The purpose: Conducting the analysis of survival after surgery and the study of factors associated with mortality in patients with multifocal atherosclerosis (MFA) in diferent age groups.
Material and methods. It were included 764 consecutive patients aged 39 to 84 years with the MFA, who underwent isolated coronary artery bypass grafting (CABG) or CABG in combination with simultaneous or staged surgical interventions in the non-coronary vascular beds. The treatment procedure was determined by the heart team. Depending on the age of patients formed 4 groups: Group 1 - patients up to 60 years (n = 338), 2 group - 60-64 years (n = 185), 3 group - 65-69 years (n = 137) and group 4 - patients 70 years and older (n = 104).
Results. Analysis of hospital mortality after CABG surgery showed no signifcant diference between the groups, despite its increase among patients older than 65 years (p = 0.373). A similar trend was observed for remote mortality rates without statistical signifcance between the groups. Survival analysis showed no diference between groups in the time to onset of death (p = 0.205), the proportion of survivors over the period of observation in all groups was more than 75%. The regression survival Cox model showed that, in time before the fatal outcome after revascularization surgery were signifcantly associated female gender (p = 0.009), presence of diabetes mellitus (p = 0.003), stroke history (p = 0.002), the risk of surgical intervention on a scale EuroSCORE (p = 0.011) and left ventricular ejection fraction (p = 0.008).
Conclusion. Advanced age in combination with the MFA is a marker of increased mortality after revascularization surgery; however, these patients have favorable results on the long-term survival after staged surgery

The purpose: to study the effectiveness of patch of the left ventricle according to the method of Dor in young people (up to 45 years).
Materials and methods: The study was conducted on the basis of the Cardiosurgery Unit No. 2 of the RRCH for 10 years. 38 patients with left ventricular aneurysm and reduced left ventricular function were included in the prospective study. A functional class of heart failure and quality of life before surgery was determined, after surgery before discharge of patients from the hospital and 12-24 months later (on average 20 months later) after discharge from the hospital by questionnaire method. The quality of life was assessed using the Medical Outcomes Study 36 Item Short Form Health Survey (SF-36). The questionnaire consists of 36 questions, the results are presented in the form of scores from 0 to 100 and are distributed over 8 scales, the higher the ball, the better the patient's quality of life. The functional state of the patients was assessed based on the dynamics of the NYHA functional class of heart failure.
Results: This study showed that, after the Dor method, left ventricular function increased from 39.3 ± 1.40% to 45 ± 2.2%. According to the SF-36 questionnaire, the overall scores of physical functioning improved significantly 12-24 months after the operation (+ 29% p <0.05). Mental health scores also increased (+ 20%, p <0.05) at the end of follow-up.
Conclusions: Patch of the aneurysm of the left ventricle by the method of Dor together with mammary-coronary or aorto-coronary bypass allows to significantly improve the quality of life of patients under 45 years old, restore the ability to work, improve the psychological state of patients.

This article provides an overview of existing studies on percutaneous intervention in the affected left main coronary artery. The present state of the problem, outlines the latest recommendations for endovascular coronary revascularization in patients with lesions of the left main coronary artery.

The purpose. Preservation of native properties of autologous vein for coronary artery bypass grafting.

Materials and methods. The use of preoperative ultrasound marking saphenous veins, ultrasonic harmonic scalpel, axial intraoperative marking outs.

Results. The use of techniques proposed by sparing with explantation and transposition outs in the coronary arteries, in contrast to the classical methods, can significantly increase the duration of the functioning autovenous coronary bypass grafts in patients with coronary heart disease in the long term.

Conclusions. Studies have shown that improving techniques of careful explantation outs for coronary artery bypass grafting and qualitative positioning in the coronary arteries, contribute to a better patency vein grafts in the late postoperative period.

