Highlights

• Polymorphism rs5918 in the ITGB3 gene is associated with procedural features, acute complications and long-term prognosis after elective endovascular myocardial revascularization. In the group of patients with stable coronary artery disease who have indications for elective PCI, the presence of the T allele is associated with concomitant carbohydrate metabolism disorders, multivessel coronary artery disease, implantation of 2 or more stents, and a lower rate of achieving complete myocardial revascularization during index PCI.
• The presence of the minor allele C and the homozygous genotype CC is associated with greater comorbidity in patients, features of coronary atherosclerosis in the form of more frequent hemodynamically significant lesions of the left main coronary artery and anterior descending artery, more frequent achievement of complete myocardial revascularization and a lower value of the residual SYNTAX index with the implantation of a smaller number of stents during the index intervention. In the recessive model (TT + TC/CC), the presence of the minor homozygous CC genotype increased the odds of developing periprocedural AKI by 7.2 times (OR 7.200; 95% CI [1.827–28.379], p = 0.011). Five years after the index PCI, patients with the minor C allele had worse renal function than those with the T allele (GFR ≤ 60 ml/min/1.73 m² in 19%, 36%, and 40% of patients in the groups with the TT, TC, and CC genotypes, respectively, p = 0.04).

Aim. To study the association of the T1565C (rs5918) polymorphism in the ITGB3 gene with the characteristics of interventions, periprocedural complications and long-term prognosis of patients after elective endovascular myocardial revascularization.

Methods. Polymorphic variants of the single nucleotide polymorphism T1565C (rs5918) in the ITGB3 gene were identified in 364 patients undergoing elective PCI. We studied the characteristics of coronary artery disease and the interventions performed, and also assessed the frequency of acute complications, late (5-year) adverse events, and the dynamics of renal function in the acute and late periods in groups of patients with different genotypes of the rs5918 polymorphism in the ITGB3 gene. Contingency tables and odds ratio (OR) calculations were used to assess the association of this polymorphism with endpoints.

Results. The minor allele 1565C and the 1565CC of the polymorphism T1565C (rs5918) in the ITGB3 gene genotype are associated with more frequent hemodynamically significant stenosis of the left main coronary artery (4.4, 6.9 and 30% in the TT, TC and CC groups, respectively, p = 0.003) and the anterior descending artery (79, 66.7 and 100% in the TT, TC and CC groups, respectively, p = 0.01), more frequent achievement of complete myocardial revascularization (54.4, 70.6, 70% in the TT, TC and CC groups, respectively, p = 0.01) and a lower residual SYNTAX index (4.1 ± 6.7 (0–43.5); 2.9 ± 6.2 (0–28.5) and 2.4 ± 4.6 (0–14) in the TT, TC and CC groups, respectively, p = 0.02) with implantation of a smaller number of stents. In addition, an association was found between the minor 1565CC genotype with acute periprocedural kidney injury (OR 7.200; 95% CI [1.827–28.379], p = 0.011) and deterioration of renal function 5 years after index PCI (SCF ≤ 60 ml/min/1.73 m² in 19, 36 and 40% in the TT, TC and CC groups, respectively, p = 0.04).

Conclusion. Under conditions of dual antiplatelet therapy, selected taking into account the residual platelet reactivity according to the aggregogram data, no association was found between the T1565C (rs5918) polymorphism in the ITGB3 gene and acute periprocedural myocardial injury and long-term cardiovascular complications. Polymorphism rs5918 in the ITGB3 gene is associated with acute periprocedural kidney injury and decreased renal function in the late period.

Highlights

The study demonstrates that in patients with uncomplicated STEMI and intermediate stenoses of non-infarct-related arteries, performing staged complete revascularization only with a hemodynamically significant fractional flow reserve (FFR) value ≤ 0.80 at 30–45 days after primary intervention is associated with no cases of cardiovascular death and recurrent myocardial infarction over a median follow-up of 21 months. The uniqueness of the approach lies in the selection of hemodynamically significant stenoses, which avoided excessive stenting in 40% of patients without worsening prognosis. Thus, the work makes an important contribution to the rationale for FFR-guided staged complete revascularization in STEMI patients with multivessel coronary artery disease.

Aim. To evaluate the incidence of major adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease after staged complete revascularization of non-infarct-related arteries (non-IRAs) guided by fractional flow reserve (FFR).

Methods. This single-center prospective study included 52 patients with STEMI and intermediate non-IRA stenoses (50–85%). All patients underwent primary percutaneous coronary intervention of the infarct-related artery. At 30–45 days, FFR assessment in non-IRAs was performed; revascularization was performed when FFR ≤ 0.80. Median follow-up was 21 months. The primary endpoint was cardiovascular death and recurrent myocardial infarction.

Results. Hemodynamically significant stenoses were identified in 31 patients (59.6%), who underwent stenting; 21 patients (40.4%) received only medical therapy. During the follow-up period, no cases of cardiovascular death or recurrent myocardial infarction were recorded (0%; 95% CI 0.0–5.6%). Repeat revascularization was performed in 4 patients (7.7%), and 2 cases of non-cardiovascular death (3.8%) were recorded. No cases of contrast-induced nephropathy, clinically significant bleeding, or stroke were observed.

Conclusion. In patients with uncomplicated STEMI and intermediate non-IRA stenoses, an FFR-guided staged complete revascularization strategy performed at 30–45 days after primary intervention was associated with a low incidence of cardiovascular events; no cases of cardiovascular death or recurrent myocardial infarction were recorded in this cohort. This approach avoids excessive stenting but requires confirmation in larger studies.

