EuroSCORE II+STS use for precise risk stratification.

Papillary Fibroelastoma of the Heart: Controversies in Histogenesis, Detection, and Surgical Strategy

2025-12-25T17:24:46+02:00

Background. Papillary fibroelastoma (PFE) is a small endocardial tumor, typically located on heart valves, with a disproportionately high embolic risk. Despite classic echocardiographic descriptions, debate continues regarding its origin (reactive vs. “thrombo-endothelial,” potentially arising from Lambl’s excrescences), the indications for surgery in asymptomatic patients, and the role of minimally invasive or percutaneous resection.

Aim. To analyse the prevalence and characteristics of PFE among cardiac tumors based on our institutional experience and current literature, to address controversial aspects, and to outline surgical strategies according to neoplasm localization.

Materials and Methods. Between 1969 and 2025, 1046 patients with cardiac tumors underwent surgery at the Amosov National Institute of Cardiovascular Surgery (Kyiv, Ukraine). Myxomas accounted for 89.4 % of benign cardiac tumors, while PFE accounted for 1.3 % of all cases and 34.2 % of non-myxomatous benign tumors.

Results Most PFEs were valvular, predominantly located in the aortic and mitral positions. Although frequently asymptomatic, they were associated with embolic events. Surgical “shave excision” with valve preservation enabled complete resection with minimal morbidity. In large series (Mayo Clinic and other centres), surgical outcomes are excellent; however, recent data show a significantly higher long-term recurrence rate for aortic PFEs than previously reported, reaching 15-16 % over 10 years, underscoring the need for prolonged echocardiographic follow-up [13]. Percutaneous ablation is emerging as an option for selected asymptomatic patients, though robust evidence remains limited.

Conclusions. PFE is a small but clinically significant tumor with serious embolic potential. Optimal management includes timely recognition, valve-sparing surgical excision, and structured postoperative surveillance. Further studies are needed to clarify its histogenesis, establish operative thresholds for asymptomatic patients, and define the role of percutaneous interventions.

Penetrating Cardiac Injuries: “Damage Control” and ERAS Ways of Thinking

2025-12-25T17:30:50+02:00

Background. Penetrating stab wounds to the heart are potentially survivable injuries, with reported mortality ranging from 9.7 % to 35 % among patients who arrive at the hospital with signs of life. Management remains challenging and depends on rapid diagnosis, timely surgical intervention, coordinated anesthesiological resuscitation, and streamlined perioperative algorithms.

Aim. To describe the variability of clinical presentation, to analyze and optimize diagnostic, surgical, anesthetic, and postoperative approaches, and to identify management errors based on 23 years of institutional experience.

Materials and Methods. This retrospective cohort study covered a 23-year period and included 67 adult patients who met the inclusion criteria. Patients were stratified into four clinical categories on admission: benign condition, cardiac tamponade, critically unstable, and patients with signs of life or in cardiac arrest. All patients underwent anterolateral thoracotomy (Spangaro incision) for tamponade release, cardiac repair, and management of associated injuries. Anesthetic management consisted of general intravenous anesthesia, with rapid sequence intubation performed in 100 % of cases.

Results. Among the 67 patients, 61 (91.05 %) had isolated cardiac injuries and 6 (8.95 %) had multiple-chamber wounds. Overall survival was 91.05 %. Emergency department thoracotomy (EDT) was performed in 8 patients (11.94 %), with a 50 % survival rate. The distribution of isolated injuries was as follows: LV 29 (47.54 %), RV 24 (39.36 %), RA 4 (6.55 %), and LA 4 (6.55 %). Associated injuries occurred in 15 patients (22.38 %). Mortality was 8.95 %; deaths resulted from cardiac tamponade (4 patients, 66.7 %), exsanguination (1 patient, 16.65 %), and injury to the left anterior descending artery (1 patient, 16.65 %). Postoperative complications occurred in 5 patients (7.46 %).

Patients were subsequently divided into two groups: Standard (n=35) and ERAS-based management (n=32). Implementation of ERAS principles led to a significant reduction in ICU stay (2.2 → 1.6 days, p<0.05) and hospital LOS (9.3 → 6.5 days, p<0.05) without an increase in complications or mortality.

Conclusion. Survival after penetrating cardiac injury can be improved through the implementation of a simple, rational, and scientifically grounded management strategy that integrates damage-control principles and ERAS-based perioperative optimization.

Management Strategies for Cardiac Fibromas in Early Childhood: Comparative Analysis of Surgical Outcomes and Natural History

2025-12-25T17:39:20+02:00

Background. Cardiac fibromas (CFs) are rare primary cardiac tumors. Defining surgical indications for CF resection in early childhood represents a challenging clinical issue and varies substantially between centers. The optimal management strategy, particularly in infants and young children, requires further generalization of accumulated clinical experience.
Aim. To analyze the experience of a single specialized center in managing children with CFs and to compare the outcomes of surgical treatment with the natural course of the disease.

Materials and Methods. In this retrospective single-center study (2014–2023), 12 cases of CF in early childhood were analyzed: seven patients were managed conservatively, and five underwent surgical tumor resection.

