RICICD has large experience in the development of products for cardiovascular surgery, in particular, the bioprosthesis heart valves and blood vessels. Since 2010, under the leadership of the academician of RAS L. S. Barbarash researches to create bioresorbable vascular prostheses of small diameter began. The primary purpose – to create polymer structures with bio-directed action capable to replace individual structures of a living organism, in particular, of cardiovascular system. Scientific novelty of the problem lies in using a new approach for creation an organ directly in the patient’s body by biofunctional and bioresorbable features of polymer structures. The long-term patency of PCL vascular grafts and PHBV and PCL composition grafts had proved. The in vitro experiments had proved that growth factors incorporated into composition of biodegradable grafts retain their biological activity. The long-term in vivo experiments had demonstrated that vascular endothelial growth factor had accelerated endothelization and had improved vascular patency of biodegradable polymer grafts. 

Purpose. To determine whether laser induced fluorescence is significant for the diagnostics of ischemic and reperfusion injury of isolated heart in a cardioplegic arrest conditions.

Materials and methods. Isolated hearts (n=14) of Wistar rats (♂) were perfused by Langendorff method. The experimental and control groups included hearts with or without intracoronary injection of Neoton in reperfusion period, respectively. Continuous monitoring of the hearts was performed using the LAKK-M device. We recorded the dynamics of fluorescence of NADH, pyridoxine and flavins. We also fixed physiological indices of the hearts. By using ELISA, we studied the perfusate for release of both classic and highly specific markers of myocardial damage in coronary arteries.

 Results. The highest correlation coefficients were obtained between Kf of NADH and Heart-FABP, Troponin I, and the total concentration оf peroxides: r=0.76, r=0.63, r=-0.83 respectively. Neoton prevented energy shortage that contributed to the increase in shift of NAD/NADH to the right and reduction of oxidative stress.

Conclusions. The optical biopsy is a promising method for diagnostics of ischemic and reperfusion injury. 

The article presents a comparative analysis of two strategies for surgical myocardial revascularization: a hybrid revascularization, including minimally invasive direct LAD revascularization and implantation of drug-eluting stents (DES) of the second generation of the coronary arteries and the traditional coronary bypass surgery at a selected group of patients.

Purpose. Analyze the results of 30-day strategy hybrid revascularization and CABG in patients with stable coronary heart disease and multivessel coronary disease.

Materials and methods. The study included 100 patients (50 patients in each group) with stable coronary artery disease and multivessel coronary artery disease. In the group of hybrid revascularization, the first step is performed MID CAB (minimally invasive direct coronary artery revascularization) in the LAD followed by other PCI with implantation of DES of the second generation Xience. In group CABG performs traditional coronary artery bypass grafting. 30 day assessment undergone such indicators: the success of the procedure, the frequency of MACE (significant adverse cardiovascular events), bleeding, restenosis / thrombosis of bypass or stent.

 Results. In most cases, it was successful revascularization (98 % hybrid revascularization, CABG – 100 %). Five patients (10 %) in the group of hybrid revascularization request a conversion to sternotomy with performance of the standard CABG.

During the observation period of thirty mortality rate was in the group of hybrid revascularization was 2 % (1 patient). In the group of CABG deaths not registered. In 1 patient (2 %) in the group of hybrid revascularization when performing endovascular stage mammary shunt thrombosis identified in connection with which the underwent PCI. Myocardial infarction and stroke are not fixed in any way.

Conclusion. Strategy hybrid revascularization using MID CAB and subsequent PCI with implantation of drug-eluting stents in the second-generation coronary artery is not LAD localization is an effective and safe treatment for patients with multivessel coronary artery disease. 

Purpose. Make a comparative assessment of supportive methods of myocardial revascularization in ischemic heart disease patients with low left ventricular ejection fraction (<35 %) conducted under CPB with cardioplegic cardiac arrest and on a beating heart combined with intraoperative use of IABP or levosimendan.

Materials and methods. The study included 90 patients with coronary artery disease and left ventricular ejection fraction <35 %, which was performed CABG under normothermic CPB. Patients were randomized into 4 groups: IABP+CP (CPB with cardioplegia and IABP) (n=30), IABP+CPB (beating heart on a parallel CBP and IABP) (n=14), LS+CP (CBP with cardioplegia and levosimendan) (n=30), LS+CBP (beating heart on a parallel CBP and IABP) (n=16). The primary endpoint wastroponinI.Hemodynamic parameters, the markers of myocardial damage and heart failure, postoperative complications, length of ICU stay, length of hospital stay was evaluated.

