Highlights

Patients with coronary heart disease often present with comorbid depressive disorders, insomnia and a significant decrease in heart rate variability, which can aggravate the clinical course of the disease and increase the risk of sudden death.

Abstract

Aim. To study the presence and severity of insomnia and the range of heart rate variability (HRV), as well as their relationship in a patient with coronary heart disease (CHD) with depressive disorders (DD).

Methods. The study included 101 patients with CHD (more than 6 months after myocardial infarction): 67 patients with DD and 34 patients without DD. The Beck Depression Scale consultations with a psychotherapist were used to diagnose DD. Sleep disturbances were assessed using the Sheehan Rating Scale. HRV parameters were assessed using the SCHILLER MT-200 Holter-ECG device. Data are presented as M ± SD; n (%); Me [25%; 75%], tables of connectivity and χ² criteria were used. The difference was considered significant at p <0.05.

Results. Sleep disturbances and night awakenings in the general group of patients occurred in the following cases: none or clinically not significant – 50 (49.5%) cases, clinically significant – 51 (50.5%) cases. Sleep disturbances and night awakenings were significantly pronounced in CHD patients with DD compared with patients without DD: clinically significant sleep disturbances in 45 vs 6 patients (p = 0.00001), night awakenings – 43 vs 8 patients (p = 0.003), respectively. In patients with DD, compared to patients without DD, a significant decrease in HRV was noted in the following parameters: SDNN (97 [83; 113] ms vs 110 [98; 124] ms, p = 0.01), SDANN 80 [67; 94] ms vs 91 [79; 102] ms, p = 0.01), SDNN index (46 [38; 56] ms vs 55 [48; 66] ms, p = 0.005), pNN50% (4 [2.4; 5.7] vs 6 [ 3; 12.6], p = 0.02). There was a more significant decrease in the SDNN index in patients with severe sleep disturbances, compared with patients with normal sleep (38 [34; 51] ms vs 57 [48; 61] ms, p = 0.02).

Conclusion. Changes in the circadian rhythm in CHD patients with DD take the form of insomnia and a significant decrease in HRV. Insomnia increases sympathetic activation, which aggravates the clinical course of CHD and increases the risk of sudden death due to arrhythmias.

Highlights

For the first time we have established an association between a prolonged duration of aortic valve implantation and deterioration of memory and attention, as well as a lower frequency of alpha activity, which indicates adverse changes in neural network activity.

Abstract

Aim. To examine the neurophysiological parameters of patients who underwent transcatheter aortic valve implantation (TAVI), taking into account the intervention's duration.

Methods. The prospective study involved 53 patients, 13 of whom were men. All patients were divided into two groups depending on the duration of TAVI: up to 90 min (n = 21) and more than 90 min (n = 32). To determine the state of brain function in patients who underwent TAVI, preoperative cognitive screening, extended neuropsychological testing to determine postoperative cognitive dysfunction (POCD), and electroencephalographic (EEG) study 1–2 days before and 5–7 days after TAVI were conducted.

Results. The majority of patients (83%) had a decreased preoperative cognitive status (36% severe, 47% moderate cognitive impairment). Extended neuropsychological testing at 5–7 days after TAVI demonstrated that the patients with a longer TAVI time had worse adaptation and greater exhaustion of the directed attention system, and remembered fewer words than the patients with an intervention time of less than 90 minutes. The patients with a longer TAVI time had a lower central frequency of EEG activity (alpha peak) at 5–7 days after TAVI than those with a shorter intervention time. The duration of TAVI has a statistically significant negative correlation with the central frequency of EEG activity.

Conclusion. The results of the study demonstrated the significance of TAVI duration as a complex indicator, possibly associated with the features of the intervention, such as mechanisms of material embolism and impaired cerebral perfusion. The identification of specific perioperative factors and mechanisms that contribute to brain damage and POCD should be the focus of further investigation into TAVI patients' neurophysiological state.

Highlight

Neointimal hyperplasia and aneurysm formation are common complications in the development of vascular grafts. For the effective assembly of newly formed tissue based on biodegradable grafts and targeted remodeling, the creation of additional incentives is an urgent issue. The study involved comparative assessment of remodeling based on biodegradable vascular grafts, depending on the presence of proangiogenic factors and the effect of an antibacterial agent on the sheep carotid artery model.

Abstract

Aim. To comparatively describe remodeling of two types of grafts, depending on the presence or absence of proangiogenic factors and the influence of an antibacterial agent.

