Complex Issues of Cardiovascular Diseases
Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”
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ALGORITHM FOR RISK STRATIFICATION OF ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION DURING ONE-YEAR FOLLOW-UP
Highlights Based on one-year prospective follow-up data, a risk stratification algorithm was developed for patients with heart failure with preserved ejection fraction (HFpEF), incorporating clinical and anamnestic characteristics as well as laboratory and instrumental parameters. The proposed algorithm enables the stratification of patients with HFpEF and coronary artery disease with non-obstructive coronary lesions into high-, intermediate-, and low-risk groups for adverse cardiovascular events over a one-year follow-up period. The implementation of this algorithm may help optimize clinical decision-making in patients with HFpEF and non-obstructive coronary atherosclerosis. Aim. The aim of this study was to develop an algorithm to stratify patients with heart failure with preserved ejection fraction (HFpEF) into risk groups based on a one-year prospective observation. This algorithm will consider clinical, anamnestic, laboratory, and instrumental parameters. Methods. The study included 55 patients diagnosed with HFpEF and coronary artery disease, who had with non-obstructive atherosclerotic lesions of the coronary arteries. Patients underwent assessment of left ventricular diastolic function, and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) was measured according to current clinical guidelines. The level of growth differentiation factor 15 (GDF-15) was studied. Quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire, and patient’s adherence to treatment was assessed using the Morisky Medication Adherence Scale. Results. The incidence of unfavorable clinical course of HFpEF during one-year follow-up was 41.8% (n = 37). According to the algorithm, if a patient has carbohydrate metabolism disorders, treatment adherence should be assessed. Low treatment adherence indicates a high risk of cardiovascular events (CVS). With high treatment adherence, the duration of arterial hypertension (AH) should be assessed. Values of ≥ 15 years indicate a high risk of CVS, while values < 15 years indicate an intermediate risk. In the absence of carbohydrate metabolism disorders, the GDF-15 concentration should be measured. If the GDF-15 concentration is ˂ 1753.5 pg/mL, the patient’s treatment adherence should be assessed. Low adherence indicates an intermediate risk, while high adherence indicates a low risk of CVS. If the GDF-15 concentration is ≥ 1753.5 pg/mL, the duration of AH should be assessed. Duration of AH ≥ 15 years indicates a high risk of developing CVS, while duration < 15 years indicates an intermediate risk. Conclusion: The algorithm developed in this study allows stratifying patients with HFpEF and non-obstructive coronary artery disease into groups with high (> 40%), intermediate (20–40%) and low (< 20%) risk of adverse CVS events during one-year prospective observation.
IMMEDIATE OUTCOMES OF TRANSCATHETER PULMONARY ARTERY VALVE IMPLANTATION IN THE TREATMENT OF PATIENTS AFTER SURGICAL CORRECTION OF COMPLEX CONGENITAL HEART DEFECTS
Highlights This study by the A.N. Bakulev NMRC of Cardiovascular Surgery reports for the first time in Russia on domestic clinical experience with transcatheter pulmonary valve implantation. Against the backdrop of the widespread adoption of this minimally invasive alternative to open surgery, the study provides a detailed analysis of the immediate results, efficacy, and safety of the technique at the A.N. Bakulev NMRC of Cardiovascular Surgery, which has performed the largest number of implants in the country. Aim. Evaluation of the safety and efficacy of transcatheter pulmonary valve implantation in the 30-day postoperative period. Methods. A prospective single-center study included 55 patients aged 9 to 32 years (mean age 14.7 ± 3.36 years, male – 43 (78.2%)), operated on at the A.N. Bakulev National Medical Research Center of Cardiovascular Surgery in the period from June 2023 to November 2025 (1 patient – in 2008, assessed retrospectively). The most common initial diagnosis was tetralogy of Fallot (n = 29 (52.72%)). In 32 patients (58.18%), valve implantation was performed in the native right ventricular outflow tract (RVOT), 17 (30.91%) – in a conduit, 6 (10.91%) – in an allograft. In 9 cases (16.36%), implantation was performed into a stented conduit, in 3 cases (5.45%) – into a previously installed pulmonary valve prosthesis. The predominant pathophysiological mechanism was a combination of stenosis and regurgitation (56.37% (n = 31)); isolated pulmonary regurgitation was detected in 20 patients (36.36%), and isolated pulmonary valve stenosis was found in 4 patients (7.27%). The median lumen area in the implantation zone was 482.3 (279.1; 601.4) mm2. Results. Valves were implanted in all 55 (100%) patients. The following stent valves were implanted: 38 (69.1%) Myval, 13 (23.64%) Pulsta, 2 each (3.63%) VenusP-Valve and Melody. The median stent-valve diameters were 27.5 (23; 32) mm. The median intervention time was 85 (65; 135) min. The invasive RVOT systolic pressure gradient decreased from 15 (10; 29) to 9 (4; 15) mmHg after the surgery, and the noninvasive peak gradient decreased from 40 (26; 60) to 14 (8; 20) mmHg. Pulmonary regurgitation was eliminated or became minimal in 100% of patients. Technical success of the procedure was achieved in 94.5% (n = 52) of cases, and clinical success was achieved in 96.36% (n = 53). 3 (5.45%) complications occurred, 1 of which (1.82%) was intraoperative and required surgical stent removal (prestenting). There were no cases of valve displacement or dysfunction during the follow-up period, and the mortality rate was 0%. Conclusion. Transcatheter pulmonary valve implantation is an effective and safe alternative to repeated cardiac surgery in the treatment of patients who have underwent multi-stage surgical correction of congenital heart disease.