Results. The median age at diagnosis was 1.1 years. Asymptomatic presentation occurred in 58 % of children, arrhythmias in 33%, and signs of heart failure (HF) in 17 %. Fibromas were most commonly located in the interventricular septum (33 %), right ventricle (33 %), and left ventricle (25 %), and less frequently in the right atrium (8 %). In the observation group (median follow-up 3.6 years), an increase in absolute tumor area was noted, while the indexed area decreased (-0.94 cm²/m²/year); no deaths were recorded, and two children required antiarrhythmic therapy. In the surgical group, complications occurred in 60 % of patients (left ventricular dysfunction, ventricular septal defect, tumor recurrence, repeat surgery). Overall survival was 100 % in both groups.
Conclusions. In early childhood, CFs tend to regress relatively as the child grows. In contrast, early radical surgery is frequently associated with postoperative complications. Therefore, a stratified management strategy appears optimal: urgent resection should be performed in cases of severe arrhythmia or hemodynamic obstruction, while delayed surgery is preferable for asymptomatic patients or those with medically controlled symptoms.

Tachicardia-Induced Cardiomyopathy: Current Status of Diagnosis and Treatment

2025-12-25T17:42:05+02:00

Tachycardia-induced cardiomyopathy (TIC) is characterized by a decrease in left ventricular systolic function due to chronic tachyarrhythmia or frequent ventricular extrasystoles in the absence of structural heart disease.

Aim. To analyze the current literature data about TIC.

Materials. Clinical guidelines and current literature from the PubMed database on the diagnosis and treatment of TIC.

Results. Due to the lack of established TIC diagnostic criteria, the main problem remains its untimely diagnosis, as well as the difficulty in understanding whether the arrhythmia is a cause or a consequence of cardiomyopathy. The main strategy for treating TIC is to restore the heart rhythm, which can be achieved both medically and by invasive methods. Current American and European guidelines prioritize catheter ablation, which results in normalization of chamber size, increased left ventricular ejection fraction, and symptomatic resolution, which indicates reversibility of the disease. Although previous studies have recommended antiarrhythmic drugs before catheter ablation, the current evidence supports ablation as the first-line therapy for AF. A more stringent heart rate control strategy is appropriate (target heart rate <80 bpm at rest and <110 bpm during moderate exercise). AV node ablation with pacemaker implantation provides safe and effective heart rate control in patients with AF whose heart rate cannot be effectively controlled with catheter ablation and medical therapy.

Multiparametric Cardiac MRI for the Diagnosis and Differentiation of Cardiomyopathy Phenotypes: Current Applications and Future Perspectives

2025-12-25T17:49:48+02:00

Introduction. Cardiomyopathies are myocardial diseases characterized by structural and functional abnormalities in the absence of coronary artery disease, arterial hypertension, or valvular pathology sufficient to explain the observed changes. Their origin may be either genetic or acquired. Cardiac magnetic resonance imaging (CMR) is the leading non-invasive diagnostic tool that enables comprehensive assessment of cardiac morphology, function, and tissue characteristics. The use of LGE and parametric techniques (T1-, T2-mapping, and ECV) facilitates the detection of fibrosis, infiltration, and edema. In 2023, the European Society of Cardiology introduced a phenotype-based classification in which CMR plays a central role, highlighting five main phenotypes: hypertrophic, dilated, non-dilated left ventricular, arrhythmogenic right ventricular, and restrictive cardiomyopathy.

Aim. To demonstrate the key role of multiparametric CMR in identifying, differentiating, and prognosticating cardiomyopathies through analysis of characteristic CMR features and application of a systematic interpretative approach.

Review and discussion. Over the past decades, cardiomyopathy classifications have evolved substantially – from the basic morphological forms of the WHO/ISFC (DCM, HCM, RCM) to the contemporary phenotype-based model of ESC 2023. A pivotal milestone was the introduction of multiparametric CMR, which combines precise morpho-functional assessment with quantitative tissue characterization. CMR enables accurate evaluation of chamber volumes, ventricular function, and myocardial tissue changes (fibrosis, edema, infiltration) using LGE, T1- and T2-mapping, and ECV. The presence and extent of LGE are associated with an increased risk of sudden cardiac death, whereas parametric mapping techniques provide valuable diagnostic insights into diffuse myocardial processes even in the absence of contrast administration.

The current ESC classification distinguishes five principal phenotypes–hypertrophic, dilated, non-dilated left ventricular, arrhythmogenic right ventricular, and restrictive cardiomyopathy. In all these phenotypes, CMR plays a central role in diagnosis, risk stratification, and therapeutic decision-making.

In Ukraine, multiparametric CMR is gradually being implemented in leading cardiac surgery centers. However, wider adoption remains limited by the high cost of software, lack of dedicated workstations, and shortage of trained specialists. The future development of the method depends on protocol standardization, improved accessibility, and integration into national clinical guidelines.

Conclusions. Multiparametric cardiac magnetic resonance imaging is a key method for the diagnosis and differentiation of cardiomyopathy phenotypes. It provides a precise assessment of cardiac volumes, function, and myocardial tissue characteristics (LGE, T1-, T2-mapping, and ECV), enabling determination of disease etiology and differentiation of its variants. This technique is essential for accurate diagnosis, risk stratification, and selection of optimal management strategies for patients with cardiomyopathies.

