Aim. To estimate the clinical success of cryoballoon pulmonary vein isolation (PVI).

Methods. 230 patients (males: 49.6%, mean age 57 (53; 62) with symptomatic paroxysmal and persistent atrial fibrillation (AF) resistant to antiarrhythmic therapy were included in a single-center prospective study. The patients were randomized into 2 groups to undergo either cryoballoon ablation (n = 122) or radiofrequency (RF) (n = 108) ablation. Both groups were comparable in baseline parameters. The follow-up period was 12 months. Clinical outcomes were estimated with the use of a three-stage scale. The rates of cardiovascular rehospitalizations, direct-current cardioversions and repeated ablations during were estimated within the follow-up. The quality of life (QoL) in the cryoablation group was measured using the AFEQT scale.

Results. 77% (n = 94) of patients in the cryoballoon ablation group and 71.3% (n = 77) of patients in the RF group (р = 0.71) demonstrated reported the optimal clinical effects. Both groups, cryo ablation and RF ablation, had similar rates of cardiovascular hospitalizations (23.8 vs 28.7%, OR 0.8, 95% CI 0.4–1.4; р = 0.39), direct-current cardioversions (12.3 vs 17.6%, OR 0.7, 95% CI 0.3–1.4; р = 0.26) and repeated ablations (9.8–11.1%, OR 0.9, 95% CI 0.4–2.0; р = 0.75). The patients treated with cryoballoon as opposed to RF ablation had significantly more successful usage of “pill-in-pocket” strategy – 14.8 vs 6.5% (OR 2.5, 95% CI 1.01–6.2; р = 0.04). Significant improvements of the QoL parameters with strong size effect have been found in the cryoablation group, i.e. global score (GS) increased by 8.9±6.9 (95% CI 6.6–10.1; dCohen 1.2; р<0.001), symptoms (S) – by 8.3±7.9 (95% CI 4.2–8.8; dCohen 1.5; р<0.001), daily activities (DA) – by 10.0±6.9 (95% CI = 6.4–10.6; dCohen 0.9; р<0.001), treatment concerns (TC) – by 5.5±6.0 (95% CI 6.3–9.2; dCohen 1.2; р<0.001) and treatment satisfaction (TS) – by 5.5±6.0 (95% CI 5.4–9.8; dCohen 0.9; р<0.001).

Conclusion. The both catheter-based technologies had comparable clinical success. Cryoablation was characterized by improvement in all QoL parameters based on the AFEQT score.

Aim. To evaluate clinical efficacy of high-intensity exercise training included in the prehabilitation program for elective coronary artery bypass grafting (CABG).

Methods. 38 male patients were included in the study before on-pump CABG. After fulfilling the inclusion/exclusion criteria, patients were randomized into two groups: Group 1 patients (n = 20) underwent supervised treadmill exercise, and Group 2 patients (n = 18) were referred to surgery without any exercise training. Patients underwent a 7-day exercise training with daily measurements of hemodynamic parameters and electrocardiogram (ECG) monitoring. The load intensity was measured with cardiopulmonary exercise testing and accounted for 80% of the maximal oxygen uptake. Postoperative complications were recorded in the in-hospital period and analyzed. Quality of life indicators were measured by the SF-36 standard version 7–10 days prior to surgery and on days 7-10 of the postoperative period. Adherence to drug and non-drug therapy was assessed during the 6-month follow-up.

Results. There was a significantly lower incidence of postoperative complications during the in-hospital period in patients undergoing prehabilitation program with supervised high-intensity exercise training, compared with patients without any exercise training (p = 0.002). Group 1 patients had reliably better mental health (MH) scores compared with Group 2 patients (48.9±7.60 vs. 39.1±6.80 scores, respectively; p = 0.03) on days 7–10 after CABG. Six months after the CABG, patients who underwent prehabilitation exercise training were less likely to resume smoking than patients without any exercise training (p = 0.04). The tendency towards improved adherence to drug therapy and compensation in arterial hypertension has been determined among Group 1 patients.

Conclusion. Exercise training included in the prehabilitation program proved to be safe and effective in terms of improved clinical outcomes after CABG, quality of life and adherence to treatment in this group of patients.

