Aim. Evaluates 3-year clinical outcomes of percutaneous coronary intervention (PCI) with bioresorbable vascular scaffold (BVS) versus minimally invasive direct coronary artery bypass (MIDCAB) surgery for the treatment of left anterior descending (LAD) lesions.

Methods. In this single-center study were included 130 patients with stable angina and significant (≥70%) LAD disease. Patients were randomly assigned in a 1:1 ratio to PCI with everolimus-eluting bioresorbable vascular scaffold (Absorb) (n = 65) or MIDCAB (n = 65). The primary end-point was major adverse cerebrocardiovascular events (MACCE) and secondary was. Primary and secondary endpoints were, respectively, major adverse cerebro-cardiovascular events (MACCE) and target vessel failure at 3-year.

Results.The groups of patients were comparable for all baseline demographic, clinical and angiographic parameters. The primary composite endpoint of MACCE through 3 years occurred in 16.9% of BVS patients and 9.2% of MIDCAB patients (p = 0.19). But 3-year any revascularization rates were higher with BVS (13.8% vs. 3.1%; p = 0.027). TVF was favor of the MIDCAB group (12,3% vs. 3,1%, p = 0.04), mainly triggered by high subsequent need for revascularization of the targeted vessel in the BVS group (9.2% vs. 1.5%; p = 0.05).

Conclusion. At 3-year follow-up, PCI by BVS and MIDCAB in in patients with isolated LAD lesions yielded similar long-term outcomes regarding the primary composite clinical endpoint. The bioresorbable scaffold was associated with a higher incidence of reinterventions, TVF and TVR than the MIDCAB through 3 years of follow-up.

Aim. To study the features of the prevalence of coronary heart disease (CHD) in the period 1998–2001 and 2013–2017 in the indigenous population of Gornaya Shoria.

Methods. In the first period of the study (from 1998 to 2001), 550 respondents of indigenous nationality living in rural areas of Gornaya Shoria (v. Orton and v. Ust-Kabyrza) were included. In the second period (from 2013 to 2017) – 937 people in the same villages, as well as in the urban village Sheregesh and city Tashtagol. The presence of coronary artery disease was estimated by the sum of three epidemiological criteria: based on the analysis of ECG by Minnesota code, Rose questionnaire and a history of myocardial infarction. Statistical analysis was performed using the program Statistica 6.0 (StatSoft Inc., USA.) Qualitative features were described using frequencies as a percentage. To determine the statistical significance of these differences, Pearson's criterion c2 was evaluated. In the study, the critical level of significance when testing statistical hypotheses was taken p<0.05.

Results. The frequency of CHD in the first stage of the study in the village was 6.2%, in the survey of the rural population in the Gornaya Shoria in 2013–2017 this figure was 8.0%. Comparative analysis at the second stage of the study showed a higher prevalence of this disease among urban residents (12.6%) compared with rural (8.0%, p = 0.048). These differences reach statistical significance due to the female population in the age groups of 40–49 years and 50–59 years (7.1% vs. 0% (p = 0.051) and 15.4% vs. 4.1% (p = 0.031)). In males living in the city, revealed an earlier debut of CHD in 40–49 years (5.6%).

Conclusion. The study revealed an increase in the prevalence of CHD in women in the indigenous small population of Gornaya Shoria from 1998–2001 to 2013–2017, as well as a number of significant statistically significant differences in the frequency of CHD among the urban and rural population.

Aim. To evaluate the neuropsychological parameters from the main cognitive domains (neurodynamic functions, attention and short-term memory) and the brain electrical activity in patients with non-valve atrial fibrillation (AF).

Methods. 21 patients with the mean age of 61 [56; 67] years with non-valve AF who were admitted to the Department of Interventional Diagnosis and Treatment at the Research Institute for Complex Issues of Cardiovascular Disease were included in the study. The control group consisted of 17 healthy individuals with the mean age of 55 [49; 62] years. All patients underwent neuropsychological screening and computerized testing of neurodynamic functions, attention and short-term memory along with electroencephalographic studies. Statistical analysis was performed using the STATISTICA 10.0 software package.

Results. Mild cognitive impairment was observed in 43% of patients with non-valve AF accompanied by ischemic brain matter changes according to the findings of magnetic resonance imaging. Patients with AF had slower complex sensorimotor reaction, more errors, worse directed attention, memorization of words and meaningless syllables in comparison with healthy individuals. In addition, patients with AF and healthy subjects had differences in the fronto-occipital gradient of theta-2 rhythm. The worst neurodynamic parameters were associated with a greater power of theta rhythms predominantly in the posterior parts of the brain only in patients with AF.