Efficacy of Sodium–Glucose Cotransporter 2 Inhibitors in Chronic Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2025-12-25T18:14:22+02:00

Background. Sodium–glucose cotransporter 2 (SGLT2) inhibitors are now a foundational therapy for heart failure (HF), yet uncertainties remain regarding their impact on mortality, recurrent events, patient-reported outcomes, and biomarkers.

Aim. To evaluate the efficacy and safety of sodium–glucose cotransporter 2 (SGLT2) inhibitors in patients with chronic heart failure across the spectrum of ejection fraction, based on evidence from randomized controlled trials.

Materials and Methods. We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 (PROSPERO: CRD420251138644). PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov were searched through 25 June 2025. Eligible studies were randomized controlled trials (RCTs) of SGLT2 inhibitors versus placebo in adults with chronic HF. The primary endpoint was time to first cardiovascular (CV) death or HF hospitalization. Secondary outcomes included all-cause mortality, recurrent hospitalizations, quality of life, natriuretic peptides, and safety. Hazard ratios (HRs) were pooled using Hartung–Knapp random-effects models where definitions were consistent; other outcomes were narratively synthesized. Risk of bias was assessed with RoB 2, and the certainty of evidence with GRADE.

Results. Five RCTs (n = 16,222) were included: DAPA-HF, EMPEROR-Reduced, DELIVER, SOLOIST-WHF (providing recurrent-event analyses), and DEFINE-HF (mechanistic, biomarker-focused). SGLT2 inhibitors reduced the risk of CV death or HF hospitalization (pooled HR 0.79, 95% CI 0.74–0.83; I² = 0%). The reduction in hospitalization was consistent across trials (HRs ≈ 0.69–0.75), while all-cause mortality showed a modest but significant benefit (HR 0.90, 95% CI 0.83–0.98). Trials consistently demonstrated improvements in Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and natriuretic peptide response rates. Safety findings were consistent with the established SGLT2 inhibitor profile, with no signals of serious adverse events.

Conclusions. SGLT2 inhibitors confer robust reductions in HF hospitalizations and provide supportive benefits on mortality, quality of life, and biomarkers across EF phenotypes, reinforcing their role as a cornerstone therapy in chronic HF.

Effect of Surgical Intervention on Proteolytic Activity of Blood in Chronic Venous Disease of the Lower Extremities

2025-12-25T18:18:24+02:00

Background. Chronic venous disease (CVD) with chronic venous insufficiency (CVI) involves disruption of the proteolytic balance in the venous wall driven by an imbalance between matrix metalloproteinases (MMPs) and tissue inhibitors (TIMPs), particularly MMP-2 and TIMP-4.

Aim. To assess changes in MMP-2, TIMP-4 and their ratio before and after surgical treatment of CVD and to compare the effectiveness of different surgical techniques.

Materials and Methods. A total of 139 patients with chronic venous disease (CEAP C3–C6), aged 18–75 years, were enrolled and allocated into three groups based on the extent of surgical intervention performed. All participants underwent standard clinical assessment and duplex ultrasound. Serum MMP-2 and TIMP-4 concentrations were measured before and after treatment using validated ELISA assays under identical laboratory conditions. Thirty age-matched healthy volunteers served as the control group.

Results. Before treatment, patients showed elevated MMP-2 and reduced TIMP-4 compared with controls. Combined intervention (RFA + miniphlebectomy + perforator ligation) resulted in the most significant decrease in MMP-2, increase in TIMP-4 and near-normalisation of their ratio. Less pronounced but significant changes occurred in subgroup 2A, whereas subgroup 2B and the RFA-only group retained an abnormal MMP-2/TIMP-4 ratio.

Conclusions. Combined surgical treatment most effectively restores proteolytic balance in CVD. Dynamic assessment of MMP-2, TIMP-4 and their ratio may serve as a laboratory indicator of treatment efficiency.

Features of Cerebral Hemodynamics and Cognitive Status in Patients with Chronic Ischemia of the Brain on the Background of Stenosing Atherosclerosis of the Brachiocephalic Arteries

2025-12-25T18:24:39+02:00

Aim. To study the state of cerebral circulation and cognitive status (CS) in patients with chronic cerebral ischemia (CCI) associated with atherosclerotic lesions of the brachiocephalic arteries (BCA).

Materials and Methods. A total of 128 individuals aged 42 to 60 years were examined, including patients with CCI in the compensated (Group I, n=24) and subcompensated (Group II, n=38) stages, as well as 46 patients (Group III) with decompensated CСI, who had a history of an ischemic stroke (IS). The state of the carotid (CA), and vertebral (VA) arteries was assessed, as well as the time-averaged maximum blood flow velocity (TAMX) in the cerebral arteries, as well as in the vertebral (VA, segment V4) and basilar (BA) arteries, the functioning of the anterior (AComA) and posterior (PComA) communicating arteries. The assessment of CS was performed using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and a 10-word recall test.