Background. Despite an increase in the number of surgeries performed in elderly patients, conventional aortic valve replacement is associated with high postoperative mortality in comparison to young adults. The risk of surgical intervention in elderly patients is associated not only with the age, but also with the presence of a large number of concomitant diseases.

Aim. To evaluate the immediate results of conventional aortic valve replacement and assess the impact of preoperative risk factors on surgical treatment.

Methods. A retrospective analysis of the results of aortic valve replacement was performed in patients older than 65 years operated in the period from 2011 to 2015 (a total of 253 cases). The mean age of the patients was 70.4±4.14 years. The mean EuroSCORE was 6.09±4.45%. The impact of more than 30 preoperative risk factors on the in-hospital mortality and development of postoperative complications has been analyzed.

Results. The overall in-hospital mortality was 10.3%. In-hospital mortality of isolated aortic valve replacement was 4.8%. In-hospital mortality of aortic valve replacement combined with coronary artery bypass grafting was 8.8%. High postoperative mortality rate was reliably associated with the urgency of surgery, a positive history of stroke, obesity, chronic renal failure, chronic obstructive pulmonary disease, pulmonary hypertension, a positive history of malignant neoplasms, polyvascular disease, pre-operative atrial fibrillation, IV class NYHA, post-stenotic aortic dilation, severe calcification, small aortic root.

Conclusion. Aortic valve replacement in elderly and advanced age patients have relatively similar results to those of the younger patients. High risk of surgery in advanced age patients is mainly associated with the presence of concomitant extracardiac pathology and preoperative risk factors.

Aim. To evaluate the safety of the pulmonary artery radiofrequency catheter denervation in different pulmonary hypertension (PH) clinical forms.

Methods. 6 patients with different clinical forms of PH were included in the study with the further randomization into two groups. Group I patient (n = 3) underwent pulmonary denervation and group II patients (n = 3) underwent a placebo procedure. The examination of patients included routine clinical tests, the measurements of N-terminal precursor of the brain natriuretic peptide (NT-proBNP) levels, coagulation blood tests, ECG recordings, echocardiography (with the estimation of mean pulmonary artery pressure), chest X-ray, the assessment of the respiratory function, right heart catheterization (RHC), six-minute walk test (6MWT), the assessment of the quality of life according to the SF-36 questionnaire. Intraoperative measures indicating the safety of the procedure were also studied.

Results. There were no statistically significant differences found in the intraoperative data between the groups. None intraoperative and postoperative complications during in the in-hospital period found. Mean pulmonary artery pressure reduced in two patients without any elevations 24 hours following the intervention. A decrease in mean pulmonary arterial pressure from 48 to 41 mm Hg was observed in a patient with primary PH. The second patient with post-embolic pulmonary hypertension demonstrated a reduction in mean pulmonary artery pressure from 43 to 32 mm Hg. The third patient had no changes according to the RHC. All three patients showed a positive tendency according to the 6MWT and echocardiography, while none of these changes were recorded in Group II. The mean NT-pro-BNP level in Group I decreased from 1767±291 to 488±129 vs. 1519±305 and 1594±337 in Group II, respectively (P = 0.013). Conclusion Pulmonary artery denervation is a safe and promising treatment method, but further studies are required to prove its effectiveness.

Aim. To evaluate the hospital outcomes of chemical angioplasty in patients with vasospasm secondary to the clipping of the ruptured cerebral artery aneurysm.

Methods. 18 patients who underwent chemical angioplasty were included in the study. Patients’ age ranged from 24 to 66 years old, the mean age was 46.6±13.2 years. Indications for chemical angioplasty and the criteria for its termination were determined by the neurosurgeon based on clinical signs and symptoms, and the data of the non-invasive examination.

Results. The sessions of chemical angioplasty were performed an average of 4.7±2.3 days after the aneurysm clipping and 6.5±3 days after the onset of subarachnoid hemorrhage. The number of sessions was 4.8±2.2 and varied from 1 to 9 sessions. The baseline Lindergard index was 3.82±0.6. Three patients (16.6%) died in the in-hospital period. The Lindergard index after the end of chemical angioplasty was 2.75±0.84, which is unreliably lower (p = 0.31) than that at the baseline.