SAFETY OF DIFFERENT BIOPROSTHESIS TYPES IN TRANSCATHETER IMPLANTATION IN PATIENTS WITH BICUSPID AORTIC VALVE
Highlights The use of balloon-expandable and self-expanding bioprostheses in bicuspid anatomy is characterized by a comparable safety profile. Hemodynamic advantages of self-expanding systems are negated in the presence of massive calcification of the left ventricular outflow tract. The use of balloon-expandable prostheses in favorable anatomy is associated with a significantly lower risk of conduction disturbances and pacemaker implantation. Aim. To conduct a comparative analysis of the immediate safety and efficacy outcomes of balloon-expandable and self-expanding bioprostheses in patients with bicuspid aortic valve stenosis, including those with severe calcification of the left ventricular outflow tract (LVOT). Methods. This single-center study included 102 patients with severe bicuspid aortic valve stenosis. Based on the device type and anatomy, patients were divided into three groups: Group 1 (n = 32) received a balloon-expandable valve (BEV, Myval); Group 2 (n = 41) received a self-expanding valve (SEV, Evolut PRO/PRO+); Group 3 (SEV-2, n = 29) included patients with massive LVOT calcification who underwent SEV implantation. Patients with severe LVOT calcification were excluded from the BEV group to prevent annular rupture. Endpoints were evaluated according to VARC-3 criteria. Results. No statistically significant differences were found between the groups regarding primary safety and efficacy endpoints at 30 days. The SEV group demonstrated superior hemodynamic parameters (mean gradient 8.9 ± 3.1 mm Hg) compared to the BEV group (11.6 ± 4.2 mm Hg, p = 0.003). However, in the SEV-2 group, the presence of calcification negated this advantage (mean gradient 12.3 ± 2.8 mm Hg) and was associated with a trend towards a higher incidence of paravalvular regurgitation ≥ grade 2 (13.8%). The permanent pacemaker implantation rate was lower in the BEV group (6.3%) compared to the SEV (12.2%) and SEV-2 (17.2%) groups. The incidence of new left bundle branch block was statistically significantly higher in the SEV-2 group compared to the BEV group (31.0% vs. 9.4%, p = 0.050). Analysis of neurological complications showed that the majority of stroke cases were non-disabling with full regression of symptoms. Conclusion. The use of balloon-expandable and self-expanding bioprostheses in bicuspid aortic valve stenosis is characterized by a comparable safety profile. Device selection requires a differentiated approach: self-expanding systems are the method of choice for massive LVOT calcification, whereas balloon-expandable prostheses are preferred to minimize the risk of conduction disturbances in patients with favorable anatomy.
THE IMPACT OF VARIOUS FACTORS ON THE ENGRAFTMENT OF FREE MUSCLE FLAPS DURING INDIRECT REVASCULARIZATION OF THE LOWER LIMBS IN PATIENTS WITH CRITICAL LIMB ISCHEMIA
Highlights When direct revascularization of the limb, either open or endovascular, is not feasible in patients with critical limb ischemia, these patients are often destined to undergo major limb amputation, which is associated with high rates of postoperative disability and mortality. Various indirect revascularization techniques have been proposed as alternatives to major amputation in this patient population, one of which is free flap transfer to the ischemic area. Subsequently, the flap becomes integrated into the ischemic tissues of the limb, enhancing local perfusion and thereby contributing to the gradual relief of critical ischemia. However, despite the advantages of this approach, the procedure is technically demanding and, in a subset of patients, is complicated by early perioperative flap loss. The present study attempts to analyze factors associated with early perioperative flap survival in patients with different etiologies of arterial disease and to propose preventive measures. Aim. To analyze various factors affecting the survival of free flaps in the early postoperative period. Based on the analysis of these factors, to propose methods for preventing early postoperative flap failure and to refine patient selection criteria. Methods. A retrospective analysis was performed of medical records from 39 patients (10 with thromboangiitis obliterans (Buerger’s disease), 16 with diabetes mellitus, and 13 with atherosclerosis) operated between 2016 and 2025, who underwent lower limb revascularization using a free muscle flap (gracilis or latissimus dorsi). Age, laboratory parameters (Hb, protein, creatinine), presence of infection and spectrum of pathogens, as well as outcomes in terms of flap survival or necrosis were assessed. Results. The overall free muscle flap engraftment rate was 64.1% (25 out of 39 patients). Flaps failed more frequently in older patients (66.8 ± 13.4 years, p = 0,0075). In patients with diabetes mellitus, flap necrosis occurred more often (62.5%), mainly associated with wound infection or flap vessel compromise. In the Buerger’s disease group, the engraftment rate was maximal (90%). Similar pathogens of wound infection were observed across all patient groups, with no correlation between specific pathogens and flap loss. No significant associations were found between laboratory parameters and flap failure. Conclusion. Further investigation of this technique is warranted, particularly in patients with diabetes mellitus. Monitoring glycated hemoglobin as a long-term marker of wound immune dysfunction and microangiopathy, and postponing surgery until target values are achieved, may improve outcomes in this patient group. To enhance flap survival and the success of revascularization, a comprehensive approach is required, including careful patient selection, optimization of comorbidities and aggressive management of wound infection.