Results. In Group I, isolated lesions of the CA or VA were observed, whereas in Groups II and III, multiple lesions predominated. The severity of CCI correlated with a decrease in TAMX, most pronounced in the middle cerebral artery (MCA) in Group II (p < 0.05) and Group III (p < 0.01). Such vascular ischemia was clinically accompanied by an increase in ataxic, pseudobulbar, dysmnestic, and pyramidal syndromes. In patients with a non-functioning AComA and hemodynamically significant BCA lesions, a decline in memory, intelligence, and behavioural stability was noted. In cases of non-functioning PComA, a decrease in TAMX in the posterior cerebral (PCA), basilar (BA), and vertebral (VA, V4) arteries was associated with more severe vestibular and ataxic symptoms. According to the MMSE, the average score indicated mild cognitive reduction (CR) in Group I (25.5 ± 0.6 points) and mild dementia in Groups II and III (23.6 ± 0.2 and 20.9 ± 0.4 points, respectively). In Group III, these values approached the threshold of moderate dementia. In the FAB test, moderate CR with impaired praxis and spatial activity was noted in Group I, severe CR with impaired praxis and object function in Group II, and dementia in Group III.

Conclusions. In patients with decompensated CCI, hemodynamically significant stenoses of the CA were often combined with VA lesions. The functional state of the AComA and PComA plays an important role in the development of clinical manifestations of CCI. Patients with compensated CCI exhibited moderate cognitive impairment, those with subcompensated CCI demonstrated severe cognitive impairment, while patients with decompensated CCI and a history of IS showed signs of vascular dementia.

Results of Endovascular Occlusion of Vertebro-Vertebral Arteriovenous Fistulas

2025-12-25T18:30:29+02:00

Aim. To analyze the results of endovascular treatment of vertebro-vertebral arteriovenous fistulas (VV-AVFs).

Materials and Methods. A retrospective analysis was performed on the treatment outcomes of 291 patients with arteriovenous fistulas (AVFs) of various localizations who were treated at the State Institution “Scientific-Practical Center of Endovascular Neuroradiology of the NAMS of Ukraine” between January 2012 and March 2024. All patients underwent endovascular embolization of AVFs and follow-up cerebral angiography (DSA) at different intervals, ranging from 1 to 12 years. Five patients (1.7 %) were diagnosed with VV-AVFs. Patient age ranged from 48 to 61 years (mean: 54 years). The fistulas were most commonly located in the V2 segment of the vertebral artery. Typical clinical manifestations included a pulsatile mass or bruit, often accompanied by neck pain or upper-limb paresthesia. Regarding etiology, three cases were spontaneous, and two were traumatic in origin.

Results. Five embolization sessions were performed in five patients with VV-AVFs (one per patient). Detachable coils were used in all procedures, and n-butyl cyanoacrylate (nBCA) in four. No procedural complications occurred. Complete occlusion of the fistulous connection was achieved in four cases. In one patient, a residual low-flow shunt from the external carotid artery territory was identified, for which conservative observation was chosen. No patient experienced neurological deterioration after embolization. Postoperative recovery was uneventful, and symptomatic improvement was noted in all patients upon discharge. The mean hospital stay was 5.6 days. All patients were discharged with modified Rankin Scale (mRS) scores of 0-1. Follow-up angiography was available in three patients and revealed no signs of recanalization.

Conclusions. Endovascular exclusion of vertebro-vertebral arteriovenous fistulas is a modern, minimally invasive, and effective treatment technique that prevents serious complications and improves the quality of life in affected patients. However, the decision to perform the procedure should be made individually, taking into account the patient’s condition, as well as the location, size, and hemodynamic characteristics of the fistula.

Minimally Invasive Treatment of Recurrent Varicose Veins with Thrombotic Complications

2025-12-25T18:34:04+02:00

Background. Recurrent varicose vein disease (RVVD) remains a frequent problem after surgery or endovenous ablation (≈13-65 %). Mechanisms include residual reflux, de novo varicosities, and neovascularization. When RVVD is complicated by superficial vein thrombosis (SVT), treatment becomes challenging because current guidelines focus mainly on anticoagulation and rarely address reflux correction.

Aim. To evaluate the feasibility, safety, and effectiveness of combined minimally invasive therapy for RVVD complicated by SVT.

Materials and Methods. This single-center cohort included 31 patients (24 women, 7 men; mean age 55±13 years) with duplex-verified SVT and RVVD (CEAP C2r–C6r) treated between 2013 and 2025. Interventions comprised endovenous laser or radiofrequency ablation (EVLA/RFA), ultrasound-guided foam sclerotherapy (UGFS), and miniphlebectomy (MF), individually or in combination. Short-term rivaroxaban (15-20 mg/day for 20-45 days) was prescribed for SVT. Primary endpoints: segment occlusion, reflux elimination, thrombus regression, recurrence, and complications (EHIT/DVT/PE). Secondary endpoints: changes in VCSS, CIVIQ-14, VDS, and VDSS.

Results. Great saphenous vein (GSV) reflux occurred in 20 (65 %) patients, small saphenous vein (SSV) reflux in 15 (48 %) patients, and perforator incompetence in 23 (74 %). Neovascularization at the SFJ/SPJ was detected in 10 (32 %), confirming true recurrence. EVLA was performed in 29/31 patients, usually with UGFS ± MF. Clinical improvement was significant: mean VCSS decreased from 5.5 to 2.1, and CIVIQ-14 from 35.2 to 22.2 (p<0.001). No EHIT ≥ II, DVT, or PE occurred. Duplex confirmed thrombus regression in 94 % of cases.