Conclusion. Timely chemical angioplasty can reduce the development of significant vasospasm complications, particularly ischemic neurologic deficit.

High-risk percutaneous coronary intervention involves technical challenges in performing revascularization, hemodynamic instability and heart rate variability, and possible complications. Mechanical circulatory support devices ensure hemodynamic stability and expansion of opportunities for revascularization. Current methods include the following devices: intra-aortic balloon counterpulsation, Impella, TandemHeart, and venoarterial extracorporeal membrane oxygenation. The review accumulates current evidences on the use of these devices for mechanical circulatory support during high-risk percutaneous coronary intervention from the reports, registries, randomized and observational studies, as well as clinical trials.

The review encompasses the latest literature on the prevention of postoperative cognitive dysfunction after coronary artery bypass grafting. We performed an attempt to provide all existing data on the prospects of using physical prehabilitation, particularly aerobic exercise, for prevention of cerebrovascular complications during coronary artery bypass grafting. The article summarizes recent studies on the effects of exercise trainings on wellbeing and cognitive functions. Particular attention has been paid to the review of the studies stating the presence of cerebroprotective effects and mechanisms of aerobic exercise on cognitive function. The prospects of aerobic prehabilitation before coronary artery bypass grafting for prevention of postoperative cognitive dysfunction are discussed.

The article discusses key issues on the relationship between the qualitative and quantitative characteristics of mtDNA and the risks of atherosclerosis and myocardial infarction. Russian and international research literature was analyzed regarding point and deletion mutations in mtDNA, including heteroplasmy, related to the risks of developing cardiovascular diseases and acute cardiovascular events. The review also discusses the relationship between cardiovascular events and oxidative stress severity, the number of intracellular and free-circulating mtDNA copies.

Atrial fibrillation might occur up to 2% of the general population, with a lifetime risk of 24% in persons > 40 years of age. Catheter ablation is increasingly being used to treat drug-refractory atrial fibrillation. The long-term efficacy of catheter ablation is disappointing, with success rates about 50%. Stroke is one of the major complications of atrial fibrillation because of atrial thrombus formation. The overall annual stroke risk is 5% in patients with atrial fibrillation, increasing up to 15% in high-risk patients. The left atrial appendage was the source of thrombi in >90% of the patients with non-valvular atrial fibrillation. Anticoagulation should be given to prevent thromboembolic events. However, anticoagulant therapy has several disadvantages, such as (major) bleedings, interactions with some dietary components and other medications, and a narrow therapeutic range. In addition, patients with atrial fibrillation, especially the elderly, have low compliance. Exclusion of the left atrial appendage from the systemic circulation could be an alternative. Thus, the combination of the left atrial appendage closure with the isolation of the pulmonary veins appears to be a rational method for the treatment of atrial fibrillation. This approach eliminates the need for anticoagulants and reduces the risk of stroke.

The review presents current data on the use of the long-term ECG monitoring for the management of patients with atrial fibrillation (AF). Long-term ECG monitoring allows receiving large amounts of diagnostic data and optimizes clinical management by the timely start of anticoagulant therapy in the patients with silent AF. This is a crucial issue for prevention of thromboembolic events.

Human telomere length shortens with aging and limits the number of cell divisions (Hayflick limit). This phenomenon is believed to be an evolutionary compromise to prevent the risk of cancer. However, the shortening of telomeres can play an important role in the development of age-associated diseases in the modem society with significantly increased life expectancy and, particularly, cardiovascular diseases, causing 35% of deaths among the elderly. The review provides the latest data from the studies aimed at determining the role of telomeres in the risk of developing cardiovascular diseases and describing the factors affecting the telomere length as well as possible causes of genomic instability due to the damage of telomeric regions.

The review presents the current concept oftotal arterial myocardial revascularization, main studies focusing on it, recent guidelines and commonly used techniques, which let speak about high efficacy this kind procedure. However, in medical society there is a certain part of disbelief with respect to performance of coronary artery bypass grafting using only arterial conduits, and even in justifiable cases when the choice is obvious, the percentage of mentioned operations is still low. It can be explained by both technically much more difficult manipulations and particular risk factors, which contribute discreet approach in the wide use of total arterial myocardial revascularization.