Highlights

Arterial hypertension is a key modifiable risk factor for cardiovascular diseases and premature mortality, in the pathogenesis of which inflammatory processes play a significant role. Periodontitis, as a chronic inflammatory disease, may be associated with elevated blood pressure and, in patients with hypertension, may increase the risk and severity of target organ damage. Therefore, it is important to study the impact of chronic inflammation associated with periodontitis on the course of hypertension, the degree of target organ damage, and the development of associated clinical conditions.

Aim. To determine the prevalence of associated clinical conditions and target organ damage in patients with arterial hypertension and periodontitis.

Methods. The study included 150 patients with AH, divided into two groups: with periodontitis (study group, 76 patients) and without periodontitis (control group, 74 patients). Clinical and laboratory parameters were assessed (age, BMI, smoking status, CRP, lipid profile, etc.), as well as target organ damage (left ventricular hypertrophy (LVH) by ECG and echocardiography, retinopathy) and arterial status (pulse wave velocity (PWV) and vascular age (VA)). The diagnosis of periodontitis was established in the presence of clinical attachment loss at two or more non-adjacent interproximal sites with a periodontal probing depth greater than 3 mm.

Results. In patients with concomitant AH and periodontitis, hypertension developed at an earlier age (47 years) compared with the group without periodontitis (50 years). Patients with periodontitis had higher levels of systemic inflammation (elevated hs-CRP: 5 mg/L vs 2 mg/L in the control group) and dyslipidemia (higher triglyceride levels). Patients with periodontitis demonstrated statistically significantly higher PWV and VA values, as well as a higher prevalence of LVH and predominance of concentric left ventricular hypertrophy. The prevalence of ACCs (type 2 diabetes mellitus (T2DM), coronary artery disease (CAD), myocardial infarction (MI), and acute cerebrovascular events (stroke)) was significantly higher in the periodontitis group.

Conclusions. Periodontitis in patients with arterial hypertension is associated with increased systemic inflammation, more pronounced target organ damage, and a higher risk of associated clinical conditions. Incorporating measures for the prevention and treatment of periodontitis may improve hypertension control and reduce its complications.

Highlights

Several studies have demonstrated the advantage of using the branch-first technique for aortic arch branch replacement in terms of reduced mortality and neurological complications. The unavailability and high cost of the multi-branch graft used for the branch-first technique has prompted the search for and development of new grafts, such as the X-graft. Both types of multi-branch grafts have demonstrated comparable results in terms of the incidence of neurological deficit, mortality, significant postoperative complications, and angiographic patency. Furthermore, the X-graft has the advantage of reduced fabrication time, which may be important in emergency situations.

Background. The optimal method for aortic arch branches reimplantation during total aortic arch replacement remains a matter of debate, as the incidence of neurological complications is quite high.

Aim. To present a new multi-branch X-graft and compare its clinical outcomes with a standard multi-branch graft.

Methods. This retrospective, single-center study included 153 patients with aortic arch pathology who underwent total aortic arch replacement and all its branches from January 2019 to February 2026. Of these, 88 patients underwent aortic arch replacement using a prefabricated 12 × 10 × 8 × 8 TAPP graft or its equivalent, formed from individual linear grafts (TAPP group). A new X-graft formed from two linear grafts was used for this purpose in 65 patients (X-graft group). The primary endpoint was neurological deficit. Secondary endpoints included in-hospital mortality, significant postoperative complications, and patency of the multibranch graft branches. Regression analysis was performed to identify predictors of neurological dysfunction.

Results. The incidence of permanent neurological deficits was higher in the TAPP group, but the differences were not statistically significant (6.8% vs. 3.1%, p = 0.468). In-hospital mortality was 5.7% in the TAPP group and 9.2% in the X-graft group (p = 0.529). Significant postoperative complications did not differ between the groups. The X-graft group had a lower need for red blood cell transfusions (p = 0.004). Stenosis greater than 50% or branch occlusion of the multi-branch graft were detected in three patients in the TAPP group (3.4%) and two patients in the X-graft group (3.1%). An independent predictor of permanent neurological deficit was cerebral malperfusion (OR 11.658, p = 0.005).

Conclusion. The new X-graft for antegrade cerebral perfusion and supra-aortic branch replacement in aortic arch surgery is comparable in clinical efficacy and angiographic patency to the standard four-branch graft. In the absence of a prefabricated TAPP graft, the X-graft has an advantage in formation speed compared to an intraoperatively fabricated TAPP graft analogue.

Highlights

For the first time, a comparative study was conducted of the medium‑term results of using aortic homografts, autografts (Ross operation), and a domestic biological conduit in the surgical treatment of aortic root pathology. It has been shown that all three biomaterials provide high survival rates, acceptable freedom from reoperations, and stable hemodynamics in the medium term. The data obtained indicate the clinical viability of the domestic biological conduit as a competitive alternative to traditional biological solutions.

Background. Surgical correction of aortic root pathology remains one of the most challenging tasks in cardiac surgery. The choice of biomaterial for aortic root reconstruction may influence long-term outcomes and the frequency of reoperations.

Aim. To evaluate mid-term results of surgical treatment of aortic root pathology using different biomaterials – aortic homografts, pulmonary autografts (the Ross procedure), and “Russian conduit”.