Conclusion. Patients with non-valve AF had cognitive deficit with impaired executive control, attention and short-term memory as well as the slowing of cortical electrical activity in comparison to healthy individuals. The data obtained in our study are beneficial for developing an individual approach to prevent the development and progression of cognitive impairment in patients with AF.

Aim. Importance studying of clinical and biochemical signs within the nutrition status estimation and diet therapy effectiveness in children with congenital heart diseases (CHD) in newborn period.
Methods. Clinical and morphometric data were studied in 52 newborn children with different variants of feeding (brest-feeding, adaptive milk formula, pre-milk formula), which created 3 groups: the first group – 23 children with CHD without heart failure (HF), the second one – 16 children with CHD and HF, the third one included 13 newborn children of the corresponding gestation age, weight and age without CHD and other congenital defects as well as general infectious. the data were analyzed on the 10th and 20th days of birth.
Results. Feeding children with various diseases, including CHD with varying degrees of severity of HF, with breast milk is preferable and su൶cient up to 10 days of life, provided that the nutrients are not lower than the physiological level. After 10 days of life, children with CHD underwent dietotherapy correction, prescribed hypercaloric nutrition, taking into account somatometric data and the values of biochemical parameters (prealbumin, urea, transferrin). Diet therapy optimization was done after the 10th day and hypercaloric feeding was prescribed. Increase of calorific value was reached due to pre-milk formula prescribing as a main kind of feeding as well as supplements together with saving breast-feeding if it was available. To the 20th day all babies with CHD and HF had more proteins, fats, carbohydrates and calories. In such a case the level of proteins, urine, transferrin, prealbumin in hemolymph didn’t differ in comparing groups, having different nutrition supplement.
Conclusion. Children with CHD with HF have high protein and energetic exigencies. Differential hypercaloric feeding prescribing taking in consideration somatometric data and biochemical signs (prealbumin, urine, transferrin) as a pre-milk formula allowed to grade energetic deficit and provide biochemical hemostasis.

Aim. To find out the problems in children health in long-time postoperative period after cardiosurgery using the comprehensive method for creating rehabilitation program.

Methods. A prospective investigation of group of children was done before (n = 88) and in a year (n = 115), in 2 years (n = 90) and in 3 years (n = 58) after the surgical correction of congenital heart defects on the base of Kuzbass cardiological center. The anamnesis, clinical and hemodynamic aspects were studied as well as the postoperative period, residual problems after the correction, social status of the family and the comprehensive assessment was done in the both groups.

Results. Before the correction the most part of children had low and very low levels of physical functioning, but there was a positive dynamic right after the surgery: the most part of children had high and middle levels (13% and 44% in a year), while the amount of children with low and very low data were reduced. Nevertheless, in 3 years after the surgery the amount of children with low and very low data was increased while the hemodynamic became better. Such tendency was mentioned with all aspects of the health.

Conclusion. Despite of hemodynamic normalization the quality of life with all aspects still suffers. It predicts dangers in development and quality of life in general.

Aim. To assess the incidence of moderate systolic dysfunction in patients with stable coronary artery disease and determine the factors associated with it.
Methods. 200 patients with coronary artery disease admitted to the Cardiology Department of the Research Institute for coronary artery bypass grafting were included in the study. Patients were assigned to two groups depending on the presence or absence of right ventricular systolic dysfunction (RVSD). Patients with RVSD (n = 30, 64 [59; 68] years), were assigned in Group 1, whereas patients without it (n = 170, 64 [60; 68] years) were assigned to Group 2.
Results. Univariate logistic regression reported the following factors to be associated with RVSD: prior myocardial infarction (p = 0.098), chronic heart failure (p = 0.020), long smoking history (p = 0.003), increased left ventricular end-systolic and enddiastolic volumes (p = 0.005 and p = 0.004), decreased tricuspid annular plane systolic excursion (p <0.001), decreased early mitral flow propagation velocity (p = 0.027) and left ventricular ejection fraction (p = 0.002), significant circumflex artery stenosis (p = 0.075), right coronary artery occlusion (p = 0.073), singlevessel and three-vessel coronary artery disease (p = 0.055 and p = 0.014). Three multivariate models were generated. A decrease in the left ventricular ejection fraction (p = 0.009), three-vessel coronary artery disease (p = 0.055), and early mitral flow propagation velocity (p = 0.072) were considered as independent predictors of RVSD.
Conclusion. Moderate RVSD was found in 15% of patients with stable coronary artery disease and preserved left ventricular function. A decrease in the left ventricular ejection fraction, but not damage to individual coronary arteries, the number of affected coronary arteries, the presence and localization of myocardial infarction were among the factors independently associated with right ventricular systolic function.

