Amosov National Institute of Cardiovascular Surgery

The article presents a review of literary and scientific sources from the MEDLINE database on PubMed, Web of Science, Scopus, and Google Scholar platforms, focusing on hypertrophic cardiomyopathy and its treatment aspects. In accordance with the recommendations of leading experts, a modern definition of hypertrophic cardiomyopathy is shown with a description of the classification of structural and functional cardiac abnormalities, associated symptoms, and generalized risk factors for sudden cardiac death in patients. A ranking of patients related to the left ventricular outflow tract obstruction and clinical manifestations is submitted. Based on international guidelines, the main principles for treating patients are given, depending on hemodynamic and clinical characteristics, including pharmacotherapy and invasive methods. Pathophysiological reasoning and clinical justification for prescribing drugs to correct complications are provided. The use of septal myectomy and alcohol septal ablation to correct morphological cardiac abnormalities and improve the clinical status of patients is outlined in a historical context. The results of one’s own experience in surgical treatment of patients with hypertrophic cardiomyopathy are presented.

Hypertrophic obstructive cardiomyopathy (HOCM) remains a prevalent and clinically significant condition with a global prevalence of 1:200 to 1:500. In Ukraine, the estimated burden is approximately 75,000 patients, although national data remain limited. Since 2016, the Amosov National Institute of Cardiovascular Surgery in Kyiv has been a leading center for HOCM surgery, primarily performing septal myectomy (SM) with concomitant mitral valve (MV) repair. This review summarizes the evolution of the Institute's surgical program, outcomes, and challenges faced under extraordinary circumstances. Institutional experience with SM and MV repair between 2016 and 2025 was reviewed. Preoperative evaluation included transthoracic echocardiography (TTE), cardiac magnetic resonance (CMR) imaging, and/or computed tomography (CT). A refined transaortic SM technique was applied to optimize septal resection, relieve left ventricular outflow tract (LVOT) obstruction, and address dynamic mitral regurgitation (MR). SM consistently reduced LVOT gradients and eliminated MR in the majority of patients. In-hospital mortality remained below 1%, with a low incidence of major complications directly attributable to myectomy. Despite significant external pressures, including the coronavirus disease 2019 (COVID-19) pandemic and the ongoing full-scale war in Ukraine, surgical activity continued without interruption. Innovations in operative techniques and perioperative management further enhanced safety and outcomes. The Amosov Institute has established a high-performing national program for HOCM surgery, demonstrating durable results despite unprecedented challenges. Ongoing refinement of minimally invasive strategies and strengthened international collaboration remain essential to address the global shortage of experienced myectomy surgeons and ensure wider access to advanced surgical care. The online version contains supplementary material available at 10.1007/s12055-025-02125-0.

Disruption of the balance between oxygen delivery and consumption remains a key contributor to metabolic disturbances and potential perioperative complications. This study explores the feasibility of calculating and applying the oxygen mass transfer coefficient (KO₂) as a core indicator of the mass-exchange capacity of the microcirculatory membrane. The proposed approach is grounded in the theoretical linkage between critical parameters of cardiopulmonary bypass (CPB) and the fundamental Fick’s law, enabling a quantitative assessment of oxygen diffusion efficiency under artificial circulation conditions. Objective. To improve the assessment of systemic oxygen balance during CPB by introducing an integral oxygen mass transfer coefficient (KO₂), which combines the main perfusion adequacy criteria based on Fick’s principle. Materials and Methods. A total of 129 intraoperative observations were analyzed during cardiac surgical procedures involving cardiopulmonary bypass (CPB). These data served as the basis for all necessary calculations to determine the oxygen mass transfer coefficient (KO₂). CPB monitoring parameters included standard acid–base balance and blood gas variables consistent with the alpha-stat strategy, based on Astrup’s micromethod and the Siggaard–Andersen principles, using conventional blood gas analyzers. Additionally, physiological variables were taken into account, including hemodynamic indices, hematological status, anthropometric characteristics, as well as indicators of perfusion efficiency and metabolic balance. Results. Within the framework of analytical validation, KO₂ dynamics demonstrated consistent behavior across both temperature groups and aligned with independent markers of tissue oxygenation status – specifically, increases in lactate levels and oxygen extraction, decreases in venous blood gas parameters, and shifts in acid–base balance. As these variables were not included in the clustering algorithm, their concordance supports the analytical independence and functional informativeness of KO₂. Furthermore, changes in KO₂ were often observed to precede alterations in metabolic parameters. Conclusions. The construct validity of KO₂ demonstrated sensitivity to early alterations in oxygen balance and functional concordance with independent metabolic indicators, supporting its potential as a promising engineering parameter for automated assessment of oxygenation efficiency during cardiopulmonary bypass.