Conclusions. Combined minimally invasive treatment (EVLA/RFA + UGF±MF) is a feasible, safe, and effective option for RVVD complicated by SVT. This reflux-directed, office-based approach ensures durable anatomic success, rapid recovery, and meaningful quality-of-life improvement.

NPWT in Complex Surgical Management of Combat Vascular Injuries of the Limbs: Fundamentals of Safe Application and Clinical Experience

2025-12-25T18:39:36+02:00

Introduction. Combat vascular injury of the limbs represents one of the most complex categories of trauma. Such injuries are rarely isolated and are often accompanied by extensive soft-tissue defects and microbial contamination, leading to severe complications such as thrombosis and erosive bleeding. Their treatment remains challenging, prolonged, and frequently results in limb loss. Negative pressure wound therapy (NPWT) has proven to be an effective method for managing complex gunshot wounds in combat conditions; however, evidence on its safe application in vascular limb trauma remains limited.

Aim. To analyze theoretical and practical aspects of the safe use of NPWT in combat-related injuries of major limb vessels and to determine the indications, contraindications, and optimal technical parameters for its application.

Materials and Methods. A comparative analysis of published data and clinical observations was performed, including cases of combat vascular injury of the lower limbs with associated soft-tissue defects where NPWT was used as part of staged surgical management.

Results. Key indications, contraindications, and principles for safe NPWT use in vascular surgery were defined. The application of a two-layer dressing with a protective interface and continuous negative pressure of 70–80 mmHg ensured procedural safety in vascular reconstruction zones, promoted rapid wound cleansing and granulation, and enabled successful delayed closure using skin-grafting techniques.

Conclusions. NPWT is an effective adjunct in the complex surgical management of combat vascular limb injuries combined with soft-tissue loss. Safe application requires reliable protection of the vascular anastomosis, maintenance of continuous negative pressure, and individualized risk assessment. Further research should focus on developing unified clinical protocols for NPWT in combat vascular trauma, including reliable vessel protection methods and prevention of procedure-related complications.

Effect of Macrolide and Non-Macrolide Therapy on QTc Interval Prolongation in Cardiac Patients with Community-Acquired Pneumonia

2025-12-25T18:53:02+02:00

Introduction. Azithromycin is a macrolide antibiotic widely used to treat various infectious diseases, such as respiratory infections. Several studies have reported an association between azithromycin and QT interval prolongation. QTc prolongation is one of the causes of the life-threatening arrhythmia torsade de pointes (TdP). Torsade de pointes has been reported in approximately 1 % of patients with QT interval prolongation after exposure to azithromycin.

Aim. This study aims to determine the effect of macrolide and non-macrolide regimen therapy on the prolongation of the QTc interval in cardiac patients with community-acquired pneumonia.

Materials and Methods. This is a retrospective cohort study of 33 cardiac patients with community-acquired pneumonia who received macrolide and non-macrolide therapy during hospitalization. Serial electrocardiograms were performed on days 1, 3, 5, and pre-discharge to evaluate the QTc interval.

Outcomes. In the group of heart disease patients with community-acquired pneumonia who received macrolides, there was a significant prolongation of the QTc interval (p<0.05) in the independent T-test, Mann-Whitney test, and Friedman test. Risk factors of age, female gender, history of hypertension, and diabetes mellitus had a significant effect (p<0.05) in the Friedman test.

Conclusions. This study shows that macrolide therapy in heart disease patients with community-acquired pneumonia significantly and consistently prolongs the QTc interval throughout the treatment period compared with non-macrolide therapy. Risk factors include age, female gender, history of hypertension, and diabetes mellitus.

Endovascular Occupational Radiation: Immediate and Acute Effects

2025-12-25T18:58:21+02:00

Introduction: Medical professionals in catheterization laboratories are routinely exposed to ionizing radiation during fluoroscopy-guided procedures. While long-term risks such as cataracts and malignancies are well documented, there is limited evidence about the acute symptomatic effects experienced during or immediately after procedures. Early detection of such symptoms may help in minimize health risks and improving protective measures.

Aim: To assess the prevalence and severity of acute health symptoms among catheterization lab personnel and evaluate their correlation with weekly exposure hours, years of experience, age, and adherence to radiation protection practices.

Materials and Methods: A cross-sectional survey was conducted among 50 catheterization lab staff in Iraq, including physicians, technicians, and nurses. The survey collected data on demographics, weekly exposure hours, years of experience, and protection practices, alongside self-reported severity [0-10 scale] of symptoms like headache, fatigue, dizziness, poor concentration, and more. Spearman’s correlation and multivariate regression analyses were used to identify predictors of symptom severity.

Results: Headache, drowsiness, fatigue, and muscle pain were the most prevalent acute symptoms (92-96 %), followed by poor concentration (86 %) and blurred vision (92 %). Years of experience emerged as a strong predictor for several symptoms, including headache (p=0.0028), pharyngeal pain (p=0.0164), and sexual dysfunction (p=0.0432). No significant protective effect was observed from self-reported adherence to radiation safety practices.