Aim. To estimate the efficacy of pulmonary veins (PV) cryoballoon isolation in its different anatomical variants.

Methods. 230 patients 57 (53; 62) years of age were enrolled in the study in approximately equal proportion of males and females. Up to 1/3 of patients suffered from isolated AF, most of them belonged to the category of high risk of thromboembolic complications. To evaluate the PV anatomical variant, a modified classification of E. Marom et al was used. In groups of cryoballoon and radio-frequency isolation, subgroups of typical and variant anatomy were distinguished. Evaluation of the effectiveness of the intervention was based on the identification of any (symptomatic and asymptomatic) documented episodes of atrial arrhythmias lasting more than 30 seconds during the observation period of 12 months.

Results. Comparison of efficacy in typical PV anatomy did not reveal significant differences between cryo and RFA groups, regardless of the type of device used. Subgroup I of generation of cryoballoons showed freedom from AF 83.2%, II generation – 87.5%, RFA group – 82.7% at p = 0.82. At the same time, with PV variant anatomy, the efficiency of cryo isolation with the use of II generation devices was 52.2 versus 85.7% in the RFA group (OR = 0.25; 95% CI 0.09–0.71; p = 0, 02). When analyzing long-term results in cryo and RFA groups depending on the anatomical variant, it was found that with RFA, the presence of a left PV common trunk (collector / vestibule), as well as the presence of additional veins, showed results comparable with the group of typical anatomy. At the same time, in the cryoablation group, the presence of a left common trunk was accompanied by a decrease in efficiency to 23.1 versus 84.9% for typical anatomy (OR = 0.14; 95% CI 0.03–0.6; p = 0.02) and 90% in the presence of additional veins (OR = 0.1; 95% CI 0.01–0.64; p = 0.02). In the presence of a left common trunk, the efficiency of cryoablation using second-generation cylinders was 23.1 versus 82.4% in the RFA group (OR = 0.16; 95% CI 0.05–0.5).

Conclusion. The presence of a left PV common trunk leads to a decrease in the effectiveness of cryoablation in the long-term observation period relative to the group of typical anatomy to 23.1 versus 84.9% (OR = 0.14; 95% CI 0.03–0.6) and 82.4% for radiofrequency ablation (OR = 0.16; 95% CI 0.05–0.5). The presence of additional veins of right-sided localization does not affect the effectiveness of the intervention.

Aim. To evaluate the effectiveness of electrical muscle stimulation (EMS) in patients with the complicated early postoperative period after cardiac surgery.
Methods. 61 patients (44 men and 17 women) aged 52-70 years with the complicated early postoperative period after cardiac surgery were included in the study. The complications included prolonged length of stay in the intensive care unit and prolonged mechanical ventilation. The initial muscle performance of the lower extremities was measured with the carpal and isokinetic dynamometer in all patients. The six-minute walk test was performed in all patients after they had been transferred to the department of cardiac surgery.
Results. Patients in the study group had reduced lower extremity muscle strength at baseline, compared with the control group. After the EMS sessions, the study group patients demonstrated pronounced improvements in muscle performance as compared to the control group. Both knee-joint extension values increased during the isometric contraction as compared to those in the control group (38.8% and 40.0% versus 8.1% and 8.4%, p <0.001), similarly to right knee-joint flexion (23.7% versus 10.1%, p = 0.008), left ankle joint (18.6 versus 4.3%, p = 0.010), right-hand grip strength (18.3 versus 11.1%, p = 0.042). In addition, the six-minute walk test results improved in the EMS group (119.72% (293 meters) and 87.13% (315 meters)) as compared to the control group (p = 0.079).
Conclusion. The EMS sessions did not affect the clinical status of cardiac surgical patients with the complicated postoperative period. Moreover, it appeared to be beneficial in terms of the improved lower extremity muscle strength that was more pronounced in the study group than in the control group. Therefore, the effects of EMS on the clinical status of these patients require the further investigation.

Aim. Evaluation of short- and mid-term (up to one year) results of aт atrial fibrillation thoracoscopic radiofrequency ablation (TRFA) combined with left atrial appendage resection.

