Thе article describes the methodological approach to the assessment of the neurophysiological status of patients undergoing transcatheter aortic valve implantation, including cognitive screening, extended neuropsychological testing with the identification of postoperative cognitive dysfunction and electroencephalographic study used in daily practice at the Federal State Budgetary Institution “Research Institute of Complex Issues of Cardiovascular Diseases”, Kemerovo. The approach was illustrated by a clinical case. The neurophysiological method demonstrated an informational value and satisfactory individual tolerance. The patient, an elderly female, had postoperative cognitive dysfunction and cortical dysfunction as revealed by postoperative dynamics of cognitive and electroencephalographic parameters.

Highlights. The association of single nucleotide polymorphic variants rs12143842 and rs4657139 of the NOS1AP gene with the duration of the QT interval was found in men of the Siberian population.

Aim. To study the association of single nucleotide variants rs12143842 and rs4657139 of the NOS1AP gene with the duration of the QT interval.

Methods. The study sample of men (1353 people) aged 25–69 years was formed from the DNA bank of participants in the international HAPIEE project and screening of young people 25–44 years old, residents of Novosibirsk. From each age subgroup (25–29, 30–34, …, 65–69 years old), about 10–15% of men with the shortest, average and longest QT interval were selected and the corresponding groups were formed. Genotyping of rs4657139 was carried out using PCR with RFLP (polymerase chain reaction followed by restriction fragment length polymorphism analysis). Genotyping rs12143842 – using RT-PCR (real-time polymerase chain reaction).

Results. At the age of over 50 years, the CC genotype rs12143842 was detected in 66.1% of men in the group with a short and average QT interval and in 50.6% in the group with a long QT interval, while the TT genotype prevailed in the group with a long QT interval, 10, 8% of cases (odds ratio (OR) = 3.345, 95% confidence interval (CI) 1.149–9.739, p = 0.02). The homozygous TT genotype rs4657139 was more common in the long QT group, in 20.1% of cases, while the AA and AT genotypes predominated in the short, average QT groups (p = 0.041). A similar trend persists when separating by age in people over 50 years of age (p = 0.031) and when comparing genotype frequencies in the long and average QT groups in the model TT vs AA + AT & long QT vs short + average QT (p = 0.003).

Conclusion. Single nucleotide variants rs12143842 and rs4657139 of the NOS1AP gene are associated with the duration of the QT interval in male residents of Novosibirsk.

Aim. To study the perioperative dynamics of myocardial injury biomarkers and determine their significance in assessing the postoperative mortality risk in patients with nonsmall cell lung cancer.

Methods. The study included 82 male patients with non-small cell lung cancer undergoing pneumonectomy. The median age was 64 (59; 67) years. The blood levels of cardiac troponin I (cTnI), N-terminal pro b-type natriuretic peptide (NT-proBNP) and fatty acid-binding protein (FABP) were noted before and after surgery. The rate of myocardial injury after non-cardiac surgery (MINS) was determined. The postoperative cTnI level above 0.023 μg/L was considered as MINS criterion. The significance of the studied biomarkers in predicting the total mortality within 6 months after surgery was assessed using the univariate and multivariate Cox regression and ROC analysis.

Results. Compared to baseline levels, all myocardial injury biomarkers increased in 24 and 48h after surgery: cTnI by 120 and 85%, NT-proBNP by 128 and 129%, FABP by 207 and 31%, respectively. The postoperative cTnI levels met the MINS criterion in 45.1% of patients. During the follow-up period 12 patients died, 9 (75%) of those were diagnosed with MINS. Based on the results of the univariate Cox regression overall postoperative mortality was associated with NTproBNP levels before and after the surgery, cTnI growth rate after the surgery and MINS. According to the multivariate Cox regression (adjusted for age and other clinical parameters), preoperative NT-proBNP and atrial fibrillation proved to be the independent predictors of postoperative mortality. The cut-off value of preoperative NT-proBNP was 225 pg/mL; relative risk of death above that value was 5.9 and 95% confidence interval of 1.74–20.0.