Results. In LS+CP and LS+CBP groups was revealed reduction in blood pressure (p=0.002 and p=0.013 respectively) and increase in heart rate (p=0.0008 and p=0.0002 respectively) before CBP in comparison with IABP. The average area under the curve (AUC) of troponin I concentration in LS+CP group was less than in IABP+CP group: 11.75 (6.28–13.29) ng/ml vs 24.43 (12.52–27.88) ng/ml, p=0.013. In LS+CP group was revealed decrease in length of ICU stay (2 (2–3) days) compared with IABP+CP group (4 (3–4) days, p=0.0002) and IABP+CBP group (4 (3–6) days, p=0.0008). Preoperative BNP concentration ≥203 pg/mL was a predictor of necessity for inotropic support with sensitivity 60 % (95 % CI 47.1–72.0) and specificity 93.75 % (95 % CI 69.8–99.8) (AUC 0.728; p=0.0001). Preoperative NTproBNP concentration ≥8.24 fmol/L was a predictor of necessity for inotropic support in the postoperative period with sensitivity 77.78 % (95 % CI 64.4–88.0) and specificity 66.67 % (95 % CI 38.4–88.2) (AUC 0.745; p=0.0012). In singlefactor regression analysis the independent effect on necessity for inotropic support in the early postoperative period exert the concentration of preoperative BNP (OR=1.01; 95 % CI 1.001–1.014; p=0.033). Belonging to LS+CP group reduces the risk of ICU stay for more than 3 days on 72 % (OR=0.28; 95 % CI 0.09–0.82; p=0.021). In multivariate regression analysis, a risk factor for 30-day mortality was the concentration of troponin I on the second postoperative day (OR=1.15; 95 % CI 1.03–1.27; p=0.010) and the preoperative concentration NTproBNP was a risk factor for the 1 year mortality (OR=1.02; 95 % CI 1.001–1.032; p=0.006). 6 hours CPK level after CBP was a predictor of atrial fibrillation development in the early postoperative period (OR=1.003; 95 % CI 1.001–1.005; p=0.003) and prolonged hospital stay for more than 14 days (OR=0.996; 95 % CI: 0.994–0.999; p=0.007)

Conclusion. CABG on a beating heart under CPB in ischemic heart disease patients with low left ventricular ejection fraction (regardless of the hemodynamic support method) does not lead to significant decrease in serum concentration of Troponin I in the postoperative period. Intraoperative levosimendan infusion together with cardioplegic cardiac arrest improves early postoperative period, which is expressed in significant reduction in ICU stay. Thus, the most preferred method to support myocardial revascularization in ischemic heart disease patients with low left ventricular ejection fraction is combination of a standard methodology for CABG with cardioplegic myocardial protection accompanied by intraoperative infusion of levosimendan.

Key words: cardiopulmonary bypass; coronary artery bypass surgery; beating heart; IABP; levosimendan.

The article provides surgical treatment outcomes of combined atherosclerotic lesions of carotid and coronary arteries in 143 patients who underwent different surgical treatment tactics. The major criteria for the choice of surgical treatment stages in patient Group 1 were degree of carotid and coronary circulation lesion and severity of clinical manifestations of CAD and chronic cerebrovascular insufficiency. Surgical treatment for patient Group 2 was identified taking into account the study data of functional reserve of myocardial and cerebral perfusion. In patient Group 3 the tactics of simultaneous surgical treatment was based only on the presence of combined, hemodynamically significant atherosclerotic lesion of carotid and coronary arteries.

The outcomes showed that functional evaluation of myocardial and cerebral perfusion reserve allows differentiation of high risk patients with combined atherosclerotic lesion of carotid and coronary circulation and thus contributes to the choice of the best possible surgical treatment tactics. Simultaneous surgeries are reasonable for the patients with lowered reserve of both coronary and cerebral circulation. Moreover, the risk of cerebral and cardiac postoperative complications in such patients is not higher than that after staged surgical treatment.

The article presents analytical review of literature data on the problem of combined lesions of the aortic valve and coronary arteries. It outlines the current views on the assessment approach to the selection of methods and volume of surgical intervention and reflects the current state of the problem of endovascular treatment of patients with concomitant coronary artery in patients with severe aortic stenosis in the era of transcatheter aortic valve implantation.

Purpose. Selection of the optimal revascularization strategy for patients with acute coronary syndromes without ST-segment elevation (Non-STE-ACS) and multivessel coronary disease (MVD) remains open. The purpose of the study is to evaluate the results of treatment in this group of patients depending on the strategy of revascularization.