Conclusions: Acute symptoms during or after fluoroscopic procedures are common and significantly associated with cumulative radiation exposure. The absence of a protective relationship from self-reported shielding behavior underscores the need for real-time dosimetry, improved shielding, and institutional health surveillance programs.

Age- and Sex-Related Variations of Myocardial T2: Insights from Quantitative Mapping in a Healthy Ukrainian Population

2025-12-25T19:03:23+02:00

Background. Cardiac magnetic resonance imaging (CMR) is recognized as the gold standard for non-invasive myocardial tissue characterization. Quantitative T2 mapping provides a direct measurement of myocardial transverse relaxation time (T2), which reflects tissue water content and serves as an objective marker of myocardial edema. Prolonged T2 values indicate increased free water content and are commonly associated with inflammation, ischemic injury, or with myocarditis. Unlike conventional T2-weighted techniques such as T2-STIR, which are prone to motion artifacts and subjective interpretation, T2 mapping enables absolute, reproducible, and quantitative assessment of myocardial tissue. However, reference T2 values remain insufficiently defined for the Ukrainian and broader Eastern European populations, particularly in pediatric cohorts. Establishing such reference ranges is crucial for accurate clinical interpretation and differentiation between physiological variability and early myocardial pathology.

Aim. This study aimed to establish age- and sex-specific reference values for myocardial T2 relaxation time in a healthy Ukrainian population and to evaluate potential influence of age and sex on these parameters.

Materials and Methods. A total of 310 healthy individuals (196 adults and 114 children and adolescents) underwent CMR on a 1.5 Tesla scanner using a standardized T2-prepared balanced steady-state free precession (bSSFP) sequence. Measurements were acquired at mid-ventricular short-axis levels, excluding blood pool and epicardial fat. Data were analyzed using IBM SPSS Statistics v26 and GraphPad Prism v10. Normality was assessed with the Shapiro–Wilk test. Group comparisons employed independent-sample t-tests, one-way ANOVA, or nonparametric Kruskal–Wallis tests as appropriate, with statistical significance set at p<0.05.

Results. The overall mean myocardial T2 value across the cohort was 45.1±2.7 ms (range 31-50 ms) with a normal distribution. In adults, mean T2 was 45.0±2.6 ms, and in children 45.3±2.8 ms (p>0.05). Age-stratified analysis among children revealed no significant differences between infants, early childhood, school-age, and adolescents (ANOVA F=0.16, p>0.05). In adults, women exhibited slightly higher T2 values than men (46.0±3.3 ms vs 44.6±2.2 ms; t=3.42, p<0.001), consistent with previously reported sex-related variability. In pediatric cohorts, no significant sex-based difference was observed (45.3±2.7 ms vs 45.3±2.9 ms; p=0.98). Visual analysis using boxplots and violin plots confirmed symmetric distributions, overlapping interquartile ranges, and the absence of age-dependent trends.

Conclusions. Myocardial T2 mapping using a T2-prepared bSSFP sequence at 1.5 T provides stable, reproducible, and physiologically consistent quantitative measurements across all age groups. The unified reference interval of 45±3 ms can be applied for both pediatric and adult populations. Slightly higher T2 values in adult women should be considered a normal physiological variation rather than a pathological indicator. These results establish foundational reference data for myocardial T2 mapping in the Ukrainian population and support its clinical use for accurate, contrast-free quantification of myocardial tissue characteristics across the lifespan.

Risk Assessment of Gram-Negative Sepsis in Cardiac Surgery: From Clinical and Anamnestic Predictors to a Prognostic Model

2025-12-25T19:08:51+02:00

Gram-negative sepsis remains a serious threat to cardiac surgery patients. The incidence of gram-negative sepsis at the preoperative stage accounts for 10-25 % of all reported cases. In the postoperative period, gram-negative bacteria were responsible for sternal wound infections in 35 % of cases and caused bacteremia in 11 % of cases. Preoperative assessment of the risk of gram-negative sepsis represents an essential component of the clinical strategy in cardiac surgery.

Aim. To investigate the clinical, laboratory, and anamnestic risk factors associated with the development of gram-negative sepsis in cardiac surgery patients, with the goal of constructing a prognostic model to identify high-risk patients at the preoperative stage.

Materials and methods. The study included clinical data from 116 patients who underwent examination and treatment at the M.M. Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine between January 1, 2020, and January 1, 2025. Inclusion criteria were bacteriological identification of a gram-negative pathogen in blood cultures at any stage of treatment, admission to the intensive care unit (ICU), and age over 18 years.

Results. Multivariate analysis showed that identification of a gram-negative pathogen in a chronic wound at the preoperative stage was most strongly associated with an increased likelihood of sepsis development (OR=18,101.36; 95 % CI: 13.95-23,487,640.00; p<0.05). The presence of more than two intravenous catheters in the ICU significantly increased the risk of gram-negative sepsis (OR=376.86; 95 % CI: 4.15-34,210.14; p<0.05). Use of corticosteroids in the ICU prior to the diagnosis of sepsis increased the odds of developing gram-negative sepsis by 7.55 times (95 % CI: 1.31-43.35; p<0.05). To assess the prognostic performance of the developed multivariate model, a ROC curve was constructed, demonstrating an AUC of 0.96, with a sensitivity of 90 % and a specificity of 90 %.