Methods. 10 patients with persistent AF were included in the study. In 5 cases surgical ablation was performed as the primary intervention and in 5 cases surgery were preceded by two unsuccessful catheter procedures. Age of the patients was 54.4 (41; 63) years, duration of arrhythmic anamnesis – 5.6 (4.8; 6.8) years, anteroposterior size of the left atrium – 4.7 (45; 51 mm), LV ejection fraction – 63 (58; 68) %. TRFA included an isolation of right and left pulmonary veins, ablation lines along the roof and base of posterior wall of the left atrium, left atrial appendage resection.

Results. In all cases of TRFA exit-block from the pulmonary veins was achieved. Among 10 procedures, a stable sinus rhythm was documented in 6 patients. In the remaining 4 patients AF was observed only in one case, and the other three demonstrated atypical atrial flutter, that given us a reason to repeat catheter procedures. In three cases of left atrial flutter, catheter ablation led to sinus rhythm restoration, and in case of AF and total sclerosis of left atrium a decision to refuse RF ablation was made. Complications were presented by a single case of bilateral phrenic nerve palsy, which required plication of the diaphragm, and two spontaneously resolved pulmonary atelectasis.

Conclusion. The efficacy of atrial fibrillation thoracoscopic radiofrequency ablation during the follow-up period of one year was 90% regarding selective hybrid approach (thoracoscopic + catheter procedure). Procedure safety of TRFA was much lower than that of catheter ablation: the total number of small and big complications was 30%.

Background. Coronary artery bypass graft surgery is the most common cardiac surgery in the world. Graft failure is a complex multifactorial process that occurs in a significant part of all grafts.
Aim. To identify predictors of early coronary bypass failure using optical coherence tomography.
Methods. A prospective observational study included 10 patients with multivessel coronary artery disease who underwent coronary artery bypass grafting. After surgical myocardial revascularization, the patients underwent coronary angiography with optical coherence tomography (OCT) of arterial and venous grafts, including the distal anastomosis and conjugate segment of the target coronary artery. Endothelial damage; the presence of severe tortuosity, stenosis, spasm and parietal thrombi; the ratio of the diameters of the conduit and the native coronary artery was assessed.
Results. A control study revealed several findings. In one case, the left internal mammary artery was occluded, which required stenting of the left anterior descending artery. In one patient, a dissection of the left internal mammary artery anastomosis was revealed, while a double lumen with the formation of a false channel was revealed on the OCT. In one case, stenosis of a saphenous vein graft on the right coronary artery was determined (53.1% by area). In three cases, a pronounced recalibration of the diameters of the saphenous vein graft and the target coronary artery with more than two times the ratio was revealed, and in one case, the diameter of the target artery was less than 2 mm.
Conclusion. OCT is an effective method for visualizing morphological changes not only in coronary arteries, but also in coronary bypass grafts, which may be associated with early graft failure.

Aim. Mechanical thrombectomy is standard of care for the treatment of acute ischemic stroke. The objective of this study is to analyze the results of our own experience of endovascular treatment in Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” Kemerovo.

Methods. 12 patients with AIS and underwent mechanical thrombectomy with «Trevo» stent-retriever were included in this analysis. Primary outcomes included 90-day modified Rankin scale (mRS) score, first pass effect (FPE) and recanalization rate (TICI score), the combined incidence of postintervention hemorrhages and mortality at 90 days.

Results. Among 12 patients (66.7% male, age 59.5 [57.5; 66.5] years) hypertension were in 100%, 61.5% had an ischemic heart disease, 53.8% was current smoking and atrial fibrillation. Median of the NIHSS scale was 13 points, mRS≥4 was in 75% of patients. In 33.3% was a tandem lesion (internal carotid artery terminus and middle cerebral artery) and 25% required stenting of the carotid artery. Good clinical outcomes (mRS≤2 at 90 days) were achieved in 77.8% (7/9) among surviving patients. The 90-day NIHSS score – 4 [1; 5]. The first pass effect and recanalization rate (TICI Scores 2b-3/3) was achieved in 50% and 91.7% of patients. The combined incidence of postintervention hemorrhages and mortality at 90 days was 33.3% and 25% respectively.

Conclusion. Despite the small sample size, stent retriever mechanical thrombectomy in AIS provides satisfactory clinical results.