Methods. Two types of biodegradable vascular grafts were made from poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) and poly(ε-caprolactone) (PCL) by electrospinning. On the inner surface of the PHBV/PCL/Ilo/A vascular grafts, a drug coating was formed from cationic amphiphile and iloprost, and a reinforcing spiral frame was created by extrusion. In the manufacture of the PHBV/PCL/GFmix/Hep/Ilo vascular grafts, a composition of growth factors (GFmix) was introduced at the electrospinning stage: vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and a chemoattractant molecule (SDF-1α). Additionally, iloprost and heparin were modified by complexation via polyvinylpyrrolidone to impart thromboresistant properties. The resulting grafts were implanted into the carotid artery of a sheep (n = 12). The explanted vascular grafts were examined using histological and immunofluorescence staining, the genetic profile of vascular wall remodeling was studied by quantitative polymerase chain reaction.

Results. According to the results of histological and immunofluorescence studies, a newly formed three-layer structure of vascular tissue without calcification deposits formed on the PHBV/PCL/GFmix/Hep/Ilo grafts. Genetic study showed that at 6 months of implantation, remodeling, compared to the sheep carotid artery, occurred in an inflammatory environment (IL1A, IL4, IL8), and was also characterized by inflammatory activation of the endothelium (KLF4). The newly formed vascular wall formed on the basis of the PHBV/PCL/Ilo/A grafts showed signs of neointimal hyperplasia and increased expression of anti-inflammatory IL10, which might reflect the development of a chronic inflammatory process. Moreover, it showed the formation of a vasa vasorum network in the adventitia and increased expression of the CXCR4 gene, encoding a receptor associated with angiogenesis. There were no signs of acute inflammation in both study groups, however, we detected aneurysmal expansion of vascular lumen. When comparing a newly formed vascular tissue formed on the PHBV/PCL/GFmix/Hep/Ilo grafts to a newly formed vascular tissue on the PHBV/PCL/Ilo/A grafts, we observed a lower level of expression of proinflammatory and anti-inflammatory cytokines, as well as molecules of inflammatory and prothrombotic activation of endothelial cells.

Conclusion. Growth factors introduced into the composition of the PHBV/PCL/GFmix/Hep/Ilo grafts are capable of modulating the microenvironment. After 6 months of implantation it led to the newly formed three-layer structure of vascular tissue, characterized by a decrease in the level of expression of pro- and anti-inflammatory cytokines and chemokines, as well as molecules of inflammatory and prothrombotic activation of the endothelium compared to the newly formed vascular tissue on the PHBV/PCL/Ilo/A grafts.

Highlights

The organoprotective effect of nitric oxide during cardiac surgery, including reconstructive interventions on the aorta, is widely studied, however, its use may be limited due to the likely development of side effects, including kidney damage. This paper presents data on the study of the possible negative effects of nitric oxide on the kidneys in patients undergoing Hemiarch surgery.

Abstract

Aim. To evaluate the effect of perioperative nitric oxide delivery on the severity of nitrosyl stress and renal tubular injury mediated by local inflammation activation during Hemiarch surgery under conditions of cardiopulmonary bypass and hypothermic circulatory arrest.

Methods. The work presents the data of a single-center, single-blind, prospective, randomized controlled trial. The study included 80 patients over 18 years of age who underwent Hemiarch surgeries under artificial circulation and hypothermic circulatory arrest for non-syndromic ascending aortic aneurysms in the period 2020–2023. All patients were randomized into two groups in a 1:1 ratio: the NO group (main group), which received perioperative delivery of nitric oxide at a concentration of 80 ppm, and the standard perioperative support group (control group, NO delivery was not performed). To assess the severity of NO-mediated nitrosyl stress, the concentration of nitrotyrosine in the blood serum was measured. Blood was sampled immediately after placement of the central venous catheter and 4 hours after the end of the surgery. To assess the severity of renal tubular injury mediated by local inflammation activation, the concentration of IL-18 in urine was determined. Urine was collected after bladder catheterization and 4 hours after the end of surgery.

Results. The concentration of nitrotyrosine 4 hours after surgery was 10.67 [8.99; 12.50] ng/ml in the NO group and 6.74 [5.89; 10.50] ng/ml in the no-NO group (p = 0.13). The concentration of IL-18 in urine 4 hours after surgery was 5.01 [4.06; 5.98] ng/ml in the NO group and 5.82 [3.60; 29.40] ng/ml in the no-NO group (p = 0.50).