Conclusions. The study demonstrated that the key independent risk factors for the development of gram-negative sepsis were preoperative colonization of a chronic wound with gram-negative flora, a high frequency of intravascular device use in the ICU, and the immunosuppressive effect of corticosteroid therapy.

Comparative Effects of 12 Weeks of Center-Based versus Home-Based Exercise Training on hs-CRP and IL-6 Levels in Patients with Heart Failure Reduced Ejection Fraction

2025-12-25T20:35:50+02:00

Introduction. Heart failure (HF) is a global health concern characterized by significant morbidity and mortality, often associated with chronic systemic inflammation. Exercise-based cardiac rehabilitation is a cornerstone of HF management; however, accessibility limitations often restrict participation. Home-based exercise programs offer a potentially viable alternative. This study aimed to evaluate the effects of 12 weeks of center-based versus home-based exercise training on inflammatory markers, specifically high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6), in patients with heart failure with reduced ejection fraction.

Aim. This study aimed to evaluate the effects of 12 weeks of center-based versus home-based exercise training on inflammatory markers, specifically high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6), in patients with heart failure reduced ejection fraction.

Materials and Methods. A quasi-experimental design was employed involving 31 patients diagnosed with heart failure with left ventricular ejection fraction below 40 %. Participants were allocated into two groups: center-based exercise (n=15) and home-based exercise (n=16). Both groups underwent a 12-week exercise rehabilitation program consisting of light-intensity sessions five times per week. Baseline and post-intervention blood samples were collected to measure serum levels of hs-CRP and IL-6. Clinical and demographic data were also recorded. Statistical analyses were performed using the Mann–Whitney and Wilcoxon signed-rank tests, with significance set at p<0.05.

Results and Discussion. Both exercise modalities resulted in significant reductions in IL-6 and hs-CRP levels after 12 weeks (p<0.001). Median IL-6 decreased from 13.1 pg/mL to 4.8 pg/mL, while median hs-CRP declined from 4.3 mg/L to 2.5 mg/L across all participants. No statistically significant differences were observed between the center-based and home-based groups in the extent of reduction for either biomarker (IL-6, p=0.906; hs-CRP, p=0.200).

Conclusions. Twelve weeks of home-based exercise training is as effective as center-based training in reducing systemic inflammation, as measured by IL-6 and hs-CRP, in patients with heart failure with reduced ejection fraction. These findings support the use of home-based rehabilitation as a viable alternative to center-based programs for managing inflammation in this patient population.

Comparative analysis of Treadmill Walking with different occlusion pressure on aerobic capacity and muscle strength among Sedentary Collegiates- A Randomized Controlled Trial

2025-12-25T20:39:05+02:00

Background. Sedentary lifestyles among college students pose a significant public health challenge, contributing to diminished aerobic capacity and muscle strength. Blood Flow Restriction training (BFRT) has emerged as an effective method to enhance physiological adaptations with low mechanical stress.

Aim. This study evaluates the comparative effects of treadmill walking under varying occlusion pressures on aerobic capacity and knee extensors strength in sedentary collegiate.

Materials and Methods. Thirty sedentary college students (aged 18-25 years) were randomized into three groups: Group A (low-pressure BFRT at 40 % limb occlusion), Group B (high-pressure BFRT at 60 % limb occlusion), and Group C (control, no occlusion). Participants underwent supervised treadmill walking for 20 minutes, three times per week over four weeks. Outcomes measured pre- and post-intervention included VO₂ max (aerobic capacity) and quadriceps strength. Statistical analysis was performed using SPSS v25.0 with significance set at p<0.05. A one-way ANOVA was employed to compare differences between groups at baseline and post-intervention. Paired t-tests were used for within-group comparisons.

Results. Significant improvements were observed in group A&B. Although Group B demonstrated the highest increase in VO₂ max (18 %) and muscle strength (22 %), followed by Group A (13 % and 16 %, respectively), while Group C showed minimal gains (6 % VO₂ max, 8 % strength) with no adverse events occurred in any group.

Conclusions. Treadmill walking with BFRT especially at higher occlusion pressures is an effective, safe, and time-efficient intervention to enhance aerobic capacity and knee extensors strength in sedentary young adults. These findings support the integration of individualized BFRT protocols in fitness and rehabilitation settings to counteract inactivity-related deconditioning.

Effectiveness of Virtual Reality among Patients with Cardiopulmonary Disorders- A Narrative Review (Literature Review)

2025-12-26T14:45:42+02:00

Background. Cardiopulmonary disorders, including chronic obstructive pulmonary disease (COPD), heart failure, and post-cardiac surgery conditions, significantly impact patients' physical capabilities and quality of life. Traditional rehabilitation programs often face challenges such as low motivation and adherence. Virtual Reality (VR), with its immersive and interactive features, has emerged as a potential tool to enhance engagement and improve clinical outcomes in cardiopulmonary rehabilitation.

Aim. This narrative review aims to explore the effectiveness of VR-based interventions in the rehabilitation of patients with cardiopulmonary disorders by analyzing current evidence and clinical applications.

Materials and Methods. A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Google Scholar. Studies focusing on the use of VR in patients with cardiopulmonary conditions were selected, including randomized controlled trials, observational studies, and pilot trials published in English. Key outcomes assessed included physical performance, respiratory function, psychological well-being, and adherence.