Background. Today, a number of unresolved issues remain regarding vulnerable coronary plaques, one of which is the need for preventive revascularization.
Aim. Evaluation of the appropriateness of preventive revascularization of functionally insignificant lesions of the coronary arteries with signs of vulnerability according to the virtual histology of intravascular ultrasound in patients with stable coronary artery disease.
Methods. The prospective randomized study includes patients with stable coronary artery disease and isolated intermediate-grade coronary stenosis. The first step in patients is measured fractional flow reserve to confirm the hemodynamic insignificance of stenosis. Then an intravascular ultrasound is performed to verify signs of plaque vulnerability: a thin-cap fibroatheroma and / or minimum lumen area <4 mm² and/or plaque burden >70%. After that, patients are randomized into two groups: preventive revascularization or optimal medical therapy. After 12 months, patients undergo repeated intravascular ultrasound and end-point analysis.
Results. So far, 10 patients have been included in the study (6 in the preventive revascularization group and 4 in the optimal medical therapy group). No endpoints and complications were recorded in both groups in 30-days follow-up.
Conclusion. Intravascular imaging methods can identify vulnerable coronary plaques, which allows you to use a personalized approach in determining treatment tactics, one of which can be preventive revascularization.

Aim. To evaluate the impact of environmental community profile on the physical activity among the residents of Siberia.
Methods. A cross-sectional study of 1263 participants aged 35–70 years was performed. All respondents were surveyed to assess their environmental community profile using the Neighborhood Environmental Walkability Scale and physical activity using the International Physical Activity Questionnaire. The estimated binary indicators of physical activity, including driving, cycling, transport and recreational walking, sports, daily brisk walking (over 150 minutes per week). Logistic regression adjusted to the gender, age and socio-economic parameters was used to determine the presence of any associations between the environmental community profile and physical activity. The cluster analysis was used to group the communities by their environmental profile on the high walkability level and low walkability level.
Results. Car driving was negatively associated with pedestrian and cycling facilities within the selected communities (OR 0.84; 0.71–0.99). The positive correlation of transport walking with the access to the community facilities (OR = 1.48; 1.17–1.87) and pedestrian and cycling facilities (OR = 1.24; 1.06–1.44) was found. The negative association of transport walking with traffic safety (OR = 0.74; 0.57–0.97) was determined. Recreational walking was positively associated with the access to the community facilities (OR = 1.23; 1.04–1.45), pedestrian and cycling facilities (OR = 1.20; 1.08–1.33), aesthetics (OR = 1.30; 1.11–1.51) and walkability index (OR = 1.45; 1.23–1.87). Brisk walking of more than 150 minutes per week was positively associated with the access to the community facilities (OR = 1.22; 1.02–1.47) and pedestrian and cycling facilities (OR = 1.15; 1.02–1.29).
Conclusion. The impact of the environmental community profile on the transport physical was considered as a positive and was consistent with the results of other similar studies. However, some associations require further in-depth analysis.

Lipid metabolism disorders play a key role in determining cardiovascular risk. The level of low-density lipoprotein cholesterol is a significant factor in the pathophysiology of atherosclerosis and an indicator, the assessment of which reduces the risk of cardiovascular events. The prevalence of acute coronary syndrome in Russia remains at a high level. To date, the successful implementation and implementation of standards for the management of acute coronary syndrome has significantly reduced hospital mortality rates, however, secondary prevention issues remain relevant. Despite a wide range of lipid-lowering drugs, the use of which at maximum doses in acute coronary syndrome does not allow reaching the target levels of the lipid spectrum, the risk of developing repeated cardiovascular events remains high. Recently, a promising direction is the use of type 9 subtilisin/ kexin proprotein convertase inhibitors for the intensification of lipid-lowering therapy in patients with acute coronary syndrome. This article presents the clinical case of the successful use of one of the inhibitors of the proprotein convertase of subtilisin/kexin type 9, alirocoumab, in lowering low-density lipoprotein cholesterol and thereby reducing the risk of repeated cardiovascular events in a patient with acute coronary syndrome.

Percutaneous Vertebroplasty (PVP) is the minimally invasive radiological procedure consisting in the transdermal injection of bone cement into the damaged vertebral body. PVP performing has a high risk of complications including vascular embolism which has value from 3.5 to 30 %. There is an example of cardioembolism with bone cement as a result of PVP complication after surgical treatment of a patient with a spinal cord injury after ancar accident and the successful extraction of this embolus is given in this clinical case.The authors describe the approaches to this problem, including the diagnosis of the condition and treatment options.