THE RABBIT AS A MODEL FOR TESTING MATERIALS IMPLANTED INTO THE ARTERIAL BED
Highlights Additional risks associated with conducting preclinical testing in the rabbit model have been identified and thoroughly characterized. The methodology for conducting preclinical testing of materials implanted into the arterial bed in the rabbit model has been modified, encompassing all stages of the experiment – from anesthetic management to postoperative care. Background. Preclinical in vivo testing is a mandatory stage in the development of high-risk medical devices intended for implantation into the human body. The selection of an appropriate experimental model is critical for obtaining reliable and reproducible results. Despite the widespread use of the rabbit model in vascular implant research, not all risks accompanying this study and arising from the characteristics of the chosen animal model have been described and corrected throughout the experiment – from anesthetic management to postoperative care. Aim. To identify additional risks associated with preclinical testing of materials implanted into the arterial bed in a rabbit model and to modify the testing methodology by incorporating methods for correcting the identified risks. Methods. The study was performed on rabbits (n = 11) of the Soviet Chinchilla breed (body weight 4.45 [4.3;4.8] kg). The test object was a semi‑tubular nitinol specimen. The protocol included premedication, induction and maintenance of anaesthesia with mechanical ventilation using retrograde intubation. Access to the thoracic aorta was achieved by left‑sided thoracotomy. After systemic heparinisation, a stepwise ischaemic preconditioning protocol was applied. The specimen was implanted through a longitudinal aortotomy. Postoperative management included oxygen therapy for 24 h, a five‑day course of antibiotics, analgesics and anticoagulants. On day 90, ultrasound examination of the implantation zone was performed to assess patency, flow velocity parameters and the presence of thrombotic masses, followed by euthanasia of the animals and tissue sampling for histological analysis. Results. During the experiment (n = 11), the following complications were recorded: difficulty in performing intubation, paraplegia, and early postoperative respiratory failure. The modifications introduced included: optimization of animal positioning for intubation, implementation of stepwise ischemic preconditioning, reduction of occlusion time, performance of intercostal blockade, and administration of oxygen therapy during the first 24 hours after surgery. The modifications resulted in complete elimination of intubation-related and ischemic complications, and no early postoperative mortality occurred. In the surviving animals (n = 5) at 90 days, complete patency of the implantation zone was observed (peak systolic velocity 1.4 m/s, peak velocity ratio = 1), with no thrombosis, stenosis, or infection. Conclusion. The implemented modifications (optimized retrograde intubation, stepwise ischemic preconditioning, and oxygen therapy within the first 24 hours) proved effective in chronic testing of arterial implants in rabbits, significantly reducing the complication rate. The identified critical points determine the directions for further protocol optimization.
PERFUSION REHABILITATION OF A DONOR HEART FOLLOWING WARM ISCHEMIA: AN EXPERIMENTAL STUDY
Highlights Normothermic regional perfusion enables successful recovery of contractile function after 30 minutes of warm ischemia after circulatory death. Perfusion strategies targeting either a constant aortic root pressure (60–70 mmHg) or a constant systemic flow (100 mL/kg/min) yield comparable restoration of systolic and diastolic myocardial function, similar histological findings, and equivalent coronary sinus lactate levels. Flow‑targeted perfusion is associated with significantly higher systemic arterial pressure after weaning from cardiopulmonary bypass, suggesting more favourable early hemodynamic adaptation of the graft. Background. The shortage of donor organs remains an unresolved issue in transplantology. Donation after circulatory death is a promising avenue for expanding the donor pool but requires optimization of perfusion resuscitation protocols for grafts subjected to warm ischemia. Aim. To compare two strategies of normothermic regional perfusion – control of perfusion pressure (60–70 mmHg, group A) versus control of systemic flow (100 mL/kg/min, group B) – in an experimental DCD-donor model. Methods. The experiment was performed on 10 Landrace pigs (aged 3–5 months). Circulatory arrest was induced by exsanguination followed by 30 minutes of warm ischemia. NRP was conducted for 30 minutes, after which animals were weaned from cardiopulmonary bypass. Hemodynamic parameters, echocardiographic indices of systolic and diastolic function, coronary sinus lactate levels, myocardial edema extent, and histological changes were assessed. Results. Sinus rhythm was restored in all cases. After weaning from perfusion, group B demonstrated significantly higher systolic (107 vs. 61 mmHg, p = 0.036) and mean arterial pressure (92 vs. 71.5 mmHg, p = 0.041) compared to group A. No significant intergroup differences were found in cardiac output, echocardiographic parameters of ventricular function, lactate levels, edema extent, or myocardial histology. Conclusion. Both studied NRP strategies effectively restore heart graft function after warm ischemia. Flow-targeted perfusion is associated with higher systemic arterial pressure in the early post-reperfusion period, which may be relevant for graft hemodynamic stability.
COMPARISON OF HOUSEKEEPING PROTEIN AND TOTAL PROTEIN NORMALIZATION IN WESTERN BLOTTING ANALYSIS OF ENDOTHELIAL CELL LYSATE AND VASCULAR HOMOGENATE
Highlights Acid Black 1 and Fast Green FCF are the most sensitive dyes for total protein staining in endothelial cell lysate or vascular homogenate, detecting as low as ≥ 1 µg protein. Staining with antibodies to β-actin, TBP, and PCNA has the highest sensitivity in endothelial cell lysate, detecting as low as ≥ 1–2 µg protein, ≥ 2–4 µg protein, and ≥ 4 µg protein, respectively. Total protein staining can be employed for the signal normalization in Western blotting of endothelial cell lysate or vascular homogenate if coefficient of variation is ≤ 20% (in case of endothelial cell lysate) or ≤ 25% (in case of vascular homogenate). Aim. To compare the sensitivity of housekeeping proteins and total protein staining for the signal normalisation during Western blotting of endothelial cell (EC) lysate and vascular homogenate. Methods. Serial dilutions of EC lysate or vascular homogenate (1, 2, 4, 8, 16, and 32 µg protein) were loaded into bis-tris polyacrylamide gel and stained for EC housekeeping proteins: platelet endothelial cell adhesion molecule 1 (CD31/PECAM1), β-actin, β-tubulin, glyceraldehyde 3-phosphate dehydrogenase (GAPDH), TATA-binding protein (TBP), proliferating cell nuclear antigen (PCNA), histone H3, and cytochrome c oxidase subunit 4 (COX4). Housekeeping protein expression was detected using secondary antibodies conjugated with 680RD and 800CW fluorophores or horseradish peroxidase. Total protein staining was performed using Acid Black 1, Fast Green FCF, Ponceau S, Congo Red, nigrosine, Revert 700, and 2,2,2-trichloroethanol. Results. Acid Black 1 and Fast Green FCF were the most sensitive (≥ 1 µg protein) dyes for total protein staining in EC lysate or vascular homogenate on polyvinylidene fluoride or nitrocellulose membranes. Among the housekeeping proteins of EC lysate and vascular homogenate, the highest sensitivity was detected for β-actin (≥ 1–2 µg protein), TBP (≥ 2–4 µg protein), and PCNA (≥ 4 µg protein). Total protein staining was more sensitive than β-actin or TBP staining. Total protein staining of EC protein lysate showed maximum and median coefficient of variation of ≈ 20% and ≈ 12% for the EC lysate and ≈ 40% and ≈ 17% for vascular homogenate. Conclusion. The most sensitive dye for total protein staining in EC lysate and vascular homogenate is Acid Black 1, the most sensitive cytoplasmic housekeeping protein is β-actin, and the most sensitive nuclear housekeeping protein is TATA-binding protein (TBP). For the respective normalization, total protein staining can be employed if coefficient of variation is ≤ 20% (for EC lysate) or ≤ 25% (for vascular homogenate).