Results. The review indicates that VR-based rehabilitation programs can lead to improvements in exercise tolerance, pulmonary function, and mental health indicators such as anxiety and depression. VR also shows promise in enhancing motivation and compliance, especially in home-based and tele-rehabilitation settings. Despite positive trends, heterogeneity in study design, VR modalities, and outcome measures limit definitive conclusions.

Conclusions. VR represents a promising adjunct to conventional cardiopulmonary rehabilitation strategies. It offers a novel approach to patient engagement and functional improvement. However, more standardized, large-scale studies are necessary to validate its efficacy and establish clinical protocols for widespread use.

A Case of Simultaneous Surgical Correction of Tetralogy of Fallot Combined with Tracheal Stenosis in a One-Year-Old Child

2025-12-25T20:51:14+02:00

Congenital tracheal stenosis formed by complete cartilage rings is a rare disorder, occurring in 1:64,500 newborns. Concomitant heart defects significantly complicate the course of the disease and its surgical management. The natural course of complete cartilage ring tracheal stenosis carries a mortality of up to 80 %. Currently, simultaneous surgical intervention with the use of cardiopulmonary bypass in cases of concomitant congenital heart defects is the “gold standard” of treatment and is associated with satisfactory outcomes.

Aim. To present and analyze a case of simultaneous surgical correction of congenital long-segment complete cartilage ring tracheal stenosis and tetralogy of Fallot.

Clinical case. We present a clinical case of successful single-stage correction of tetralogy of Fallot with tracheal reconstruction using the slide tracheoplasty technique in a child aged 1 year and 5 months. The diagnosis of tetralogy of Fallot was made prenatally, and congenital tracheal stenosis was identified due to the inability to perform endotracheal intubation during routine surgery for congenital heart disease. The patient was referred to a thoracic surgeon for consultation. Tracheobronchoscopy and computed tomography revealed long-segment complete cartilage ring stenosis, and a decision was made to perform simultaneous correction of the congenital defects. The patient underwent successful simultaneous correction of tetralogy of Fallot and slide tracheoplasty under cardiopulmonary bypass with bronchoscopic guidance. The total duration of the surgery was 420 minutes. The patient was extubated as planned 96 hours after control tracheobronchoscopy. There were no complications during the intraoperative or postoperative periods. The patient remained in the intensive care unit for 6 days and in the hospital for 17 days. Tracheobronchoscopy five months after surgery revealed no restenosis or granulation tissue.

Conclusions. Simultaneous surgical correction and a thorough multidisciplinary approach in the treatment of congenital long-segment complete cartilage ring tracheal stenosis with tetralogy of Fallot demonstrate satisfactory postoperative outcomes. Slide tracheoplasty is currently the gold standard in the surgical treatment of long-segment complete cartilage ring tracheal stenosis.

Surgical Reconstruction of the Aorto–Left Ventricular Junction Using a Bovine Xenopericardial Patch in Prosthetic Aortic Valve Infective Endocarditis: A Case Report

2025-12-25T20:59:49+02:00

Background. Prosthetic aortic valve infective endocarditis (PVE) complicated by a circular annular abscess with complete disruption of the aorto–left ventricular junction (ALVJ) represents a major surgical challenge. Although bovine xenopericardial patches have previously been used for annular reconstruction in complex cases of infective endocarditis (IE), this report, for the first time, describes the use of a domestically manufactured bovine xenopericardial patch produced in Ukraine. The case highlights its practical applicability and potential significance for cardiac surgeons in Eastern Europe.

Case Presentation. A 36-year-old man, who had previously undergone aortic valve replacement with a mechanical prosthesis (SJM #25) and supracoronary ascending aortic banding through a mini-J sternotomy in 2020, was admitted in May 2025 with complaints of fever, palpitations, memory impairment, and signs of systemic inflammatory response syndrome. Blood cultures grew Streptococcus pneumoniae. Echocardiography and computed tomography confirmed PVE complicated by a circular annular abscess and severe paravalvular regurgitation. After initial antibiotic therapy aimed at controlling bacteremia, the patient was referred to our center.

Intraoperatively, a circular annular abscess with complete disruption of the ALVJ was found. The infected prosthesis was explanted along with the surrounding infected tissues, and meticulous local debridement was performed using antiseptic solutions. The ALVJ defect was reconstructed with a 7 × 1.5 cm bovine xenopericardial patch of domestic production (Glutaflex®, Ukraine). Subsequently, a new mechanical prosthesis (Carbomedics #23) was implanted. The aortotomy was closed, and the previously implanted vascular graft was reused for ascending aortic banding. Postoperatively, the patient required temporary pacing. At the 3-month follow-up, he remained in satisfactory clinical condition, with no evidence of residual infection or prosthetic valve dysfunction.

Conclusions. This case demonstrates that bovine xenopericardial patches of domestic manufacture can be effectively used for annular reconstruction in IE complicated by periannular abscess formation. The material exhibited excellent intraoperative handling characteristics, biocompatibility, and accessibility, making it a promising and cost-effective alternative for cardiac surgeons, particularly in resource-limited settings.