The purpose. To assess the impact of the three-month supervised and home-based physical trainings in the outpatient cardiac rehabilitation program on exercise tolerance and double product in patients undergoing coronary artery bypass grafting (CABG).
Material and methods: 114 male patients of working age with coronary artery disease (CAD) who have undergone CABG were examined. Patients were enrolled into three groups: Group 1 − patients undergoing supervised cycling trainings (SCT) (n = 36), Group 2 − patients undergoing home-based trainings (HBT) (n = 36) and the control group without any exercise trainings (n = 42). The following parameters were assessed: the six-minute walk test (6MWT) value, exercise tolerance (ET) and double product (DP), determined by the cycle ergometer test (CET) prior to surgery, 1, 4 months and 1 year after CABG.
Results: The 6MWT value increased by 9% in the SCT group, by 6% in the HBT group, and by 1% in the control group during the outpatient cardiac rehabilitation program. ET significantly increased in all study groups according to the analysis of exercise tolerance by the CET 4 months after CABG. However, the improvement was more pronounced in patients with SCT compared to other groups. One year after CABG, this difference balanced between the study groups. DP, assessed by the CET, significantly increased in patients undergoing SCT (p = 0.01), compared to other groups. There were no significant differences found in the rate of cardiovascular events between the study groups.
Conclusion: Home-based trainings are inferior to SCT in the outpatient settings, but they are safe and may improve significantly the 6MWT values compared to patients in the control group. Therefore, home-based trainings may be recommended to patients, if they cannot visit the rehabilitation center.

The article stresses the urgency of improving the quality and efficiency of health care management at all levels, as well as the need to improve the information security management system of healthcare organizations. The aim of this work was to develop methodological bases of quality management of medical activities of medical organization. The study was applied: a method of studying and generalization of experience, analytical method, method of comparative analysis, a sociological method, the method of organizational experiment. It has been proven that the use of the expanded list of criteria indicators and analysis of their changes has allowed to detail the address management decisions aimed at improving the quality of medical practice and increasing patient satisfaction primary health organization. The article presents the analysis of the basic principles of modern health care development. Stresses the urgency of improving the quality and efficiency of health care management at all levels, as well as the need to improve the information security management system of healthcare organizations.

Introduction. The effective functioning of the quality management system is largely determined by the relationships of the personnel and the management of the organization. Among the basic principles of the quality management we can point out three of them, which characterize the relationships of the personnel and the managers: leadership of the manager, consumer orientation and employees’ involvement.
The purpose. To study and to evaluate the opinion of the personnel of the scientific healthcare organization about the character of relationships with the manager.
Materials and methods. A sociological research was conducted in 2014 by a continuous survey of the personnel of the Federal State Budgetary Scientific Institution Research Institute of Complex Issues of Cardiovascular Diseases.
Results. The majority of the respondents said that generally, they had good relationships with the direct manager, and only 2.6% had bad relationships. 81.0% of the employees were satisfied with the management style of the direct manager and 10.6% were not satisfied. 18.7% of the respondents described the established relationship between the management of the organization and its employees as “partnership”, 28.9% - “business”, 2.2% - “conflict”, 22.2% - “exploitative”, 0.3% of the respondents chose the answer “other”, and 27.7% could not answer this question. At the same time, 85.6% of the employees were generally satisfied attitude from the management and 14.4 were not satisfied. Correlation analysis showed that a good relationships with the direct manager were connected with the approval of her or her management style (r=0.69, р<0.05) and the positive (business and partnership) relations between the management of the organization and its employees (r=0.32, р<0.05).
Conclusion. In the scientific healthcare organization, we evaluated the satisfaction of the internal consumer on the basis of the personnel’s opinion study, which showed that more than 80% of the employees were satisfied with the attitude from the management, had good business relationships with the direct manager and they were satisfied with the management style. The differences in the satisfaction of the personnel of the scientific healthcare organization with the relationships with the management were detected.