Methods. A single-center retrospective comparative study was conducted including 68 patients operated on between 2015 and 2025. Patients were divided into three groups: I – aortic homografts (n = 19), II – autografts (Ross procedure, n = 24), III – “Russian conduit” (n = 25). Primary endpoints were overall survival and freedom from reoperation on the aortic root. Secondary endpoints included structural prosthesis degeneration, root dilatation, significant regurgitation, thromboembolic, and hemorrhagic complications. Statistical analysis was performed using IBM SPSS Statistics 23.0; differences were considered significant at p < 0.05. The follow-up period varied depending on the type of surgical intervention: group I – 58.2 ± 13.9 months (36–83), group II – 74.9 ± 11.3 months (40–110), group III – 62.3 ± 14.3 months (37–84).

Results. The mean age of patients was 51.1 ± 14.9 years, with a male predominance in all groups (85.3%). Groups were comparable in most demographic and clinical characteristics, except for a higher incidence of connective tissue dysplasia and infective endocarditis in group I, and more frequent cardiac rhythm disorders in group III. Overall mid-term survival was 92.6%: 89.5% in group I (2 in-hospital deaths, no late deaths), 91.7% in group II (2 late deaths), and 96.0% in group III (1 late death). Reoperations were performed only in groups II (2 cases) and III (3 cases). Echocardiography showed a statistically significant increase in maximum aortic valve velocity in group I (from 118 ± 10 cm/s to 126 ± 11 cm/s, p = 0.006), while peak and mean gradients and overall hemodynamics remained stable. Changes in maximum velocity and gradients in groups II and III were not statistically significant. Mild leaflet thickening, especially in group III, did not affect valve function.

Conclusions. All studied biomaterials demonstrated high stability and functional performance of the aortic valve in the mid-term. Aortic homografts, pulmonary autografts in the Ross procedure, and “Russian conduit” provide comparable survival, low risk of reoperation, and can be considered safe and effective for reconstructive aortic root surgery.

Highlights

● In this prospective randomized study (n = 106), no statistically significant differences were observed in the incidence of MACCE, in-hospital mortality, or conduit harvest-site complications between the I-graft and the free venous graft using the no-touch technique.

● The use of a no-touch saphenous vein conduit as part of an I-graft does not increase intraoperative risk or worsen early postoperative outcomes compared with a free venous graft configuration.

● The no-touch technique does not limit the choice of graft configuration and demonstrates comparable safety and reproducibility in the in-hospital period.

Aim. To evaluate in-hospital outcomes of myocardial revascularization using an I-conduit versus a no-touch saphenous vein graft in a randomized controlled trial.

Methods. This prospective randomized study included 106 patients with coronary artery disease who underwent coronary artery bypass grafting between January 2023 and December 2024. Patients were randomized using sealed envelopes into two groups: the first group underwent revascularization with a no-touch saphenous vein conduit configured as an I-composite graft (n = 53); the second group received revascularization with the same no-touch conduit but with a proximal anastomosis to the ascending aorta (n = 53). In-hospital outcomes included the incidence of major adverse cardiac and cerebrovascular events (MACCE), conduit harvest-site complications, and mortality.

Results. The groups were comparable in demographic, clinical, and surgical characteristics. No statistically significant differences were observed in the in-hospital incidence of MACCE (1.89% vs 0%; p > 0,99), mortality (1.89% vs 0%; p > 0.99), harvest-site complications (edema: 11.32% vs 16.98%; p = 0.58), or length of hospital stay (12.5 ± 9.2 vs 11.7 ± 4.0 days; p = 0.95).

Conclusion. This prospective randomized study demonstrated comparable safety and efficacy of the no-touch technique when used as an I-graft or as a free venous graft in coronary artery bypass surgery. No significant differences were found in MACCE, harvest-site complications, or in-hospital mortality. Both approaches showed similarly favorable early postoperative outcomes. Long-term advantages of the I-graft configuration require further investigation.

Highlights

The possibility of using biodegradable microneedles from a copolymer of polylactate glycolic acid for the delivery of drugs such as sibutramine and metformin has been demonstrated. Significant differences in the rate of release were revealed depending on the type of drug: metformin release was significantly faster than sibutramine and was characterized by a maximum release rate in the first 2 hours, reaching a plateau after 24 hours and maintaining the release rate after 48 hours, in total, 7% of metformin loaded into microneedles was released into the buffer solution. During the same period of time (48 hours), only 1% of the total amount of sibutramine loaded into microneedles passed into the buffer solution. At the same time, the release rate was also highest in the first 2 hours, after which the release of the drug slowed down, but without reaching a “plateau”. Mixing of these drugs slows down their release.

Aim. Evaluation of metformin and sibutramine drugs release rate from the developed microneedles made of poly(lactic acid glycolic acid) copolymer PLGA using high-performance liquid chromatography coupled with high-resolution mass spectrometry when loading them separately into microneedles and when loading a mixture of two drugs.