CARDIOMETABOLIC RISK IN OBESITY AND METABOLIC SYNDROME: CONTEMPORARY ALGORITHMS FOR STRATIFICATION
Highlights Modern stratification algorithms, which are based on obesity phenotyping (considering visceral fat and body composition) and novel biomarkers, allow for a more accurate prediction of cardiometabolic risk compared to classical scales that rely solely on body mass index and waist circumference. NAFLD and insulin resistance indices (including TyG and combined indices) serve as important independent risk components and should be integrated into clinical algorithms for early risk stratification. Abstract Obesity and metabolic syndrome are key drivers of cardiovascular disease and type 2 diabetes mellitus. Contemporary research identifies distinct obesity phenotypes, including metabolically healthy obesity and normal-weight obesity, necessitating refinement of approaches to cardiometabolic risk stratification. The aim of the article was to systematize current evidence on cardiometabolic risk in obesity and metabolic syndrome and to analyze contemporary risk stratification algorithms. A systematic literature review was conducted in accordance with PRISMA guidelines. The search was performed in PubMed, Google Scholar, and eLibrary databases covering the period from 2020 to 2024. Following screening of 1,099 publications, 10 studies meeting the eligibility criteria were included in the final analysis. Contemporary cardiometabolic risk stratification methods based on obesity phenotyping, visceral fat assessment, and novel biomarkers substantially outperform traditional approaches. Insulin resistance indices demonstrate high predictive value for cardiovascular mortality. The important role of non-alcoholic fatty liver disease as a component of cardiometabolic risk has been established. Contemporary cardiometabolic risk stratification methods that account for distinct obesity phenotypes and novel biomarkers provide more accurate prediction of cardiovascular complications compared to conventional approaches. Promising directions include the implementation of personalized prevention strategies and broader adoption of novel risk stratification tools in clinical practice.
MOLECULAR AND REGENERATIVE APPROACHES TO THE TREATMENT OF ISCHEMIC HEART DISEASE
Highlights Contemporary approaches to the treatment of ischemic heart disease (IHD) extend beyond conventional invasive techniques such as percutaneous coronary intervention and coronary artery bypass grafting. Although these procedures remain effective, they are often associated with significant risks, particularly in patients with multiple comorbidities. This underscores the growing need for safer and more personalized therapeutic strategies. Increasing attention is being directed toward molecular and regenerative technologies aimed at targeting the underlying pathogenic mechanisms of the disease. Nanotechnology, RNA-based therapy, and cell-based platforms have demonstrated promising potential to transform clinical practice. The use of polymeric, lipid-based, and metallic nanoparticles enables targeted drug delivery, attenuation of inflammation, and stabilization of atherosclerotic plaques. Small interfering RNAs (siRNAs) and microRNAs (miRNAs) regulate gene expression involved in lipid metabolism and inflammatory responses, while stem cells promote myocardial regeneration and immunomodulation. These innovations are forming the foundation of a new paradigm in precision IHD therapy. The integration of artificial intelligence (AI) into cardiology practice enhances the analytical potential of diagnosis and prognosis. AI algorithms (e.g., systems for coronary CT angiography analysis, automatic calcium index calculation, and ECG analysis, such as HeartFlow and KardiaAI) are successfully applied to medical image evaluation, risk stratification, biomarker analysis, and complication prediction. Taken together, this comprehensive approach, combining advances in invasive cardiology, molecular biology, regenerative medicine, and digital technologies, paves the way for personalized and pathogenetically based treatment of coronary artery disease. Abstract Coronary artery disease (CAD) remains a leading cause of death, despite significant progress in cardiology. This article presents a systematic review of current approaches to CAD treatment, including traditional invasive methods, nanomedicine, gene therapy, and cell technologies. Percutaneous coronary intervention and coronary artery bypass grafting remain the mainstays of treatment for critical stenoses. However, in some patients, these methods are associated with a high risk of complications, such as nephropathy, atrial fibrillation, or graft failure. Therefore, the attention of researchers is increasingly shifting to high-tech molecular strategies. Experimental studies in animal models (in vivo) have demonstrated that pitavastatin-loaded nanoparticles based on the copolymer of lactic and glycolic acids (PLGA) have the ability to reduce inflammation and stabilize atherosclerotic plaques. Preclinical studies indicate that the use of liposomal forms of prednisolone can provide targeted delivery of the drug to sites of restenosis. However, the clinical translation of nanotechnology faces challenges related to safety, toxicity, biodistribution, high production costs, and regulatory barriers. Photoacoustic and fluorescence imaging using functionalized nanoparticles opens up new diagnostic possibilities. Delivery of small interfering RNA (siRNA), particularly siPCSK9, via lipid carriers leads to a significant reduction in low-density lipoprotein levels in experimental models. Experimental data, primarily obtained in animal models and in vitro, link the use of microRNAs such as miR-124 and miR-34 to the modulation of inflammation and apoptosis in atherosclerosis, but their therapeutic potential in humans requires further study. Stem cells (MSCs, UCSCs) demonstrate potential for myocardial regeneration and immune response regulation. The role of artificial intelligence (e.g., deep learning algorithms for plaque segmentation, radiomics, and machine-learning-based prognostic models) in imaging data analysis, intervention planning, and outcome prediction is also discussed. Overall, the article highlights the transformation of coronary heart disease treatment toward precision, targeted, and bioengineered therapies, opening new horizons in cardiology practice.