The clinical case reports the experience of successful repeat surgical treatment of a 65-year-old patient with recurrent mitral valve disease. The use of tissue valve prostheses in the treatment of acquired heart disease allowed avoiding anticoagulant therapy in the postoperative period. In addition, the use of new surgical methods of treatment (valve-in-valve technique) contributed to a significant reduction in the risk of surgical complications during the third heart valve replacement. Thus, the use of tissue heart valves, timely diagnosis of valve dysfunction, as well as the use of novel technologies which allows reducing the risk ensure achieving optimal outcome, extending and improving the quality of life of the patient.

A clinical case presents the results of successful microsurgery in the treatment of a patient with intracranial saccular aneurysm and anomalous circle of Willis. The patient underwent right pterional craniotomy resection followed by the clipping of the saccular aneurysm at the anterior cerebral artery and anterior communicating artery complex on the right. The selected surgical strategy allowed for complete exclusion of the saccular aneurysm from the arterial circulation, maintaining the patency of the abnormal arteries and preventing ischemic stroke. The chosen surgical strategy appeared to be effective.

A single coronary artery is a congenital anomaly of the coronary arteries, in which the whole heart is supplied with a single coronary artery, which has one source of filling and leaves one orifice from one coronary sinus. Anomalies of coronary arteries are among the rare congenital heart defects. This defect is commonly detected in patients with coronary artery disease during selective coronary angiography. Single observations of coronary artery bypass grafting in patients with single coronary artery have been presented.

Current clinical practice faces the challenges in selecting optimal drugs and the duration of antithrombotic treatment in patients with acute coronary syndrome with atrial fibrillation. A continuous increase of using non-vitamin K oral anticoagulants (NOAC), dabigatran, rivaroxaban, apixaban, edoxaban, and novel antiplatelet agents, prasugrel and ticagrelor, has complicated the decision-making process in this group of patients. The presented clinical case reports the use of dabigatran as a part of double antithrombotic therapy in an elderly patient with type 2 myocardial infarction, paroxysmal AF and a high risk for hemorrhage. The drug choice and its dosage were chosen using the personalized risk assessment. The presented approach has been early proved by the results of the recent randomized clinical trials and, therefore, may be translated into routine clinical practice.

The prognosis of a patient suffering from severe chronic heart failure is determined by the impairment of cardiac and skeletal muscles. More evidence has recently emerged on the use of electrical muscle stimulation (EMS) as a method of rehabilitation in patients admitted to the intensive care units. Nevertheless, evidences on the use of this type of rehabilitation in patients after heart transplantation are still limited. This article presents the first experience of using EMS in the patient who underwent heart transplantation. Sessions of electric muscle stimulation of the quadriceps allowed maintaining muscle mass according to the ultrasound findings, as well as muscle strength and endurance. The EMC was safe, had no proarrhythmogenic effect and did not affect the pacing of the temporary pacemaker. Further data accumulation, systematization and analysis on the use of EMC in this group of patients is required.

The article presents the results of the successful surgical treatment of the young patient with cerebellar cavernous angioma. The patient underwent posterior fossa craniotomy followed by stereotactic resection of cavernous angioma and acute hematoma in the left cerebellar hemisphere. The chosen surgical approach allowed preventing the development of obstructive hydrocephaly and compression of the brainstem, which may lead to cardiovascular failure, impaired consciousness and death. We concluded that this surgical strategy appeared to be effective.

The clinical case reports the first experience of thrombus extraction in a young patient with ischemic stroke and severe concomitant pathology. The 33-year old patient was admitted to the hospital with stroke 4 hours after its onset. The occlusion of the distal Ml segment of the left middle cerebral artery was documented with MSCT. A satisfactory clinical result of the thrombus extraction in ischemic stroke was achieved, despite the changed treatment strategy commonly used for from this pathology (thrombolytic therapy and thrombus extraction). The refusal of thrombolytic therapy was associated with the presence of destructive pulmonary tuberculosis and a high risk of pulmonary hemorrhage. Successful thrombus extraction from the M1 segment of the left middle cerebral artery segment with the final blood flow in the left internal carotid artery at the level of TICI III was performed. At discharge the patient demonstrated improved neurological status with the modified Rankin score of 3.