The purpose. Analysis of the dynamics of respiratory function indicators in patients with coronary artery disease (CAD) and comorbid bronchopulmonary pathology (BPP) who underwent coronary artery bypass grafting under cardiopulmonary bypass (CB).
Materials and methods. We examined 662 patients with CAD admitted for planned CABG. The formation of groups was based on the presence criteria of BPP and broncho-obstructive type of ventilatory disorders. Group 1 included 48 (7.2%) patients with BPP without obstructive disorders, group 2 – 248 (37.5%) patients with BPP who have respiratory obstruction, group 3 – 366 (55.3%) patients with the isolated CAD. The analysis of the dynamics of respiratory system function was based on the deviation from the due values as well as on the deviation of recoded respiratory parameters, which form the basis of comprehensive assessment of respiratory function.
Results. In the postoperative periodall the patients showed a decrease of all respiratory parameters. Statistically
lower parameters were observed in patients who had broncho-obstructive syndrome. To a greater extent (for more than 15% from the baseline) we registered a decrease in forced and slow vital lung capacity, total lung capacity, forced expiratory volume in 1 second, as well as diffusing capacity, to a lesser extent –intrathoracic and residual volumes. When comparing the similar respiratory parameters, basing on their recoding, statistically marked decrease was observed in patients who had a respiratory disease (the 1st and the 2nd groups) as compared to the patients with isolated CAD.
Conclusion. After CABG under CB there was a decrease of all the indicators which characterize pulmonary function, a more pronounced decrease was noticed in the level of forced and slow vital lung capacity and forced expiratory volume in 1 second. Interpretation of the dynamic changes of the recoded indicators showed an advantage over the traditional analysis based on the deviation from the due values.

The purpose: To study the prevalence of cardiovascular risk factors and their association with this disease among rural and urban indigenous of Gornaya Shoria.
Material and methods. Clinical and epidemiological study of indigenous population of Gornaya Shoria (with a sample of 513 people, including 256 residents of Sheregesh (urban-type settlement) and 257 residents of Ust-Orton and Kabyrzy (hard to reach remote villages of Gornaya Shoria)). Medical experts in conditions of the expedition conducted examinations by standard methods (survey, collection of complaints, clinical examination) on the basis of rural medical stations and clinics. The characteristics of the blood lipid spectrum, blood pressure, carbohydrate metabolism were investigated. Electrocardiograms were taken. The statistical analyses were performed using the program "STATISTICA 6.1".
Results: It was found that risk factors such as overweight (29,61%), obesity (20,85%), abdominal obesity (45,92%) and hyperbetacholesterolemia (59,45%) more common among the urban population of Gornaya Shoria compared to the rural population (23,01%, 12,78%, 29,26% и 49,25%, соответственно). Smoking respondents was higher in the group of persons living in rural areas -41.76%, compared with urban residents - 30.82%. The risk of CHD was correlated with age and hypertension in both groups. The association of obesity and abdominal obesity with coronary artery disease among the urbanized population found. The risk of coronary disease was higher among shorians with impaired carbohydrate metabolism, living in rural areas.
Conclusions: The findings of this study indicate that urbanization affects at prevalence of cardiovascular risk factors in a natives population of Gornaya Shoria.

Scientific information of last 5-7 years about the influence of dietand its components on cardiovascular disease development is reported in this review. The data about the role of products volume, vegetable and animal proteins, lipids, unsaturated lipid acids, glucose, vitamins, ions and other components of diet are reported. These data are correspond to the thesis: «We eat not into stomach, but into heart!»

The most commonly atherosclerosis affects the aorta, coronary, iliac and extracranial arteries. Calcification is a pathological manifestation of vascular changes in atherosclerosis. At the pathologic development of atherosclerotic plaques and increasing the proportion of calcium compounds, included in its composition. Study on the relationship of calcification of the coronary and carotid arteries subject of many studies. The calcium deposits found arterial wall proteins specific to bone matrix. No one was surprised by the deterioration of bone tissue with age, and this is due to close biological and pathogenetic links atherosclerotic calcification and bone formation. They could not washed out components of the bone matrix "settle" in atherosclerotic plaques?