CHRONIC TOTAL OCCLUSIONS OF THE CORONARY ARTERIES: CURRENT OPPORTUNITIES AND CHALLENGES IN INTERVENTIONAL TREATMENT
Highlights Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is an effective treatment option for patients with refractory angina, contributing to improved quality of life and reduction of ischemic symptoms, provided that patient selection and procedural planning are carefully performed. Preprocedural planning, including dual-contrast angiography, coronary computed tomography angiography, and the use of validated scoring systems (J-CTO, PROGRESS-CTO, CT-RECTOR), plays a critical role in selecting the optimal interventional strategy and minimizing the risk of complications. An algorithmic approach and multidisciplinary collaboration enhance the success and safety of CTO PCI, particularly when hybrid and global strategies are employed and tailored to the anatomical features of the lesion. Abstract Chronic total occlusions of the coronary arteries (CTO) represent one of the most complex forms of coronary artery disease, occurring in approximately 15–20% of patients with ischemic heart disease undergoing coronary angiography. Despite the long-standing absence of a unified treatment strategy, the interventional approach to CTO has undergone significant transformation in recent decades. This evolution is largely driven by advancements in imaging technologies, improvements in guidewire and catheter systems, and the implementation of algorithmic decision-making in procedural planning. Percutaneous coronary intervention (PCI) for CTO enables effective relief of anginal symptoms, improvement in quality of life, and enhancement of functional status, while minimizing the risk of serious complications. A critical factor in procedural success is thorough preprocedural planning, which includes dual-injection coronary angiography, coronary computed tomography angiography (CTCA), and assessment of anatomical complexity using scores such as J-CTO, PROGRESS-CTO, and CT-RECTOR. The use of hybrid and global CTO management algorithms, tailored to lesion morphology, facilitates individualized strategies and improves procedural outcomes. Operator experience, availability of dedicated equipment, and cohesive team coordination are also pivotal to clinical success. This review summarizes current approaches to the diagnosis, planning, and execution of PCI in CTO cases, emphasizing the importance of a multidisciplinary approach and the role of advanced imaging modalities in enhancing the safety and efficacy of interventional treatment.
MULTIDISCIPLINARY APPROACH IN THE TREATMENT OF PATIENTS WITH VALVULAR HEART DISEASE
Highlights This article presents the key components of a successful heart valve team model, including the optimal structure of a multidisciplinary team, the main features of the multidisciplinary approach, and the central role of the patient in choosing a personalized treatment strategy for patients with valvular heart disease. This review serves as a methodological framework for implementing a modern, evidence-based model of care for patients with valvular heart disease, aimed at optimizing diagnostics, selecting the appropriate method of valve defect correction, and improving long-term clinical outcomes. Abstract This document reflects the current challenges of the multidisciplinary approach in the treatment of patients with valvular heart disease, the basic principles of organizing a heart valve team in cardiac surgery centers, and the difficulties affecting the team's effectiveness. Despite the proven benefits of the multidisciplinary approach in managing patients with valvular pathology, the institutional inadequacy of this model persists within the national healthcare system. The existing organization of care is characterized by the fragmentation of cardiovascular surgeons, cardiologists, and interventional specialists, the absence of unified interaction protocols, and consequently creates uncertainty in selecting the optimal method of correction for patients with valvular heart disease. This discrepancy between global clinical guidelines and real-world clinical practice in our country highlights the necessity of conducting this review.
A RARE CLINICAL CASE OF BILATERAL PULMONARY VEIN ATRESIA IN NEWBORN
Highlights Bilateral pulmonary vein atresia is an extremely rare congenital heart disease. Abstract Pulmonary vein atresia is a rare congenital heart defect with a high morbidity and mortality rate. This condition develops due to abnormal connections between the pulmonary veins and the left atrium. Congenital heart defect has a poor prognosis and patients die due to secondary pulmonary hypertension, hemoptysis, pulmonary edema or congestive heart failure. We report a rare case of a newborn with anomaly of pulmonary venous return: bilateral pulmonary vein aplasia.
ENDOVASCULAR EMBOLIZATION OF THE SPLENIC ARTERY ANEURYSM USING NEUROSURGICAL COILS: A CLINICAL CASE
Highlights Endovascular embolization should be considered as a first-line method for asymptomatic splenic artery aneurysms larger than 2 cm in high-risk surgical patients, pregnant women and patients with portal hypertension. The choice of a specific embolization material should be based on a thorough preoperative assessment, as well as take into account the experience of the operating surgeon. Abstract This publication presents a clinical case of successful endovascular treatment of a splenic artery aneurysm in a 49-year-old female patient. Against the background of a detailed description of the intervention technique using modern microspirals, an analysis of modern treatment strategies for this pathology is presented. Special attention is paid to the comparative characteristics of various treatment methods based on current literature data. Endovascular techniques demonstrate significant advantages over traditional surgical approaches, including a reduction in postoperative mortality from 8.5% to 1.2% and a reduction in hospital admission from an average of 9.4 to 2.3 days. This work discusses in detail the criteria for choosing embolization materials, where special attention is paid to the advantages of platinum microspirals, which provide 94.7% complete occlusion with 5-year follow-up. The article is a clinical experience supported by modern evidence-based medicine data.