Conclusion. Perioperative delivery of 80 ppm NO during Hemiarch surgery under CPB and hypothermic circulatory arrest does not induce NO-mediated nitrosyl stress and does not affect renal tubular injury mediated by local inflammatory activation.

Highlights

The method for determining the viability of mesenchymal stem cells in the composition of tissue-engineering constructs is proposed here. This method can become an effective tool for regenerative medicine and tissue engineering for assessing the mechanisms of the regenerative process when using tissue-engineered constructs and predicting their effectiveness in an in vitro system.

Abstract

Aim. Еxperimental substantiation of the efficiency of the method for determining the viability of mesenchymal stem cells in tissue-engineered constructs during regeneration

Methods. The experimental study was conducted on 12 animals (rats). A full-layer scalped wound with a diameter of 3 cm was formed in the animals. A tissue-engineering construct based on human plasma cryoprecipitate was implanted into the wound, with the composition of which a suspension of rat mesenchymal stem cells (MSCs) pre-stained with the DiOC₁₄(3) tracer was introduced. At the control periods (3, 7–8, 14 and 21 days), the animals were withdrawn from the experiment. During the operation, the wound defect area was cut out for ex-tempore examination using wide-field fluorescence microscopy with visualization of samples with 40×, 100×, 200× magnification in the GFP fluorescence channel.

Results. When examining the material obtained from animals on day 3, the external characteristics of the overwhelming majority of identified objects with characteristic fluorescent glow corresponded to the morphological characteristics of MSCs – spindle-shaped cells with characteristic processes. In the material obtained from experimental animals on days 7–8, a large number of cells stained with a tracer fluorescent membrane dye were also detected, which had a green fluorescent glow and characteristic morphology. In the biomaterial obtained on day 14 of the experiment, the number of objects with characteristic MSC morphology stained with the DiOC₁₄(3) tracer was significantly less than on days 3 and 7–8 of the experiment. On day 21, a signal specific for the DiOC₁₄(3) tracer was also detected, but it was not possible to visualize even single cells with the morphology characteristic of MSCs; the signal was probably due to fragments of membranes of eliminated MSCs labeled with a fluorescent dye.

Conclusion. It was shown that MSCs in tissue-engineering constructs implanted on the animal wound retain viability and characteristic morphology for at least 14 days. It is important that the proposed method allows intravital visualization and photofixation of viable MSCs with characteristic morphology, and thus avoiding distortions that may be associated with fixation of biological material. The proposed method can become an effective tool for regenerative medicine and tissue engineering in relation to assessing the mechanisms of the regenerative process using TECs and predicting their effectiveness in the in vitro system.

Highlights

It is necessary to take into account the type and duration of its contact with the human body to determine the possibility of using regulatory values of maximum permissible concentrations of hazardous substances when assessing the safety of a medical device.

Abstract

Background. Sanitary and chemical tests are the first stage of toxicological studies in assessing the safety of a medical device (MD) that measure the content of chemically hazardous substances in extracts from samples. Is should be noted that, unlike biological tests, the sanitary and chemical tests involving physicochemical research methods are designed to answer the question as to what is the cause of the detected adverse biological effect of a MD. However, in some cases, exceeding the maximum permissible concentration (MPC) of a toxic chemical in extracts is not accompanied by its undesirable biological effect.

Aim. To analyze, using concrete examples, the possible causes of inconsistencies in the MD safety assessment of the results of sanitary, chemical and biological parameters, as well as to demonstrate the need to take into account the type of MD contact with body tissues (direct, indirect, type of tissue) and the duration of contact when interpreting the results obtained.

Methods. The objects of the study were: (1) a piston made of polyoxymethylene and silicone in a medical device for the biological tissue retrieval with its subsequent return to a patient (StemC Biyoteknoloji Anonim Şirketi, Turkey), and (2) a diagnostic intravenous catheter made of a thermoplastic polyamide elastomer containing X-ray contrast barium sulfate and stainless steel (Merit Medical Systems, Inc., USA). The methods of gas chromatography, atomic absorption spectrometry and photometry in the visible area were used to quantify hazardous substances in the extracts. In the study of the biological effect (safety) of the samples, the following indicators were selected: cytotoxicity, irritant effect, sensitizing effect, pyrogenicity, and material-mediated and acute toxicity.

Results. In the absence of toxic effects of extracts from the piston and catheter samples in in vitro and in vivo experiments, the content of formaldehyde and barium in them was 0.49 mg/L and 1.0 mg/L, respectively, which exceeds their standard MPC values of 0.10 mg/L. Taking into account the MD type, the absence of an undesirable effect of the formaldehyde and barium content exceeding their MPC on the in vitro and in vivo safety indicators of the piston and catheter can be explained, in the first case, by a delayed effect, and in the second - by the inapplicability of the normalized MPC value for the catheter.