Lethal lung developmental disorders (LLDDs), histologically classified as alveolar capillary dysplasia with misalignment of pulmonary veins (ACDMPV), congenital alveolar dysplasia (CAD), acinar dysplasia (AcDys), and primary pulmonary hypoplasia (PH), are rare diseases associated with high neonatal mortality due to refractory respiratory failure. Although ACDMPV mostly results from single nucleotide variants (SNVs) or copy-number variants (CNVs) involving FOXF1, AcDys, CAD, and PH are often associated with abnormalities within TBX4 or FGF10. These genes interact in the SHH-FOXF1 and TBX4-FGF10 signaling network and are known regulators of lung development. Recent studies conducted in TBX4-, FGF10-, or FOXF1-deficient LLDD lungs revealed decreased expression of TMEM100 at the transcriptomic and immunohistochemical levels. Here, we present four new patients with genetically and histopathologically confirmed LLDD, including ACDMPV (n = 2), AcDys (n = 1), and PH (n = 1), in whom we detected a heterozygous variants involving FOXF1 (n = 2) or TBX4 (n = 2). Additional immunohistochemical (TMEM100) and qPCR analyses (TMEM100, TBX4, FOXF1) performed in lung tissues of these newborns revealed a significant reduction in TMEM100, TBX4, and FOXF1 expression. Our results confirm previous findings indicating the possible involvement of TMEM100 in FOXF1-TBX4-FGF10 molecular signaling that, when disrupted, may lead to LLDD.

Aortic perforation is a rare and potentially fatal complication during percutaneous coronary intervention (PCI). This Interactive CME Case presents the case of a 47-year-old man who developed cardiac tamponade secondary to iatrogenic aortic perforation during PCI—a true nightmare.

Background. There is currently limited evidence on the effective management of intensive care for infective endocarditis (IE), including specific clinical signs that indicate a poor prognosis, as well as prognostic tools that are effective in identifying high-risk patients. Aim: Evaluate the effectiveness of using a severity assessment system in patients with infective endocarditis complicated by acute heart failure in the perioperative stage. Materials and methods. The study included clinical data of 75 patients with IE complicated by preoperative acute heart failure (AHF), who were hospitalised at the State Institution ‘Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine’ from 01.01.2019 to 01.01.2023. At the perioperative stage, clinical and biochemical parameters were assessed and scores were calculated according to the sepsis-associated organ dysfunction score. Results. The median calculated preoperative APACHE II score was 14 points (11;19). In our study, 23 patients (30.7%) belonged to the group with scores from 15 to 19. Surgical intervention under conditions of artificial circulation was performed in 72 (96.0%) cases. At the preoperative stage, hospital mortality was 3 (4.0%) patients with IE complicated by preoperative AHF. The median calculated APACHE II score on the first day of the postoperative period was 11 points (6;13). The distribution of patients based on the APACHE II scale was analysed. The largest number - 12 (16.7%) - of patients had a score of 13 on the APACHE II scale. The largest cohort at this stage was made up of patients with scores from ‘4’ to ‘9’ - 42 (58.3%) cases. In-hospital mortality in the surgical treatment of IE complicated by AHF was 10 (13.9%) cases. Conclusions. A balanced preoperative assessment of the risks of cardiac surgery will allow modifying the tactics of perioperative management of patients with IE complicated by preoperative AHF.

In the world, minimally invasive mitral valve surgery (MIMVS) has a recognized role in the surgical treatment of mitral valve (MV) diseases, however, this technique has not yet been widely used in our country. Due to the lack of clear clinical guidelines and recommendations in the choice of access to MV, many cardiac surgery centers implement a minimally invasive technique insufficiently often, and this procedure is characterized by complex learning curve. The aim. To analyze the results of MV surgical treatment using a minimally invasive approach. Materials and methods. Between 2020 and 2024, surgical treatment of MV insufficiency through a right-sided minithoracotomy was performed in 34 patients aged 18 to 67 at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, forming the primary study group. The comparison group included 36 consecutive patients (aged 25 to 81) who underwent isolated MV insufficiency correction through the classic approach, i.e. median longitudinal sternotomy (between 2023 and 2024). Results. The studied groups did not differ in terms of echocardiographic parameters. It was established that blood loss in the operating room was significantly higher with median longitudinal sternotomy compared to minithoracotomy (268.06 ± 14.3 mL and 192.50 ± 12.1 mL, respectively; p = 0.001). However, duration of operation and time of aortic compression were significantly longer in patients in the main group compared to controls, which is consistent with data from other researchers. Patients after minithoracotomy had a likely lower number of hours of analgesia, compared to those after median longitudinal sternotomy (88.35 ± 12.9 hours and 148.11 ± 16.6 hours, respectively; p = 0.009). Complications occurred less often in patients after minithoracotomy than in controls (8.8% and 11.1%, respectively; p > 0.05). Conclusions. MIMVS was associated with less blood loss in the operative period and reduced the severity of early postoperative pain. The effectiveness of surgical treatment using MIMVS was 100%, while complications occurred less often than in controls.