This assumption is the subject of many studies. On the one hand, it is proved that a significant bone loss correlates with a more rapid progression of vascular calcification, increased risk of mortality from coronary heart disease and other forms of atherosclerosis. At the same time marked by mixed results with regard to gender differences in osteoporosis in patients with coronary artery disease, usually associated with low physical activity, the volume of adipose tissue, the number of pregnancy, lactation and menopause. Diabetes highlighted especially among the factors influencing the decline in bone mineral density and degree of calcification of the vascular wall with an increased risk of vascular events by 150% to 400%. But on the impact of violations of carbohydrate metabolism in the bone mineral density, as well as its "quality" with an increased risk of fractures according to world literature among scientists disagree.

Thus, the predictive scale FRAX prized highly informative method for predicting fracture risk in the general population, but also noted that in patients with diabetes type 2 FRAX type significantly underestimates the risk of fracture, which is associated with a transforming bone microarchitecture with an increase in density and thickness cortical layer, resulting in a false increase in bone mineral density.

"Gold" standard for diagnosing osteoporosis is considered to be an X-ray dualenergy densitometry and quantitative assessment of coronary calcification how and brachiocephalic arteries - multislice computed tomography using Agatson scale.

To date, it is clear that atherosclerotic calcification and bone mineralization process, of course, have a number of similar parts of the pathogenetic process, however, a clear answer to the question about the presence or absence of a direct relationship calcification and changes of mineral bone density is not obtained.

A rare unpredictable serious complication is analyzed: paragraft reaction with formation of perigraft cysts and liquid round the synthetic vessel after reconstructive operations. The etiology and pathogenesis of this uncommon reaction remain unclear and disputable. Perigraft reaction often leads to complications: Infection of the perigraft liquid or cyst with formation of false aneurysms of anastomoses, graft infection with anglogenic sepsis, graft and reconstructed arteries thrombosis because ofextravasal compression, etc. Publications on this problem are scanty. We observed perigraft. reaction in 15 (0,4%) patients after reconstructive operations implanted various grafts. The etiology, pathogenesis, clinical characteristics, prevention, and treatment philosophy in such cases are discussed, based on published reports and our data.

This article provides an overview of modern methods for the study microcirculation in patients in normal and various vascular diseases of the lower extremities. The information can be used to further study the microvasculature in various states.

We present the results of a staged surgical treatment of a subject with a rare congenital disorder – aortic coarctation in combination with an aberrant right subclavian artery. The choice of an implantation of the aberrant right subclavianartery into the right common carotid artery as the first stage of surgical reconstruction contributed to the prevention of the spinal complications connected with multiple clamping of two subclavian arteries in one-staged surgical treatment of aortic coarctation. It is concluded that the chosen method of the surgical correction is not standard and is characterized by a high level of technical complexity and allows to radically correct the complex congenital heart disease.

We present the results of a successful surgical treatment of an extremely rare disease – giant aneurysm of internal carotid artery (ICA) in patient with fibromuscular dysplasia (FMD) of type III. This case is the first experience of the surgical treatment of the patient with this pathology during 8 years of existence of the neurosurgical department of Kemerovo Cardiology Dispensary. Taking into account the anatomic features (large size of the aneurysm, expressed kinking) resection of the aneurysm with end-to-end anastomosis was chosen as a method of surgical treatment. It is concluded that surgical reconstruction of ICA with the application of end-to-end anastomosis technic without prosthetics in FMD and ICA aneurysm is the optimal therapeutic and preventive method.

Ventricular assist device (VAD) technology is being increasingly used for circulatory support and refractory heart failure. Known complications of VAD technology including bleeding and thrombosis. We report a rare case of acute mesenteric ischemia in a VAD patient, who was successfully treated with segmental small bowel resections.