Conclusion. When interpreting the obtained MPC values of toxic substances in extracts from a MD and from materials in order to assess their safety, the dependence of the adverse biological effect on the type and duration of MD contact with the human body should be taken into account. With repeated use of a MD, a delayed effect is possible due to the accumulation of toxic substances that exceed threshold values.

Highlights

The study included the analysis of structural, physical and mechanical properties of composite matrices based on silk fibroin (SF) and polyurethane (PU) with different component ratios.

Abstract

Background. SF is a polymer of natural origin, suitable for tissue engineering. Combining it with elastic polymers can improve the physical and mechanical properties of the material, making it a promising material for vascular patches in cardiovascular surgery.

Aim. To study the structural, physical and mechanical features, as well as to evaluate the hydrophilicity and adsorption of proteins by the surface of composite matrices based on SF and PU with different ratios of components.

Methods. Matrices were manufactured by electrospinning at a ratio of SF and PU of 3:1, 2:1, 1:1, 1:2, 1:3. Matrices of 10% SF and 10% PU served as controls. The ultrastructure of the composites (fiber thickness, pore size, and material porosity) was studied using SEM-images. The following physical and mechanical parameters of the matrices were measured: tensile strength, relative elongation, and Young's modulus. The hydrophilic properties of the matrix surface were estimated by measuring the contact wetting angle. The adsorption of albumin and fibrinogen by the matrix surface was studied.

Results. All scaffolds produced by electrospinning had a porous-fibrous structure. Increasing the PU content resulted in the presence of adhesions and isolated cracks of fibers on the inner surface of the scaffolds after steam crosslinking of the polymers. The combination of SF and PU increased the strength and elasticity of the scaffolds compared to pure SF and brought them closer to native human a. mammaria in their ability to resist stretching. Adding PU to the SF composite reduced its initial hydrophilicity compared to pure 10% SF. Albumin adsorption was the same for all scaffolds; fibrinogen was adsorbed to a greater extent on scaffolds with a predominance of SF in the composition.

Conclusion. Addition of PU to the composition of the SF composite does not disrupt the porous-fibrous structure of the matrix, increases its strength and elasticity, brings its properties closer to those of the native human artery, and also reduces the adsorption of fibrinogen, which expands the possibilities of this material for use in cardiovascular surgery as vascular patches.

Highlights

Coronary artery disease is one of the leading causes of hospitalization of patients. An assessment of the dynamics and structure of the number of hospitalizations over a ten-year period will allow us to determine the factors influencing the level of hospitalization of patients with various forms of coronary artery disease, and the degree of influence of each of the factors in practical healthcare.

Aim. To evaluate the dynamics and structure of the number of patients hospitalized for coronary artery disease in the Russian Federation in 2014–2023.

Methods. The analysis of Rosstat data on the structure of the number of hospitalizations (planned andemergency) for coronary heart disease among adults (18 years and older), contained in Table 2000 FFSN No. 14, was carried out and an assessment of their dynamics for 2014–2023 was performed. The statistical analysis was performed using the packages SPSS 26.0 (IBM Company) and Excel (Microsoft for Microsoft Windows).

Results. The number of hospitalizations of patients with coronary artery disease for the period 2014–2023 decreased by 20% (from 1,310 per 100,000 adult population to 1,054 per 100,000 adult population). The proportion of patients hospitalized for coronary artery disease in the structure of general hospitalization decreased from 7.7% to 6.7%. The number of hospitalizations of patients for chronic forms of coronary artery disease (I25) decreased by 0.7%, for myocardial infarction (I21–22) – by 9%; for angina pectoris (I20) – by 32%. The number of cases of hospitalization of patients for postinfarction cardiosclerosis (I25.8) increased by 31%. The share of hospitalizations of patients for chronic forms of coronary artery disease in the structure of cases of hospitalization of patients for coronary artery disease increased from 35.1% in 2014 to 43.3% in 2023; for MI – increased from 12.7% in 2014 to 14.4% in 2023; for angina – decreased from 50% in 2014. up to 42.2% in 2023, the change in the structure of hospitalization of patients for coronary artery disease is statistically significant (p<0.0001). Significant volatility in the number of hospitalizations for various forms of coronary artery disease was registered during the pandemic of the new coronavirus infection COVID-19.