CLINICAL PREDICTORS OF LONG-TERM SURVIVAL IN CHRONIC HEART FAILURE: RESULTS FROM A 5-YEAR PROSPECTIVE COHORT STUDY
Highlights Chronic heart failure (CHF) is associated with high mortality rates, which exceed those associated with cancer. Traditional methods for assessing the prognosis (based on the etiology of CHF and the condition of the left ventricle) are not accurate enough, so new predictors of an unfavorable outcome are needed. The severity of clinical manifestations and concomitant diseases has a stronger effect on the prognosis than the initial etiology of CHF. The study justifies the transition from static diagnosis to dynamic assessment of the symptomatic status of patients. The emphasis on the correction of concomitant diseases can improve the results of CHF treatment in real clinical practice. Background. Chronic heart failure (HF) remains a condition associated with high mortality rates, exceeding those of oncological diseases. Traditional risk stratification approaches, based on the HF etiology and left ventricular function parameters, do not fully capture individual prognosis, necessitating the identification of new clinically significant predictors. Aim. To conduct a comprehensive assessment of clinical symptoms, functional class (FC) of HF, and comorbid conditions in relation to 5-years mortality and survival in HF patients in real-world clinical practice settings. Methods. In this prospective cohort study 150 consecutive patients with HF were enrolled in two outpatient clinics and two hospitals located in Moscow and Barnaul in February-May 2018. Vital status during 5-years of follow-up (median 3.29 years) was obtained in 147 (98%) patients. Survival analysis was performed using the Kaplan-Meier method. For assessment of predictors’ univariate Cox regression was used to calculate hazard ratios (HR) and 95% coincidence intervals (CI). Results. The 5-years overall survival rate was 59.9% (88/147). HF etiology showed no statistically significant association with outcomes. Hepatojugular reflux (p = 0.001) and weight loss > 4.5 kg in response to 5 days therapy (p < 0.001) were associated with the highest mortality rates. HF NYHA FC demonstrated strong prognostic significance: compared to FC I, the risk of death was 7.7 times higher for patients with FC III (95% CI 3.03–19.76) and 19 times higher for those with FC IV (95% CI 4.50–80.29). The presence of comorbidities, including anemia (HR = 3.51; 95% CI 2.08–5.90), atrial fibrillation (HR = 2.12; 95% CI 1.25–3.61), chronic obstructive pulmonary disease (HR = 2.55; 95% CI 1.48–4.37), and obstructive sleep apnea (HR = 2.73; 95% CI 1.32–5.62), were associated with higher 5-years mortality. A history of endovascular interventions acted as a protective factor (HR = 0.44; 95% CI 0.24–0.81; p = 0.008). Conclusion. The severity of current clinical manifestations of HF and the cumulative burden of comorbid conditions has a greater impact on long-term prognosis than the initial etiology. These findings underscore the need to shift the focus from a static diagnosis towards dynamic assessment of symptomatic status and active targeting of key comorbidities to improve outcomes in patients with HF in clinical practice.
RELATIONSHIP BETWEEN THE HEMORHEOLOGICAL PROFILE OF PATIENTS AND THE SEVERITY OF CORONARY ATHEROSCLEROSIS
Highlights In this study, using direct measurement of arterial blood viscosity, no association was found between hemorheological parameters and the prevalence or severity of coronary atherosclerosis assessed by the SYNTAX score. These findings suggest that the adverse effects of increased blood viscosity, described in several previous studies, are likely mediated not by the progression of atherosclerotic disease but through other pathophysiological mechanisms. The uniqueness of this study lies in the use of a certified rotational viscometer for direct measurement of arterial blood viscosity, which distinguishes it favorably from most previous investigations based on indirect, calculated methods. Aim. To evaluate the relationship between hemorheological parameters and the presence and severity of coronary atherosclerosis. Methods. The study included 303 patients undergoing elective coronary angiography (CAG). The mean age was 65.5 ± 9.5 years; 55% were male. Arterial blood viscosity, sampled directly from the introducer sheath prior to CAG, was measured using a Brookfield DV2TLV (USA) rotational viscometer under standardized and controlled temperature conditions. Measurements were performed at shear rates of 1, 5, 10, 22.5, 45, 90, and 225 s⁻¹. Stiffness and non-Newtonian coefficients were calculated using the power-law model of fluid viscosity. Coronary atherosclerosis was assessed by CAG with subsequent calculation of the SYNTAX score. To minimize imbalance between patient groups, propensity score matching (PSM) was applied using the nearest-neighbor 1:1 method with a caliper of 0.05 and a balance threshold of SMD < 0.2. Results. A total of 303 patients were included in the study. The main group consisted of 105 patients (34.6%) with angiographically confirmed atherosclerotic lesions (SYNTAX > 0). The comparison group comprised 198 patients (65.4%) with no angiographic evidence of atherosclerosis or with hemodynamically insignificant coronary artery lesions (SYNTAX = 0). Hemorheological parameters, including blood viscosity at various shear rates, stiffness, and non-Newtonian coefficients, did not differ significantly between groups either before or after PSM (p > 0.05 for all parameters). Spearman correlation analysis revealed no statistically significant association between SYNTAX score and hemorheological parameters (r < 0.1, p > 0.05). Conclusion. This study demonstrated no statistically significant association between arterial blood hemorheological parameters and the prevalence or severity of coronary atherosclerosis. These results suggest that the negative clinical impact of increased blood viscosity in patients with coronary artery disease is not mediated by direct promotion of atherosclerotic progression, but rather by other pathophysiological mechanisms.