Methods. The objects of the study were biosoluble microneedles made of PLGA 50:50 copolymer (10,000–40,000 g/mol, LA tolerance 48–52%, GA 48–52%, solvent – ​​acetone) filled with either metformin or sibutramine alone in different concentrations, or a mixture of both drugs. A series of model experiments were conducted: 1) the analysis of drug release from microneedles containing metformin; 2) the analysis of drug release from microneedles containing sibutramine; 3) the analysis of a mixture of drugs release from microneedles with metformin and sibutramine. Quantitative determination of metformin and sibutramine in samples was performed by high-performance liquid chromatography in combination with high-resolution mass spectrometry

Results. Metformin demonstrated the highest release rate during the initial period (the first two hours), with a gradual slowdown in the release rate and reaching a “plateau”, where the amount of substance released over 24 hours becomes comparable to the amount released over 48 hours. Sibutramine showed a significantly slower release rate than metformin under similar conditions. In samples containing a mixture of drugs, the release efficiency was significantly reduced compared to the release of the same drugs loaded into the microneedles separately

Conclusion. The developed PLGA system is suitable for providing gradual release of drugs at the required concentration in the tissue. Differences in release rates were revealed depending on the drug type and the presence or absence of admixture with another drug. Metformin demonstrated the fastest release from microneedles, while the drugs mixing resulted in a significant reduction in the release efficiency of both drugs.

Highlights      

• Coronary microvascular dysfunction (CMD) is a pathophysiological condition characterized by impaired regulation of coronary microvascular tone and structure in the absence of obstructive epicardial artery disease. CMD is now recognized as a major contributor to myocardial ischemia, particularly in patients with angina and normal coronary angiograms (INOCA), as well as in cases of myocardial infarction with non-obstructive coronary arteries (MINOCA). The key mechanisms underlying CMD include impaired endothelium-dependent vasodilation, excessive vasoconstriction, inflammation, and capillary remodeling.
• The molecular regulation of coronary blood flow involves a complex network of signaling cascades, including ion channels, nitric oxide (NO), endothelin-1, cytokines, and regulatory non-coding RNAs. Single nucleotide polymorphisms (SNPs) in genes encoding these mediators and enzymes significantly affect microvascular function. Notably, SNPs in NOS3, KCNJ11, JAK2, HMOX1, VEGFA, and other genes have been associated with altered vasomotor reactivity, oxidative stress, inflammatory activation, and impaired angiogenesis.
• MicroRNAs (miRNAs) play a particularly important role in the pathogenesis of CMD by regulating gene expression at the post-transcriptional level. Dysregulation of miRNAs such as miR-126, miR-155, and miR-30 has been linked to endothelial dysfunction, reduced capillary density, and impaired myocardial energy metabolism. The interplay of molecular and genetic factors provides a mechanistic framework for CMD and offers new opportunities for personalized approaches in the diagnosis, prognosis, and treatment of microvascular forms of ischemic heart disease.

Abstract

Coronary microvascular dysfunction (CMD) has increasingly been recognized as an independent and clinically significant pathophysiological mechanism of myocardial ischemia, even in the absence of obstructive coronary artery disease. CMD is caused by both functional impairments, such as imbalance between vasodilation and vasoconstriction–and structural alterations of the microcirculatory network. Recent research highlights the crucial role of molecular and genetic factors in the development of CMD, including single nucleotide polymorphisms (SNPs) in genes encoding endothelial nitric oxide synthase (NOS3), ion channel subunits (KCNJ11, CACNA1C), inflammatory and angiogenic mediators (JAK2, VEGFA, HMOX1). In addition, the antioxidant system plays an important role in the pathogenesis of coronary microcirculatory dysfunction, which is involved in maintaining vascular homeostasis and protecting against oxidative stress. The main studied genes of the antioxidant system include SOD1–3, GPX1, CAT, HMOX1 and NOX2/NOX4, which provide a balance of production and utilization of reactive oxygen species and play a significant role in the pathophysiology of the vascular wall. Of particular interest are microRNAs that regulate the expression of genes involved in vascular reactivity, angiogenesis, oxidative stress, and inflammation. Dysregulation of microRNAs such as miR-126, miR-155, and miR-30 has been associated with endothelial dysfunction and capillary remodeling. This review explores key signaling pathways and molecular mechanisms underlying CMD, with a focus on their genetic and epigenetic modulation. A better understanding of these processes opens new perspectives for the development of personalized diagnostic and therapeutic approaches in microvascular forms of ischemic heart disease.

Highlights      

• Sorbs2 is an adaptor and cytoskeletal protein predominantly expressed in the cardiovascular system-specifically in cardiomyocytes, vascular smooth muscle cells, and endothelial cells. It plays a critical role in maintaining myocardial structural integrity, regulating contractility, and facilitating intercellular communication. In addition, Sorbs2 functions as an RNA-binding protein, influencing the stability and translation of mRNAs that encode essential ion channels and junctional proteins.
• Sorbs2 dysfunction is associated with a wide range of cardiovascular diseases, from cardiomyopathies and arrhythmias to dyslipidemia, hypertension, and diabetic angiopathy. Sorbs2 expression varies depending on the type of pathology and disease stage. For example, in dilated cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy, Sorbs2 levels are decreased, correlating with the severity of fibrosis, disruption of intercalated disc structure, and reduced ejection fraction. In pressure overload conditions (aortic constriction model), a compensatory increase in Sorbs2 expression has been observed during myocardial hypertrophy. Conversely, in diabetic vasculopathy, Sorbs2 expression in coronary arteries is reduced, which is linked to impaired BK-channel activity and decreased coronary perfusion.
• Given its multifunctionality and involvement in key processes underlying cardiovascular pathology, Sorbs2 is emerging as a promising molecular target. Its role in regulating inflammation, ion homeostasis, and myocardial structure suggests that Sorbs2 could serve as both a biomarker and a therapeutic target in cardiovascular diseases. However, further experimental and clinical studies are required to validate its diagnostic value and explore its full therapeutic potential.