Conclusion. There has been a steady decrease in the number of hospitalizations of patients for coronary artery disease and a change in the structure of hospitalization of patients for coronary artery disease with a continuing predominance of hospitalizations for chronic forms of coronary artery disease. The identified trends may be related both to approaches to the organization of medical and diagnostic care, and to the specifics of accounting for the causes of hospitalization according to the ICD-10 codes. Due to the large number of factors influencing the hospitalization of patients with various forms of coronary artery disease, it is advisable to determine the degree of influence of each of them in the conditions of practical healthcare in the Russian Federation.

Highlights

The first comparative review of modern models for predicting multiple PCI complications simultaneously, including those based on machine learning, is presented. The advantage of machine learning models (especially XGBoost) is demonstrated, which, even when using a single data set, have high accuracy and are able to take into account complex nonlinear factors that were not previously taken into account by traditional risk scales. The top 3 models have been identified that can simultaneously predict multiple outcomes without duplicating variables and it is what lays the foundation for more effective and versatile clinical tools.

Abstract

Modern models for predicting complications of percutaneous coronary interventions (PCI) are rapidly evolving under the influence of new machine learning (ML) technologies. This research presents a comparative review of existing methods aimed at simultaneously predicting multiple complications of PCI (death, bleeding, acute kidney failure, etc.). The study compares traditional risk stratification scales (such as NCDR Cath-PCI, CART VA, and others) with modern ML algorithms.

A keyword search in the PubMed database over the past 10 years identified 2 667 publications related to PCI complication prediction. After excluding publications that did not provide sufficient information regarding study design, model construction, and data analysis, those based on virtual data analysis, single-outcome prediction studies, as well as reviews and clinical case reports, 9 of the most relevant studies were selected. These studies covered large registries from the USA, Japan, and international database.

Despite the diversity of approaches, only a limited number of models are formally capable of simultaneously predicting multiple complications based on a single set of variables. Moreover, in most studies, the use of ML (particularly XGBoost) increased accuracy compared to traditional methods.

The results of the study confirm the potential of machine learning in the multi-outcome risk assessment of PCI. However, the effective use of these models in clinical practice requires reliable external validation, adaptation to local conditions, and consideration of technological innovations (such as intravascular imaging and invasive physiology). The development of ML-based prediction methods that meet these criteria will significantly improve the accuracy of PCI risk stratification, optimize procedural performance, and enhance patient outcomes in ischemic heart disease. A natural extension of this methodology is the inclusion of intravascular imaging and invasive physiology data in the models.

Highlights

• Specific associations between specific risk factors and types of CHD have been identified, which allows differentiating high-risk groups.
• Pathogenetic mechanisms of the influence of maternal factors on the formation of congenital heart defects, including placental dysfunction, have been established.
• The need for comprehensive prevention, including pregravid correction of modifiable factors and optimization of prenatal screening in the formed risk groups, has been substantiated.

Abstract

The article presents a comprehensive analysis of risk factors for the development of congenital heart defects (CHD) in children associated with the health status of the mother and environmental exposure. The main attention is paid to the mechanisms of influence of somatic pathology of the mother, including metabolic disorders (diabetes mellitus, obesity), pregnancy complications (preeclampsia) and environmental factors on the processes of cardiogenesis. The key pathogenetic pathways are considered, including placental function disorders, epigenetic changes and oxidative stress. Particular importance is attached to the analysis of the relationship between specific risk factors and types of developing heart defects. Modern approaches to the prevention of CHD are presented, including pregravid preparation, correction of modifiable risk factors and improvement of prenatal diagnostic methods. The importance of an interdisciplinary approach to reducing the incidence of congenital cardiac pathology is emphasized.

Highlights

Cor triatriatum is a congenital heart disease that occurs when the atrium is divided into two chambers by a fibro-muscular membrane, the left-sided atrial membrane is more common; it can be associated with a higher incidence of atrial fibrillation. The anomaly incidence rate is less than 0.1% of all congenital malformations and it is mainly diagnosed in infancy. We present a clinical case that describe cor triatriatum in a 38-year-old man.

Abstract

A triatrial heart is one of the rarest congenital heart defects, diagnosed and corrected in infancy. However, with a significant area of fenestrations, patients may remain asymptomatic throughout their life. This article describes the case of a 38-year-old man who was diagnosed at the age of 17. He chose not to undergo surgical correction, and clinical symptoms in the form of paroxysms of atrial fibrillation only appeared at age 30. The patient is observed by cardiologists and cardiothoracic surgeons, tolerates physical exertion well outside of the atrial fibrillation paroxysms, shows no signs of congestion in the pulmonary circulation according to catheterization data, continues to take anticoagulant and antiarrhythmic therapy, and still refrains from surgical treatment. The presented clinical case demonstrates that a rare congenital heart defect can be a cause of atrial fibrillation in a young adult who has been asymptomatic for a long time.