Materials and methods. In the study within the prospective registry with 2012–2015 362 patients were included with Non-STE-ACS and MVD. Patients were divided into three groups: staged PCI (PCI – PCI) in 266 (73.4 %) patients, CABG – 72 patients (19.9 %), first step PCI and second step CABG (PCI – CABG) – 24 (6.6 %) patients. Endpoints were major cardiovascular events: death, MI, repeated revascularization, bleeding of BARC score (Bleeding Academic Research Consortium). Endpoints were assessed in the time period from the start until the end of hospitalization with Non-STE-ACS only revascularization (PCI or CABG) or second phase stage (CABG).

Results. Maximum value of GRACE score was in groups of PCI – PCI and PCI – CABG 145.81±18.61, maximum value of SYNTAX was in PCI – CABG 30.94±2.42. Mortality from 2.8 % in groups of CABG to 8.3 % in groups of PCI – PCI (р=0.5). MI rate from 1.4 % in groups of CABG to 8.3 % in PCI – CABG (р=0.5). Rate of bleeding 3–5 type BARC score was 1.1 % in groups of PCI – PCI to 37.5 % in PCI – CABG (р=0.003).

Conclusions. The lack of clear guidelines for choice of optimal strategy of revascularization in these patients results in a substantial number of adverse cardiovascular events. Choice of strategy should be based on the use of stratification scores (GRACE, SYNTAX, EuroScoreII). CABG may be optimal revascularization strategy to a much larger number of patients than is currently used. 

Visceral obesity (VO) is a predictor of complications after coronary artery bypass grafting (CABG), and a risk factor for cognitive and psychological disorders.

Purpose. Of our study was to investigate features of neurocognitive disorders and their interactions in patients with VO in a perioperative period of CABG.

Materials and methods. 90 patients with a body mass index from 25 to 35 kg/m2 were included in the study, they had indications for CABG. VO was assessed in terms of «waist circumference/hip circumference» (WC/HC). Group 1 included patients with VO (WC/HC >0.9 for men and WC/HC >0.85 for women), Group 2 – patients without VO (WC/HC ≤0,9 for men and WC/HC ≤0,85 for women). Cognitive functions were evaluated with the use of the automated complex software Status PF (Kemerovo,Russia). The Spielberger State-Trait Anxiety Inventory (STAI-T, STAI-S) was used for an estimation of anxiety.

Results. Group 1 showed statistically lower rates of attention and neurodynamics and higher levels of depression and anxiety in the perioperative period of CABG. Group 1 demonstrated the decrease in memory and neurodynamics scores as STAI-T levels were higher in the perioperative period of CABG; the growth of STAI-T levels in Group 2 did not always lead to the derangements of attention and neurodynamics scores. Moreover, in Group 2 higher attention and neurodynamics scores were at higher STAI-T levels in 6 months after CABG. High STAI-S levels in both groups negatively affected the performance of attention and neurodynamics in the perioperative period of CABG.

Conclusion. Patients with VO have a higher risk of developing neurocognitive disorders in the perioperative period of CABG. 

The inversion of the left atrium appendage in infants is a very rare anomaly, which may occurs either after cardiac surgery. We introduce a case report of infant with left atrium appendage invagination after ventricular septal defect closure. 

Purpose. The use of explants in cardiovascular surgery is often accompanied by infectious, thrombotic, hemorrhagic complications and the most severe complication of postoperative period represents the infection of the explants itself, which develops at a frequency of 1.5 to 6 % followed by a mortality rate of 75–100 %. Thrombosis of the explants after surgery occur with a frequency of 6 to 42 %.

 Materials and methods. From 1996 to 2015, explants of BASEKS were used in 3 600 patients. Implants of BASEKS were used in 75 patients with aortic valve malformation in combination with an aneurysm of the ascending aorta and prosthetic endocarditis and in 1 944 patients with reconstruction of the aorta and arteries.

Results. Bacteriological studies have demonstrated a wide range of antimicrobial action of the modifying components covering the explant and patches. The most promising results were obtained for micro-organisms which most commonly caused infections of these explants. All the sample explants had antimicrobial property and the zone of lysis around these explants were maintained for a longer time (up to 30 days or more). The residual anti-microbial explants after surgery were studied in vitro in 5 patients who died from peritonitis, heart, lungs and kidney failure. Explants after sampling were placed on growth media seeded with clinical strains of microorganisms. Within 12–24 hours, zones (15–18 mm) that caused the delay of the growth of microorganisms were formed around the studied fragments, confirming the preservation of the residual antimicrobial activity of the explants after implantation. During the period of follow-up, in 1.9 % of the patients in immediate postoperative period and in 4.1 % of patients in later postoperative period occurred thrombosis of the explants. Surface festering of the postoperative wound was observed in 155 (4.3 %) patients, deep festering – in 51 (1.4 %), 98 (2.7 %) patients succumbed to postoperative complications.

Conclusion. The explants and patches of BASEKS which is antimicrobial, thromb-resistant and impermeable, could be widely used in cardiovascular surgery.