The aim. To study the effectiveness of left main coronary artery (LMCA) stenting in patients with coronary heart disease and to optimize the choice of percutaneous coronary intervention technique based on the experience of one clinic. Materials and methods. The study, which was conducted at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, included 107 patients with LMCA disease, who underwent stenting from January 2019 to December 2023. During the study, the patients were divided into two groups. One group underwent stenting using the single-stent method (44 patients, 41.1%), while the other group underwent stenting using the double-stent method (63 patients, 58.9%). Results. In the group of surveyed patients after stenting, an analysis was conducted regarding adherence to drug therapy and achievement of target lipid spectrum levels. It was found that one of the reasons for the active progression of atherosclerosis can be considered low adherence to drug therapy. A group of patients with recurrence of angina after stenting, the cause of which was restenosis in the stented segment, was analyzed. In the analysis of the frequency of repeated interventions in patients with hemodynamically significant lesions of the LMCA, who initially underwent stenting, it was found that 24.5% of patients (n = 24) underwent stenting again at the second visit and only 4 patients (4.1%) underwent bypass surgery, which is statistically significant (p ≤ 0.001). Conclusions. LMCA stenting is an effective way of treating patients with hemodynamically significant damage to it (effectiveness of the technique is 71.4%). Recurrence of angina was observed in 28 patients (28.6%). Both single-stent and double-stent procedures are effective: recurrence of angina was observed in 13.3% and 15.3% of cases, respectively. One of the main reasons for the recurrence of angina pectoris is the progression of atherosclerosis in new locations (39.3%) and restenosis in stenting segment (39.3%).

The aim of this study is to justify the use of stenting as the method of choice for revascularization of left main coronary artery lesions. Materials and methods. A comprehensive analysis of scientific publications and randomized trials was conducted to evaluate the advantages and disadvantages of various stenting techniques for left main coronary artery lesions, to optimize treatment strategies for individual patients, to improve clinical outcomes, to reduce complications, and to enhance the quality of life for patients with left main coronary artery disease. Results. The proper selection of stenting techniques for left main coronary artery lesions is a critical factor for procedural success. The choice of intervention should consider the lesion characteristics of both the main trunk and its side branches. To achieve optimal immediate and long-term outcomes, strict adherence to intervention protocols is essential, particularly in patients requiring the initial use of double-stent techniques. It is worth noting that single-stent techniques may sometimes necessitate a switch to double-stent strategies, with the TAP (T and small protrusion) and Culotte techniques being the most accessible transitions. The single-stent technique remains highly effective for patients with simple anatomical lesions. For simple bifurcation lesions, the “T-stenting” and “TAP” techniques are selectively utilized. Comparative analysis reveals a higher rate of thrombosis with the Culotte technique compared to the DK Crush technique. A critical prerequisite for successful stenting of the left main coronary artery is the use of intravascular imaging, as it ensures precise selection of equipment and reduces the risk of long-term restenosis in the stented segment. Conclusions. The right choice of stenting technique for the left main coronary artery is a key factor in the success of the procedure. Modern technologies and two-stent strategies enable effective treatment of complex lesions, minimizing the risks to the patient.

Objective. To study the clinical features of SARS–CoV–2 infection as a possible risk factor for the development of acute infective native valve endocarditis complicated by intracardiac abscesses and its mechanisms, including the persistence of SARS–CoV–2 infection in the cardiovascular system in the long term after its transmission. Materials and methods. The cohort retrospective study conducted at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 01.07.2020 to 01.07.2022 included 64 patients with infective endocarditis complicated by intracardiac abscesses, which in 18 of them was associated with SARS–CoV–2 infection. All patients showed a clear link between the onset of cardiac symptoms and SARS–CoV–2 infection. The average time to seek medical care after SARS–CoV–2 infection was (2 ± 1.2) months. The study patients (n=64) were divided into two groups: Group 1 – 18 (28.1%) patients with infective native valve endocarditis complicated by intracardiac abscesses with SARS–CoV–2 infection and Group 2 – 46 (71.8%) patients with infective native valve endocarditis complicated by intracardiac abscesses without SARS–CoV–2 infection. The average age of patients was (48.7 ± 1.4) years. Results. The diagnosis of SARS–CoV–2 was confirmed in all patients by bacteriological examination of oropharyngeal and nasopharyngeal material by polymerase chain reaction. The diagnosis of infective endocarditis complicated by intracardiac abscesses was confirmed according to the modified Duke University criteria. According to transthoracic, transesophageal echocardiography and computed tomography, massive vegetation of the aortic valve was detected in 38 (59.4%) patients, mitral valve – in 8 (12.5%), aortic, mitral and tricuspid valves – in 18 (28.1%). Intracardiac abscesses were recorded in all 64 (100%) patients, 9 (14.1%) of whom had fistulisation in the right heart. The frequency of inflammatory lung disease and aortic valve abscesses differed statistically significantly between the study groups of patients – p=0.001 and p=0.002, respectively. In all patients, the intracardiac anatomy was restored using an autopericardium. Conclusions. At the stage of hospitalisation of patients with systemic inflammatory response syndrome, the effectiveness of care depends on the timely diagnosis of complications of the underlying disease. Most current reports on SARS–CoV–2 contain only brief descriptions of cardiovascular manifestations in these patients. Given the enormous burden this disease places on the healthcare industry and the significant adverse prognostic impact of cardiac involvement with infective endocarditis, further research is needed to understand the frequency, mechanisms, clinical presentation and various cardiovascular manifestations in patients with SARS–CoV–2.