Highlights

Invasive cardiac lipoma is a rare benign cardiac tumor that can cause life-threatening conditions depending on its size and location. This article reports a rare case of surgical treatment of an invasive lipoma of the right atrium.

Abstract

The aim of this research is to demonstrate a rare case of surgical treatment of an invasive lipoma of the right atrium. Patient Ya., female, 46 years old, was admitted to the department with periodic attacks of rapid arrhythmic heartbeat. ECG: the rhythm is regular, sinus, 79 beats/min heart rate. According to transthoracic echocardiography: an additional floating heterogeneous formation of a round shape with an uneven contour, measuring 32 × 29 mm, attached to the junction of the superior vena cava was visualized and it was placed in the cavity of the right atrium. According to the results of CT and MRI with contrast the cardiac tumor growing into the right atrium wall and extracardially was also visualized. An operation was performed to remove the cardiac tumor of the right atrium, to reconstruct the right atrium with a xenopericardial patch and de Vega tricuspid valve annuloplasty on the beating heart with cardiopulmonary bypass (77 minutes). The size of the outer part of the tumor was 30 × 70 mm, the inner – 40 × 50 mm. The postoperative period proceeded without complications. Microscopic examination of cardiac tumor showed a histological picture of a cardiac lipoma. In conclusion, it should be noted that invasive lipoma of the right atrium is a rare benign tumor of the heart and this research is of scientific interest for the further study of this phenomenon. Early surgical removal of the lipoma is important, taking into account its characteristics, due to the possible risk of tumor growth and infiltration into the surrounding structure. Preoperative planning requires accurate data on the location of the tumor and its infiltration into the adjacent heart structure.

Highlights

Performing emergency coronary artery bypass grafting in patients with high-risk acute coronary syndrome without ST segment elevation and accumulating experience with these interventions will help specialists to implement open myocardial revascularization into clinical practice as a self-sufficient treatment modality.

Abstract

The presented clinical case demonstrates the possibility of performing complete myocardial revascularization by means of total autogenous arterial revascularization in high-risk non-ST-segment elevation acute coronary syndrome and multivessel coronary disease within the framework of the aortic no-touch technique in case of total calcification of the ascending aorta.

Highlights

This paper presents the long-term results of complex tricuspid valve reconstructions in severe secondary tricuspid insufficiency, such as the extension of the anterior tricuspid valve flap, the “clover” technique, as well as the immediate results of the convergence of the papillary muscles of the right ventricle. This generalized material has no analogues in the Russian-language literature and familiarization with it will expand the indications, durability and safety of tricuspid valve reconstructions.

Abstract

Aim. Tricuspid annuloplasty of the tricuspid valve is the most common and, in the vast majority of cases, the only intervention on the tricuspid valve performed for tricuspid regurgitation. However, there are a number of problems that cause dissatisfaction with a single-component treatment of the tricuspid valve, such as: the risk of recurrence of TR 2, varying from 10 to 32% depending on the annuloplasty method; high mortality during reoperation on the tricuspid valve due to the return of TR.

Methods. From 2010 to 2017, anterior leaflet augmentation of the tricuspid valve was performed in 18 patients with severe TR. According to the etiology of TR, the patients were divided into 2 groups: Group 1 – patients with organic disease of the tricuspid valve (rheumatism – 10 patients, congenital heart disease – 2 patients); Group 2 – with functional TR (6 patients). For the period from 2004 to 2019. The “clover” technique was used in TR correction in 28 patients. Myxomatosis was the predominant etiology of TR in 16 cases, functional disease of the tricuspid valve – 7 patients, rheumatism – 3 patients, infective endocarditis – 2 patients.

Results. Freedom from recurrence of TR ≥ grade 2 in the long-term period in the “clover” group was 75% (with myxomatosis – 85,7%), in the “augmentation” group – 100% with functional defect and 60% with organic valve disease. Freedom from recurrence of TR ≥ grade 3 in the “edge to edge” group was 87.5% (with myxomatosis – 100%), in the “augmentation” group – 100% with functional disease and 81.8% with organic valve disease. In the edge-to-edge group, a correlation was found between the degree of TR in the late period and the implementation of additional maneuvers on the tricuspid valve (excision of secondary chords and anterior leaflet augmentation r = 0.5, p = 0.037 and r = 0.5, p = 0.048, respectively).