Purpose. The aim of the study was to compare the accuracy of non-invasive topical diagnosis of ventricular arrhythmias and the data of intracardiac mapping.

Materials and methods. Thirty-six patients (16 male and 20 female) 44.2±7.6 years of age having ventricular ectopic arrhythmias were included in retrospective study. Patient selection was based on the results of intracardiac mapping in such a way to form six equal groups by six patients in each. Before the ablation procedure, non-invasive mapping was performed in all patients. After the procedure, the accuracy of non-invasive mapping was evaluated in comparison with invasive procedure results.

Results. Non-invasive mapping allows to localize the ectopic foci in the same anatomical zone with successful ablation site in 24 (67 %) of cases (p=0.0001 in comparison with invasive mapping). The correct localization of the ectopic foci using traditional topical diagnosis algorithm was possible in 23 (64 %) of cases (p=0.0001 in comparison with invasive mapping and p=0.805 in comparison with non-invasive mapping). Statistically insignificant bias of greater accuracy of non-invasive mapping in case of outflow tract location of the ectopic foci was registered.

Conclusion. The accuracy of non-invasive mapping varies from 50 to 83 % depending on ectopic focus location (mean 67 %) that is comparable with traditional electrocardiographic topical diagnosis algorithm accuracy. 

Purpose. The establishment of the role of water and electrolyte disorders in the pathogenesis postresuscitation hemo circulatory disorders after removal from the clinical death caused by acute myocardial infarction.

Materials and methods. In experiments with 158 dogs studied under Nembutal anesthesia recovery processes of life after 5 minutes of clinical death caused by myocardial infarction.

Results. It is found that dogs in the early postresuscitative after myocardial infarction occurs movement of sodium ions in the red blood cells, which is accompanied by gipoosmiey blood plasma and interstitial fluid. This causes the movement of water in the cell sector, which leads to the development of hypovolemia and drop in cardiac output. Movement of potassium and calcium ions from cell sector into the extracellular defines violation of myocardial, vascular tone, and increases the risk of arrhythmia postresuscitation myocardial infarction.

Сonclusion. In postresuscitative in dogs undergoing clinical death with acute myocardial infarction, there is a redistribution of electrolytes sector body. During the first 9 hours after resuscitation sodium and calcium concentration in the cell sector increase and decrease in the extracellular. Changes in the potassium content of the opposite. By the end of 1st day recovery period increases plasma sodium concentration, and the corresponding potassium and calcium indicators reduced. The osmolarity of the extracellular space is reduced by 5 min postresuscitative period and increases toward the end of 1 day. It is associated with similar changes in sodium concentration. sodium retention in the cell movement causes the space portion therein, and development of extracellular fluid volume depletion, which leads to a decrease in venous return and cardiac output drop. In the interval of 9–24 hours after resuscitation begins a long period of stabilization of the circulatory system. This is due to the normalization of the water distribution sector, which leads to the restoration of intravascular volume and resolution of hemodynamic disturbances. 

Due to the increasing age of patients in the population people over 45 years old make up about half of the entire cohort of operated patients. Therefore the problem persists of the perioperative cardiac complications development. In 2014, recommendations of the European Society of Cardiology on risk assessment and correction of cardiac complications in extracardiac operations were adopted. However, after they exit this issue remain much debated question. Because every year appear new data on this issue, there is a need for their understanding and discuss the possibility of use in the clinical setting. This review is devoted to some recent publications on the perioperative management of patients, as well as presentations at the Russian National Congress of Cardiology, held in September2015 inMoscow. 

In this paper, we summarize the main recent developments and achievements in the field of gene-eluting stents, their advantages and disadvantages as a potential alternative to the bare metal stents and drug-eluting stents are discussed. The basic optimization strategies required for the translation of technologies based on the use of gene-eluting stents from experimental sphere to clinical medicine are examined. 

The article discusses the issue of renal complications in coronary arteries interventions. A review of the latest researches about contrast-induced nephropathy occurrence in patients with acute coronary syndrome is presented. We gave a definition of a contrast-induced nephropathy, its pathogenesis and development risk factors, characteristics of radiopaque substances, preventive measures of contrastinduced nephropathy in patients with acute coronary syndrome. 

Cardiopulmonary bypass is known to cause a systemic inflammatory response. Strategies to curb systemic inflammation have been previously described. However, none of them is adequate. Improved patient outcomes are strongly associated with surgical technique (offpump coronary artery bypass), cardiopulmonary bypass modalities or drug strategies. The aim of the present digest of modern systematic reviews and meta-analysis is to discuss the main key points about the main principles in cardiopulmonary bypass curbing inflammation.