IN-HOSPITAL OUTCOMES OF MINIMALLY INVASIVE CORONARY ARTERY BYPASS GRAFTING
Highlights Modern cardiac surgery techniques are designed to minimize intervention in stenting, allowing these procedures to be performed on a wider range of patients. In this regard, the intra- and postoperative aspects of minimally invasive coronary artery bypass grafting (MICABG) are of interest, demonstrating the advantages of this procedure. Background. Minimally invasive coronary artery bypass grafting (MIDCABG) reduces surgical trauma in patients with coronary artery disease, especially when complete myocardial revascularization is not possible. However, technical difficulties can impact the quality of the mammary coronary anastomosis, resulting in dysfunction of the most important bypass graft in coronary surgery. Aim. To analyze the in-hospital outcomes of mammary coronary artery bypass grafting using lateral minithoracotomy. Methods. A total of 72 cases of minimally invasive coronary artery bypass grafting via lateral minithoracotomy (MIDCAB) were selected in 2025 (Group I) using a continuous sampling method. A comparison group of 67 cases of isolated mammary coronary artery bypass grafting via median sternotomy was selected using a continuous sampling method in 2021–2025 (Group II). Clinical, demographic, and intraoperative data, as well as in-hospital outcomes, were analyzed. Results. According to the main clinical and demographic data, the patients were comparable. The mean age was 64.9 ± 7.2 and 67 ± 5 years (p = 0.1). The main cohort of patients consisted of patients with angina pectoris of functional class I–II (90.3% and 81%, p = 0.4), functional class III–IV was noted in 8.3% and 12% of patients, the remaining patients had acute coronary syndrome (1.4% versus 7%, p = 0.08). Multivessel disease was statistically significantly more common in patients with median sternotomy (36.1% versus 52.2%, p = 0.045). The left ventricular ejection fraction was significantly lower in the sternotomy group (61.6 ± 5.7 versus 57.1 ± 10.6, p = 0.01). In the MIDCAB group, the operative time was significantly shorter (119 ± 19 vs. 129.8 ± 23 minutes, p = 0.04), and the diameter of the installed intracoronary bypass graft was significantly smaller (1.6 ± 0.2 vs. 1.8 ± 0.2, p = 0.0001). There was no in-hospital mortality in the groups, 1 (1.4%) perioperative myocardial infarction was noted in the MIDCAB group, and 1 case of acute cerebrovascular accident in the sternotomy group. No significant differences were found in the aspect of the development of major cardiovascular catastrophes (1.4% vs. 3%, p = 0.5). The duration of postoperative hospital stay was statistically significantly shorter in the MIDCAB group (9 ± 2 vs. 11 ± 3 days, p = 0.004). Conclusions. Mammary coronary artery bypass grafting from lateral minithoracotomy is a safe and effective method of myocardial revascularization, including in patients with multivessel coronary disease, in whom complete myocardial revascularization is impossible.
MODERN RUSSIAN TECHNOLOGIES FOR PATIENTS WITH ACUTE CEREBRAL DISORDERS
Highlights For the first time in real-world clinical practice across several Russian regions, the high reproducibility and efficacy of the domestic Grasper stent-retriever for mechanical thrombectomy in stroke patients have been demonstrated. An unique routing ecosystem “UDAR” was developed, integrating the pre-hospital stage, “Tele-PVU” telemedicine support, and automated 5–7-minute express CT scan evaluation driven by artificial intelligence. The synergy of digital control and domestic medical devices enabled a 2.5-fold increase in mechanical thrombectomy volumes and reduced hospital mortality from ischemic stroke by 8.1%. Aim. Analyze the results of the pilot project “UDAR” (Smile, Movement, Articulation, Solution) on reorganizing the routing of patients with acute cerebral blood circulation disorders (AHC) when using telemedicine in the territory of Primordia, to assess the effectiveness of modern methods of reperfusion using domestic stencil-reducers. Methods. The total number of patients suspected stroke included in the study was 18500. All patients at the pre-hospital stage were examined by a paramedic/ doctor of the emergency medical team, who entered on the tablet into the program “UDAR” patient data, then information was sent to the questionnaire of the program “UDAR” with automatic notification of the control center on the basis of a regional vascular center (RVC). The on-duty neurologist of the RVC then analyzed the data and gave recommendations for further routing to the primary vascular unit (PVU) or RVC (with LAMS > 3 points). If necessary, the neurologist of the RVC could conduct a telemedicine consultation with the medical doctor of the emergency medical team by video call to clarify the neurological status of the patient. Upon arrival of the patient in the PVU and CT-study of the brain, data was loaded into “UDAR” program. Control center radiologist had access to the patient’s CT scans. The first series of images was processed by artificial intelligence (AI) with identification of areas of detected pathologies, determination of the extent of lesions, scoring according to the ASPECTS scale prepared by an X-ray report. The second series was a native CT image. Based on the results of the examinations, the neurologist decided to leave the patient in the PVU or transfer to the RVC for mechanical thrombosis extraction. Results. During the lifetime of the project, there was an increase in the frequency of thrombolytic therapy (TLT) from 3.9% to 8.6% (by 4.6%), the number of mechanical thrombosis extractions increased by 1.5 times in 2022 compared to 2021 and 2.5 times in 2023 compared to 2021. Hospital mortality rates from ischaemic stroke in the Primorsky PVU have decreased from 21.7% in 2021 to 14.9% in 2022 and 13.6% in 2023. Conclusion. According to the data obtained from the pilot project, it was found that it is advisable to scale its results to other regions of the country.