Conclusion. The results of anterior leaflet augmentation of the tricuspid valve in case of functional TR, the edge-to-edge suture in case of valve myxomatosis are satisfactory and allow to expand the indications for reconstructive surgery, the techniques are reproducible, safe and durability.

Highlights

• Diet-induced metabolic syndrome does not lead to mitochondrial respiration impairment and worsening of contractile dysfunction of the rat myocardium.
• Preservation of contractile function may be associated with substrate oxidation by complex II of the mitochondrial respiratory chain. It can be assumed that the initial metabolic changes of donors are not a significant obstacle to myocardial transplantation.

Abstract

Background. Tissue resistance to acute ischemia is an important problem of medical science in general and transplantology in particular. At the same time, carbohydrate and lipid metabolism disorders can cause a decrease in organ resistance to ischemia, and the high prevalence of such disorders in the population is an important problem for the preservation of the transplanted organ.

Aim. To assess the effect of experimental metabolic syndrome (MS) on the severity of myocardial contractile dysfunction during reperfusion, and the relationship between myocardial contractility in MS and mitochondrial respiration.

Methods. The study was performed on Wistar rats. Metabolic syndrome (MS) was modeled by feeding rats of a high-carbohydrate, high-fat diet for 12 weeks. Post-ischemic myocardial contractility was assessed using an in vivo model of acute coronary occlusion-reperfusion (ACR) echocardiography and an isolated heart ischemia-reperfusion model. Mitochondria were isolated by differential centrifugation from the ischemic zone after ACR. Mitochondrial respiration was assessed in the presence of malate, pyruvate, and succinate.

Results. Keeping rats on a diet for 12 weeks led to the formation of obesity, hypertension, increased blood glucose, triglyceride, leptin, and adiponectin levels, i.e., to the metabolic syndrome formation. Myocardial contraction parameters before ischemia modeling both in vivo and in the isolated heart model did not differ. Mitochondria of rats with MS were distinguished by greater efficiency of ADP/O respiration on both NAD+ and FAD+-dependent substrates.

ACR in vivo led to a decrease in the contractile and pumping function of the myocardium, suppression of mitochondrial respiration equally in the group of control animals and animals with MS. Similar data were obtained in the isolated heart model. An inverse correlation link was established between the efficiency of mitochondrial respiration in rats with MS in the presence of a FAD+-dependent substrate and the value of the end-systolic volume at late stages of reperfusion. Such a relationship was not observed in the control group rats.

Conclusion. The obtained results suggest that diet-induced MS does not lead to mitochondrial respiration impairment and aggravation of myocardial contractile dysfunction. Preservation of contractile function may be associated with oxidation of substrates by complex II of the mitochondrial respiratory chain. It can be assumed that the initial metabolic changes in donors are not a significant obstacle to myocardial transplantation.

Highlights

• KemPeriplas-Neo xenopericardial patch, which is used for transannular patch repair at congenital heart disease, undergoes enzymatic degradation 15 years after the implantation.
• Extracellular matrix delaminates into three layers which respectively consist of fragmented, loose, and dense collagen fibers; however, pericardial patch durability is partially reinforced by neointimal hyperplasia.
• Disintegration of the collagen fibers are enhanced by natural aging of the xenopericardium, high hemodynamic load, precipitation of circulating collagenases, macrophage infiltration, and weak regeneration.

Abstract

Aim. To perform an ultrastructural analysis for assessing the remodeling of xenopericardial patch 15 years after transannular repair of right ventricular outflow tract.

Methods. KemPeriplas-Neo pericardial patch was explanted 15 years postoperation due to the structural deterioration. The patch was fixed in phosphate-buffered formalin, stained with heavy metals, dehydrated using ethanol and acetone, and impregnated into epoxy resin followed by its polymerization, grinding, polishing, lead citrate counterstaining, and sputter coating. Ultrastructural analysis was performed by backscattered scanning electron microscopy.

Results. The explanted patch exhibited extensive remodeling, including the development of a neointima and a tunica adventitia at the luminal and outer surfaces of the patch, respectively. Endothelial cells covering the neointima were elongated along the blood flow. The patch displayed a heterogeneous collagen matrix comprising fragmented, loose, and dense collagen layers. Heterogeneity of collagen fibers and significant macrophage infiltration suggested high proteolytic activity overwhelming the regenerative capacity of fibroblasts, thus indicating ongoing matrix remodeling. The adventitia consisted of loose connective tissue with numerous canonical macrophages and multiple microvessels, indicating active neovascularization. Non-implanted xenopericardial samples demonstrated a uniform collagen fiber architecture without any evidence of enzymatic degradation.