Abstract

Sorbin and SH3 domain-containing protein 2 (Sorbs2) is a multifunctional adaptor protein that plays a key role in regulating cellular architecture, signal transduction, and gene expression in the cardiovascular system. Sorbs2 is highly expressed in cardiomyocytes, vascular smooth muscle cells, and endothelial cells, contributing to both the mechanical stability and electrical excitability of cardiac tissue. Recent studies have demonstrated that Sorbs2 is involved in the pathogenesis of a wide range of cardiovascular diseases, including dyslipidemia, atherosclerosis, hypertension, cardiomyopathies, arrhythmias, atrial fibrillation, congenital heart defects, diabetic vasculopathy, and aortic aneurysms. Beyond its structural role as part of the cytoskeleton, Sorbs2 functions as an RNA-binding protein that regulates the stability and translation of mRNAs encoding proteins of ion channels and intercellular junctions, which are essential for cardiac conduction. Dysregulation of Sorbs2 has been associated with myocardial fibrosis, atrial remodeling, and impaired cardiac contractility. Notably, the data on its role in inflammation are contradictory, highlighting the need for further investigation. This review summarizes current knowledge on the molecular biology of Sorbs2, its regulatory mechanisms, and its pathophysiological relevance in the context of cardiovascular diseases. The potential of Sorbs2 as a diagnostic biomarker and therapeutic target is discussed. A deeper understanding of Sorbs2 may open new avenues for personalized medicine and targeted treatment strategies in cardiovascular pathology.

Highlights

Presented clinical case describes repeat mitral valve replacement using domestic bioprostheses in a patient with mitral valve defect who had primary mitral regurgitation and subsequently developed bioprosthetic valve dysfunction.

Abstract

Presented clinical case describes a successful repeat mitral valve replacement using domestic bioprostheses in the treatment of recurrent mitral valve regurgitation in a young patient, discusses the advantages and limitations of using biological prostheses and approaches to repeat replacement, and analyzes the adherence to therapy as one of the factors limiting the effectiveness of treatment of patients with bioprosthetic heart valves.

The study of microcirculation and the adoption of therapeutic decisions to correct microcirculatory distress with the restoration of hemodynamic coherence is one of the promising areas of intensive therapy for multiple organ failure, especially during the transition from the acute critical phase to the phase at risk of developing MODS.
Despite the development of a number of microcirculation monitoring technologies, primarily in terms of direct visualization of microcirculation, most monitoring methods have not become part of real clinical practice.
During the 27th All‑Russian Conference with international participation “Life Support in Critical Conditions,” which took place in Moscow on November 7–8, 2025, and the roundtable on the topic “Monitoring the microcirculation of critically ill patients: the first steps of our own technologies,” a number of Russian research teams presented developments at various levels of technology readiness, which can be considered as candidates for further research and implementation in real practice. From the perspective of clinical feasibility and the evidence base, the demand for these technologies should be assessed taking into account the market situation and the prospects for commercialization.
The roundtable participants presented their developments. At the same time, they noted the common problems characteristic of all the technologies under consideration. As with technologies known as the “gold standard”—in particular, direct visualization of microcirculation via manual video microscopy—most microcirculation monitoring methods lack standardized characteristics of the parameters under study according to SMART criteria:
• S (Specific) — a specific indicator clearly defined to address a specific clinical problem;
• M (Measurable) – clear units of measurement, clear cut‑off values (cut‑off values), diagnostic threshold, predictive threshold, target value;
• A (Achievable) – test availability, analysis time, cost, ease of implementation;
• R (Relevant) – the indicator must address an important clinical problem that affects the patient management strategy and outcome;
• T (Time‑bound) – defined timeframes for measuring the parameter and interpreting the results obtained.
It is projected that the market volume for hemodynamic monitors will grow from USD 1.8 billion in 2020 to USD 3 billion or more by 2025–2026. The main trend will be a shift towards less invasive, high‑tech, and user‑friendly systems that can be integrated into the infrastructure of medical information systems.
Integrating microcirculation monitoring into existing hemodynamic systems will make it possible to bring microvascular monitoring to the point of care in real time. This will make it possible to personalize therapy and improve outcomes in patients with multiple organ failure.

Highlights

• Large Language Models (LLMs) enable automation of initial abstract screening in systematic reviews, significantly reducing manual workload.
• The effectiveness of LLMs heavily depends on prompt engineering, which must clearly translate inclusion and exclusion criteria into actionable instructions.
• Two prompt design strategies are presented and illustrated: a “lenient” approach (maximizing recall) and a “strict” approach (reducing false positives).
• A practical workflow for downloading and processing PubMed abstracts using LLMs (e.g., DeepSeek, GPT‑4o, Perplexity) is demonstrated.
• Key limitations of LLMs – hallucinations, sensitivity to phrasing, and training‑data biases — are discussed, emphasizing the need for expert validation.
• A two‑stage screening strategy is recommended: first a lenient pass, followed by a stricter filter, with subsequent manual verification of relevant articles.
• Prompt engineering is framed as an iterative, domain‑specific art rather than a one‑size‑fits‑all procedure, requiring continuous refinement for each research question.