EVOLUTION OF CORONARY STENTS: FROM EARLY EXPERIMENTS TO MODERN TECHNOLOGIES
Highlights This review presents a systematic overview of scientific achievements in the development and use of coronary stents. It includes an analysis of key studies addressing various aspects of their performance. The article examines existing generations of coronary stents, materials used in their manufacture, design features, and also describes the latest advancements in this field. Abstract To trace the evolution of coronary stents and identify promising directions in the development of endovascular surgery.An analytical literature review was conducted, including results from major randomized clinical trials and meta-analyses published in leading cardiology journals between 1994 and 2025.The introduction of coronary stent implantation technology reduced the incidence of thrombosis and the need for repeat revascularization compared to balloon angioplasty. However, a high risk of restenosis limited their use. The emergence of drug-eluting stents in the 2000s led to a sharp decrease in neointimal hyperplasia and repeat interventions but was associated with a risk of late thrombosis. Modern generations of stents demonstrate improved efficacy and safety. Bioresorbable stents were an innovative development but failed to show superiority in large randomized trials. Currently, stents incorporating novel anti-inflammatory agents (such as colchicine) are under development. The evolution of coronary stents reflects the pursuit of an optimal biocompatible device that induces minimal inflammatory response, promotes rapid vascular wall healing, and eliminates the need for prolonged dual antiplatelet therapy. A literature search was conducted in the PubMed electronic database for publications from 1994 to 2025. The following keywords were used: «coronary stent», «bare metal stent», «drug-eluting stent», «polymer-free», and «bioresorbable scaffold». The review included clinical studies, systematic reviews, meta-analyses, randomized controlled trials, and comparative studies relevant to the topic of analysis.
THE CONCEPT OF PERIOPERATIVE CARDIAC RISK: LITERATURE REVIEW
Highlights This review introduces for the first time an integrative conceptual model of high perioperative cardiac risk, combining three key components: surgical risk, patient vulnerability, and dynamic monitoring, enabling a systematic approach to patient stratification prior to noncardiac surgery. It demonstrates a critical gap between the high predictive accuracy of modern machine learning models (AUROC > 0.90) and the lack of their clinical validation in real-world practice, particularly in the Russian population, highlighting the need for a national risk calculator. For the first time in Russian literature, the role of MINS (myocardial injury after noncardiac surgery) as a major driver of postoperative mortality (contributing 3.9% to overall mortality) is analyzed in detail, justifying the shift from reactive to preventive perioperative cardiac risk management based on routine monitoring of high-sensitivity troponins and natriuretic peptides. Abstract This review focuses on contemporary approaches to the assessment and management of perioperative cardiac risk in patients undergoing non-cardiac surgery. The topic's relevance stems from the high frequency of major adverse cardiovascular events (MACE), a leading cause of perioperative mortality. The work analyzes the paradigm shift from the question “is surgery feasible?” to the strategy “how to improve outcomes?” which includes pre-operative optimization (prehabilitation), active monitoring, and a multidisciplinary approach. Based on a literature search, the epidemiology and key risk factors are reviewed, with detailed classifications and definitions of complications (MACE, myocardial injury after noncardiac surgery (MINS), intraoperative critical incidents). Particular attention is paid to the role of biomarkers (NT-proBNP/BNP for prediction, high-sensitivity troponin for diagnosing MINS) and hemodynamic control in risk stratification and early detection of myocardial injury. A comparative analysis of prognostic tools is conducted: from traditional clinical scales (Lee index, NSQIP) to modern machine learning models demonstrating high accuracy. Problems with validation, clinical interpretability, and the integration of these tools into routine practice are noted. Contemporary recommendations for risk minimization, based on staged personalized assessment, patient optimization, and active postoperative monitoring, are summarized. The conclusion emphasizes the need to develop integrative, transparent, and clinically applicable algorithms that combine data from scales, biomarkers, and dynamic monitoring to transition from reactive to preventive management of perioperative cardiac risk.
INTEGRATING PATIENT-REPORTED OUTCOMES AND FUNCTIONAL TESTING IN VARICOSE VEIN EVALUATION: A CASE STUDY
Highlights This case highlights the need for questionnaires targeting functional limitations in chronic venous disorders. This case shows the gap in assessment; the functional tests are often under-evaluated. This article highlights the need for more scores and scales evaluating functional concerns rather than cosmetic. Background. Varicose veins (VV), being a chronic venous disorder, affect up to 40% adult population. While considerable attention has been given to anatomical and cosmetic concerns, functional limitations and quality of life issues remain underreported. Aim. To evaluate functional impairments in a patient with VV using validated tools available for assessment. Case Presentation. A 49-year-old female presented with nocturnal leg cramps, limb heaviness, occasional burning in the right lateral leg, and was unable to do her chores. She confirmed a history of VV diagnosed 8 years ago. During the clinical examination, she was classified as CEAP C3, and duplex ultrasound also confirmed reflux in the great saphenous vein lasting more than 2 seconds. Functional assessment included the CIVIQ-14, VEINES-QoL/Sym, and 6-minute walk test (6MWT). Scores suggested moderate impairment in functional mobility, psychosocial well-being, and walking endurance, with a 6MWT distance of 340 m, which is below age-expected values. Management and Outcome. The patient was advised to start physiotherapy as soon as possible, including compression therapy, exercises, and a mobility regimen. Following initiation of physiotherapy, her symptoms improved considerably, reflected in reduced heaviness, loss of burning sensation and improved 6MWT performance at follow-up after 3 months. Discussion. This case illustrates that the functional impact of VV is more than a cosmetic concern. Patient-reported outcome measures and mobility testing (objective walking tests) supplement the information provided by clinical and imaging data, enabling a comprehensive understanding of disease burden. Implementation of such scoring systems as a part of routine assessments could help in personalized therapy and patient-tailored care.