Conclusion. Here we provided ultrastructural evidence of long-term biological integration and remodeling of xenopericardial patches after the transannular repair of right ventricular outflow tract. Collagen fragmentation and macrophage infiltration highlighted the complex interplay of enzymatic degradation, hemodynamic stress, immune response, and precipitation of circulating proteases. These findings have critical implications for the design and longevity of next-generation bioprosthetic materials for cardiac surgery.

Highlights

For the treatment of skin wounds, it is important to create biomedical tissue engineering constructs in accordance with the features of the pathogenesis of the wound process. The article describes the issues of antibacterial protection and wound cleansing, as well as the principles of creation and the basic requirements for skin equivalents.

Abstract

Man-made disasters related to mining are often accompanied by polytrauma, characterized by burn and chemical injury to the skin of varying degrees. Currently, tissue engineering approaches are actively developing in the field of biomedical constructs, which are characterized by the use of autologous and allogeneic cells and extracellular matrix proteins, as well as various biocompatible materials acting as a cellular carrier. Therefore, it is possible to create skin equivalents that can act as effective wound healing agents, taking into account the depth of the lesion. This review examines the approach to creating tissue engineering constructs for the treatment of skin burn injuries in accordance with the features of the pathogenesis of the wound process. The article describes the issues of antibacterial protection and aspects of cleansing necrotic tissues, as well as the principles of creation and the basic requirements for skin equivalents.

Highlights

• Cardiovascular diseases remain the leading cause of mortality worldwide, driving demand for effective implantable devices (stents, valves, vascular prostheses).
• Inorganic coatings play a pivotal role in enhancing implant biocompatibility, antithrombogenic properties, and long-term durability.
• This literature review critically examines both advantages and limitations of inorganic coatings for cardiovascular implants.

Abstract

Cardiovascular implants such as stents, valves, and vascular prostheses require continuous improvement to enhance their durability and biocompatibility. This review examines contemporary inorganic coatings, including titanium nitride, metal oxides, and diamond-like carbon coatings, which demonstrate potential for improving implant hemocompatibility. Particular focus is given to their role in preventing thrombosis, restenosis, and calcification. The paper analyzes both experimental and clinical data supporting the efficacy of these coatings.

Highlights

This study makes a significant contribution to the field of endovascular treatment of aortic aneurysms by examining two approaches to managing complications such as endoleaks and stent graft infections. For the first time, the use of cryopreserved homografts for treating stent graft infections is presented, demonstrating a reduced risk of recurrent infection and improved long-term outcomes. The study highlights the importance of timely diagnosis and an individualized approach in addressing complications following stent graft implantation.

Abstract

Endovascular aortic repair (EVAR) using stent grafts has become the gold standard in the treatment of aortic aneurysms, significantly reducing surgical invasiveness. However, it may be associated with serious complications such as endoleaks and stent graft infections. This article presents two clinical cases. In the first case, a 55-year-old female patient developed a type I endoleak due to incomplete apposition of the stent graft to the aortic wall. Surgical correction was performed with resection of the affected segments and replacement of the aortic arch and its branches. In the second case, a 61-year-old male developed a stent graft infection following thoracic EVAR. The infected graft was explanted, and a cryopreserved homograft was implanted to reduce the risk of reinfection. Both patients had successful outcomes with an uncomplicated postoperative course. These cases illustrate the importance of timely diagnosis and a personalized approach to managing EVAR complications. The use of homografts in infected fields proved effective in preventing recurrent infection and improving long-term outcomes. Our experience supports the effectiveness of these surgical strategies in complex clinical scenarios requiring individualized treatment.

Highlights

This article presents a clinical case of the development of cerebral hyperperfusion syndrome in a patient after surgical correction of severe aortic stenosis via mini-sternotomy.

Abstract

Cerebral hyperperfusion syndrome is one of the causes of postoperative cerebral dysfunction development. The syndrome arises as a consequence of an increase in cerebral blood flow velocity after surgical reconstruction or revascularization of the arterial vascular bed that feeds the brain. This is a life-threatening condition that requires timely detection, accurate differential diagnosis and an interdisciplinary team approach. The article presents a case of successful treatment of a patient with cerebral hyperperfusion syndrome developed after surgical correction of severe aortic stenosis.