Abstract

Large Language Models have evolved into powerful tools for automating the primary screening of articles’ abstracts in systematic reviews, enabling a significant reduction in manual labor. The article presents a comprehensive review of prompt engineering principles, demonstrating how traditional meta-analysis criteria can be transformed into clear instructions for artificial intelligence. Using case studies in coronary artery bypass grafting and congenital heart disease surgery, we illustrate the impact of prompt formulation on the comprehensiveness, accuracy, and overall efficiency of literature screening. Furthermore, typical errors are discussed, and the ongoing necessity of expert oversight to minimize hallucinations and biases inherent in artificial intelligence conclusions is emphasized. Ultimately, systematic prompt engineering combined with expert evaluation allows researchers in cardiovascular surgery to optimize the search for meta-analysis sources based on Large Language Models, ensuring a faster and more comprehensive synthesis of evidence and methods for processing primary material.

Highlights

This study presents and validates a hybrid framework that combines deep learning with Explainable Artificial Intelligence (XAI) for the segmentation and classification of atherosclerotic plaques. The incorporation of XAI techniques improves the interpretability of deep learning models, thereby facilitating their translation into clinical practice for the diagnosis of atherosclerosis. The results highlight the potential of XAI-enabled approaches to support the development of reliable, transparent, and clinically applicable decision support systems in cardiology.

Aim. To develop and validate a comprehensive method for automated segmentation and classification of morphological features of atherosclerotic plaques based on optical coherence tomography using explainable artificial intelligence approaches.

Methods. Nine state-of-the-art segmentation neural network architectures were trained on a dataset of 103 OCT studies annotated for four key plaque features. To assess interpretability, nine XAI methods were applied.

Results. The best segmentation results were achieved with DeepLabV3+ and MA-Net models (DSC up to 72.1%). LayerCAM and HiResCAM methods provided the most stable and accurate visualization of attention areas.

Conclusion. The proposed approach demonstrates high segmentation accuracy and interpretability, enhancing clinical trust and paving the way for future development of explainable AI systems in cardiology.

Highlights

• Contemporary trends in global cardiac surgery are characterized by a growing number of operations performed using various minimally invasive techniques.
• Since 2024, we have been utilizing the da Vinci Si robotic system for cardiac surgical interventions. The results of the performed operations have demonstrated the reproducibility and safety of robot-assisted coronary artery bypass grafting during the initial phase of the learning curve.
• The phased mastery of robot-assisted coronary artery bypass grafting ensures the safe integration of robotic cardiac surgery into routine clinical practice.

Aim. To demonstrate the feasibility, efficacy, and safety of robotic technology in cardiac surgery based on our own results of robot-assisted coronary artery bypass grafting.

Methods. Between June 2024 and June 2025, 30 robot-assisted coronary artery bypass grafting procedures were performed in the Department of Cardiac Surgery at University Clinical Hospital № 1. Intraoperative parameters and patient outcomes within the first 30 postoperative days were evaluated.

Results. In-hospital mortality, conversion rate to sternotomy, and incidence of postoperative bleeding were 0%. The mean operative time was 293 ± 63 minutes. 10 (33.3%) procedures were performed using parallel cardiopulmonary bypass, while the remaining 20 (66.7%) were performed off-pump. The mean number of distal anastomoses was 1.7 ± 0.7.

Conclusion. The path to realizing the full spectrum of benefits of robot-assisted coronary artery bypass grafting – be it minimal invasiveness or rapid patient recovery – lies in overcoming the inevitable learning curve. In the initial phase of mastering this technique, the true clinical advantages may remain obscured by technical challenges, highlighting the importance of a systematic approach to integrating robotic technology into routine practice.

Highlights

● Numerical modeling demonstrated that support frames with predefined zones of controlled deformation are capable of predictably increasing in diameter during balloon dilation through localized plastic deformation and fracture.

● The geometry of the deformation zone – specifically the number of bends – determines the stress distribution pattern and allows for control over the extent and localization of frame fracture.

● The radial forces required to expand the proposed frames are significantly lower than those required to fracture traditional surgical bioprostheses, confirming the clinical feasibility of the design.

Aim. To evaluate the feasibility of controlled diameter expansion of a heart valve prosthesis support frame using predefined deformation zones by means of finite element numerical modeling.

Methods. Three three-dimensional models of heart valve prosthesis support frames with controlled deformation zones were investigated, differing in the number of bends (1, 3, and 5). Balloon dilation was simulated in Abaqus/CAE using the finite element method. The frames were radially expanded by 2 mm followed by load removal to assess elastic recoil. The frame material was modeled as 316LVM stainless steel with elastic–plastic properties. Von Mises stress, plastic strain, outer diameter change, recoil, and radial force were analyzed.

Results. All frame variants demonstrated localization of maximum stresses and plastic deformation in the curved deformation zones, where stresses exceeded the yield and ultimate strength limits. This indicates the possibility of controlled fracture or irreversible deformation during dilation. An increase in the number of bends resulted in a more uniform stress distribution and reduced severity of local damage. Elastic recoil after load removal was 0.31% for all models. The required radial forces ranged from 287 to 354 N (2.8–3.5 atm).

Conclusion. Finite element modeling confirms the feasibility of an expandable heart valve prosthesis support frame with controlled deformation zones, enabling diameter enlargement under moderate balloon dilation pressures.

Highlights

• By 12 months of age, compared with 3 months, male ApoE^−/− mice demonstrate increased expression of the pro-inflammatory cell adhesion molecules ICAM1/CD54 and SELE/CD62E, inflammasome-associated cytosolic protein NLRP3, and endothelial-to-mesenchymal transition transcription factor Twist1 in the aortic and microvascular endothelial cells.
• By 12 months of age, compared with 3 months, male ApoE^−/− mice also exhibit increased expression of glycocalyx components (syndecan-1, syndecan-2, syndecan-4, and thrombomodulin) and basement membrane components (laminin, fibronectin, and nidogen-1) in the aortic and microvascular endothelial cells.
• By 12 months of age, compared with 3 months, male ApoE^−/− mice show decreased expression of the atheroprotective transcription factor NRF2 in the endothelium of the aortic intima, suggesting the need in specific therapies for endothelial protection.

Aim. To perform an immunohistochemical analysis of pro-inflammatory activation markers in the aortic endothelial cells and microvascular endothelial cells in male hyperlipidemic (ApoE^−/−) mice of ascending age.

Methods. Cryosections of the aorta from ApoE^−/− mice aged 3, 6, 9, and 12 months (n = 6 per time point) were stained with antibodies against pro-inflammatory cell adhesion molecules (VCAM1/CD106, ICAM1/CD54, SELE/CD62E), pro-inflammatory transcription factor NF-κB, inflammasome-associated cytosolic protein NLRP3, endothelial-to-mesenchymal transition transcription factors (Snail, Slug, TWIST1, and ZEB1), endothelial phenotype receptor markers (PECAM1/CD31, KDR/CD309, CDH5/CD144, MCAM/CD146, ENG/CD105, BSG/CD147, Tie2/CD202b, EFNB2, EPHB4), endothelial basement membrane components (laminin, perlecan, fibronectin, type IV collagen, nidogen-1, and nidogen-2), endothelial glycocalyx components (endocan, syndecan-1, syndecan-2, syndecan-4, thrombomodulin, and thrombospondin-1), mechanosensitive transcription factors (KLF2, KLF4, NRF2), and complement regulatory proteins (MAC-IP/CD59, DAF/CD55, MCP/CD46), followed by digital slide acquisition. Semi-quantitative analysis of protein expression in aortic and microvascular endothelium was performed using ImageJ software.

Results. By 12 months of age, compared with 3 months, aortic endothelial cells and microvascular endothelial cells of male ApoE^−/− mice demonstrated: 1) increased expression of pro-inflammatory cell adhesion molecules ICAM1/CD54 and SELE/CD62E, inflammasome-associated cytosolic protein NLRP3, and endothelial-to-mesenchymal transition transcription factor Twist1, collectively indicating sustained pro-inflammatory activation of the endothelium; 2) increased expression of glycocalyx components (syndecan-1, syndecan-2, syndecan-4, and thrombomodulin), basement membrane components (laminin, fibronectin, and nidogen-1), and complement regulatory protein MAC-IP/CD59, suggesting compensatory activation of synthetic processes; 3) decreased expression of the atheroprotective transcription factor NRF2. No age-related trends were observed in the expression of endothelial phenotype receptor markers or other atheroprotective transcription factors.

Conclusion. Dysfunctional aortic and microvascular endothelial cells in 12-month-old male ApoE^−/− mice are characterized by pro-inflammatory activation, compensatory synthesis of glycocalyx and basement membrane proteoglycans, and reduced expression of the atheroprotective transcription factor NRF2.

Highlights

The results obtained in this study demonstrate the feasibility of further investigation of the diagnostic ability of myocardial fibrosis markers in hypertension. This will further enable the exploration and implementation of more intensive treatment strategies to prevent hypertrophic and fibrotic myocardial remodeling, which can lead to complications in hypertension, as well as the study of the effects of other drugs on myocardial fibrosis.

Aim. To evaluate the effect of sacubitril/valsartan on myocardial fibrosis and galectin-3 and transforming growth factor-beta-1 levels in rats with arterial hypertension using morphological and biochemical methods.

Methods. Arterial hypertension was modeled by unilateral nephrectomy in 32 male Wistar rats. Animals were divided into four groups: control (sham-operated, n = 8), experimental (no treatment, n = 16), treatment-25 (model + sacubitril/valsartan 25 mg, n = 4), and treatment-50 (model + drug 50 mg, n = 4). Blood pressure was measured for 8 months. Cytokine levels were determined using enzyme-linked immunosorbent assay, and myocardial fibrosis was assessed using histological and morphometric methods.

Results. In the experimental group without drug administration, a significant increase in blood pressure, cardiomyocyte hypertrophy, an increase in TGF-β1 (13.1 ± 4.18 ng/mL), and fibrosis (median final score 4) were observed. Sacubitril/valsartan 50 mg reduced blood pressure (SBP 94.0 ± 1.6 mmHg) and TGF-β1 levels (8.44 ± 0.95 ng/mL) and prevented hypertrophy but had no effect on final fibrosis (median 4 points). However, fibrosis was absent in the interventricular and interatrial septa. Sacubitril/valsartan 25 mg had no effect on blood pressure or final fibrosis (median 6 points). Galectin-3 levels did not differ between groups. ROC analysis showed low diagnostic significance of the studied cytokines (AUC < 0.73).

Conclusion. Sacubitril/valsartan 50 mg exerted a significant hypotensive and antihypertrophic effect, partially preventing fibrosis in the interatrial and interventricular septa, but did not prevent the development of overall myocardial fibrosis.

Highlights

• Artificial intelligence is transforming cardiology by enabling more accurate diagnosis, personalized therapy, and prediction of cardiovascular complications.
• The study provides a comprehensive systematization of current approaches to machine learning, neural networks, and big data analytics in clinical cardiology.
• Key directions for integrating AI into Russian healthcare are highlighted, considering ethical, legal, and organizational aspects.

Abstract

Modern cardiology is undergoing a rapid digital transformation driven by artificial intelligence (AI). The application of machine learning and deep learning algorithms provides unprecedented opportunities for diagnosis, monitoring, and prediction of cardiovascular diseases (CVDs). This review summarizes current evidence on the integration of AI across key domains of cardiovascular care–from data acquisition and analysis to personalized treatment optimization. The article highlights successful applications of AI in electrocardiogram interpretation, cardiovascular imaging, hemodynamic assessment, and prediction of heart failure exacerbations. Particular attention is paid to ethical, legal, and organizational aspects of AI implementation, including transparency, data security, and clinical accountability. International and national frameworks, such as the EU Artificial Intelligence Act, GDPR, and Russian federal regulations, are discussed as foundations for safe and equitable adoption of AI in healthcare. The review also outlines the Russian Federation’s initiatives in digital health transformation, including the development of domestic diagnostic algorithms and unified medical data repositories. Future perspectives include the use of quantum computing, emotional AI, and integration of digital competencies into medical education. Artificial intelligence is viewed as a transformative tool to enhance diagnostic accuracy, treatment efficiency, and preventive strategies in cardiology, provided that human oversight and clinical validation remain central.

Highlights

The presented publication highlights the pathophysiological aspects of multiple organ failure syndrome associated with cardiac surgical correction of congenital heart diseases in conditions of artificial circulation, as well as analyzes current indications and features of the use of inhaled nitric oxide in children.

Abstract

Congenital heart diseases remain the leading cause of infant mortality. Multiple organ failure, which develops as a result of ischemic reperfusion injury and systemic inflammation during artificial blood circulation, determines the unfavorable outcomes of operations. The key link in these processes is the deficiency of nitric oxide (NO). Traditionally, inhaled NO is used for pulmonary hypertension and hypoxemia in newborns. However, its pleiotropic effects – vasodilation, inhibition of platelet aggregation, stabilization of the endothelium and antioxidant effect – justify the expansion of indications. This review analyzes the current aspects of the use of NO in pediatric cardiac surgery: the physiological basis, current indications, as well as the causes of treatment failures. Special attention is paid to new directions – intraoperative organoprotection with artificial blood circulation. Despite the inconsistency of the data and the lack of uniform recommendations, the accumulated evidence points to the prospects of including nitric oxide in the protocols of anesthetic aids to improve outcomes in children with congenital heart diseases.

Highlights

• Patients with sickle cell anemia (SCA) have a high risk of thrombotic complications due to chronic hemolysis, inflammation, and hypercoagulation.
• D‑dimer is a promising marker of risk and therapy effectiveness in SCA, but its use is complicated by a persistent increase in baseline levels and the lack of standardized threshold values.
• Prospective studies and the development of specialized protocols are needed to introduce D‑dimer into clinical practice.

Abstract

The chronic hemolysis, inflammation, and prothrombotic status, which is a risk factor for overt and subclinical thrombotic events, are followed since birth in patients with sickle cell anemia (SCA). D-dimer, one of the most commonly employed fibrin degradation products in the assessment of venous thromboembolism, has become an indicator of thromboembolism risk and virulence in SCA. Its clinical application, however, is complicated by a persistent increase in the baseline caused by its chronic inflammatory and hypercoagulable environment. This review addresses the diagnostic and prognostic role of D-dimer in SCA, correlating it with its possible use in screening, risk stratification, or companionship during therapy. Other diagnostic strategies, including the application of clinical prediction tools such as the Wells score, are addressed within the context of their being adequate and verified in applying to this particular population. The influence of anticoagulant therapies on the dynamics of D-dimer is also discussed, which indicates the opportunity of using D-dimer as a parameter of the effect of this treatment. In spite of this promise, however, issues like a lack of standardized cut-off values and confounding interpretation variables limit this to not being used routinely. The necessary development of prospective trials and multi-marker panels and verification of protocols related to SCA are crucial for the implementation of D-dimer in SCA management. Critical to note is the fact that persistent elevation of D-dimer might not lengthen the story of thrombosis but could also be used as a cardiovascular risk marker and as an approach to chronic care management. Future research is necessary to incorporate D-dimer into an SCA complex precision medicine framework.

Highlights

We present a clinical case demonstrating the feasibility of transcatheter mitral valve repair using the MitraClip system as an effective bridging therapy to orthotopic heart transplantation in a high-surgical-risk patient with severe functional mitral regurgitation secondary to acute myocardial infarction.

Abstract

While the impact of percutaneous mitral valve repair (MitraClip) on outcomes in chronic, severe, symptomatic mitral regurgitation has been extensively studied for many years, data on the use of this edge-to-edge percutaneous mitral valve repair in patients with severe, acute mitral regurgitation are scarce and limited to isolated reports or small registries. In some patients, the MitraClip procedure may serve as a bridge to surgical correction of mitral regurgitation, and in some cases, to orthotopic heart transplantation. In this paper, we describe a clinical case of the use of the MitraClip technology in acute post-infarction mitral regurgitation as a bridge to subsequent orthotopic heart transplantation.