Conclusion. In patients with non-small cell lung cancer the increase of cTnI, NT-proBNP and FABP mean levels was observed in 24 and 48 hours after pneumonectomy. MINS was diagnosed in 45.1% of patients. According to the univariate regression analysis, MINS and preoperative and postoperative NT-proBNP levels were associated with the risk of total six-month postoperative mortality. The preoperative NT-proBNP was proved to be an independent predictor of adverse outcome.

Highlights. With the use of numerical optimization algorithms, it is possible to qualitatively improve the performance (closing) of the leaflet apparatus of the heart valve prosthesis. Changing the length of the free edge of the lealflet of the prosthesis does not reduce the von Misess stress amplitude and does not change the nature of its distribution on the diagrams.

Aim. Numerical study of the stress-strain state of a clinical heart valve prosthesis from the point of view of the impact of physiological loads and determination of ways to optimize the geometry of the biological leaflet apparatus.

Methods. The object of study was a three-dimensional model of the UniLine (NeoCor, Russia) clinical prosthesis of the heart valve, size 23 mm, as well as four modifications focused on changing the length of the free edge. The study was carried out using the finite element method with imitation of the full cycle of operation of the leaflet apparatus under physiological conditions (pressure, heart rate). The parameters for the analysis were the qualitative and quantitative characteristics of the stress-strain state of the work of the five studied geometries.

Results. It is shown that high stress areas are concentrated in two zones peripheral and free edges, regardless of the geometry. However, quantitatively, the von Mises stress amplitudes differed between the studied models. For example, the leaf shape, conventionally designated as “–10” degrees, demonstrated the smallest amplitude of this indicator relative to the original unmodified leaf model, thus reducing by a maximum of 18.8%. However, for the closed state, this model, on the contrary, showed an increase in the voltage index relative to the initial one by 8.3%. Other modification options showed similar trends.

Conclusion. It is shown that despite the initial premise for optimizing the leaflet apparatus – reducing the length of the free edge and eliminating deformations of the closed state, the proposed geometry options did not significantly change the stress distribution map in the material, and also did not allow to significantly reduce the amplitudes of this parameter. Presumably, options for modifying the geometry and/or properties (rigidity, mobility) of another important component of the bioprosthesis, the support frame, which, in addition to the bearing function, provides damping of the hydrodynamic impact on the leaf due to some of its mobility, may become more promising.

Highlights. Congenital heart defects in combination with aortic arch hypoplasia or coarctation of aorta are quite common in cardiac surgeon’s practice. The protection of internal organs is an important point in the treatment of these defects. Several methods have been proposed from hypothermic arrest to selective perfusion of various vascular regions. Given the variety of techniques, the effectiveness and advantages of each one are still a topic of debates. The article reflects the experience of using cerebro-myocardial perfusion in children with surgical correction of the aortic arch pathology.

Aim. To analyze the prospects of regional selective controlled cerebral and myocardial perfusion method in surgical correction of aortic arch obstruction in children.

Methods. A retrospective single-center analysis of the treatment in 29 pediatric patients was carried out and immediate results of cerebral-myocardial perfusion used in children with surgical correction of aortic arch obstruction in the period from 2016 to 2020 are presented. Median age was 6 days (1 day – 15 years old). Median weight was 3.6 kg (1.8–47 kg). 15 patients were girls, 14 patients were boys. The inclusion criteria for all the patients were cerebro-myocardial perfusion for aortic arch reconstruction.

Results.Cardiopulmonary bypass time median was 78 minutes (43–206 minutes). The average time of cerebro-myocardial perfusion was 22.4 + –6.4 min (12–35 min). The median duration of the surgery was 3.1 hours (2.25–5.5 hours). The median time for mechanical ventilation was 101 hours (6–744 hours), in the ICU – 8.5 days (1–31 days). The average time of hospital stay was 18.2 days + –6.7 days (7–31 days). Early postoperative mortality was 3.4%. Renal replacement therapy was required for 2 newborns (7%). Operational risks, according to the Aristotle Score, were significantly higher in newborns (χ2 = 3.9277, df = 1, p-value = 0.0475). There were no cardiac events associated with myocardial perfusion. The type of cardioplegia (blood or “Kustadiol”) did not significantly affect the pumping function of the heart, assessed by transthoracic echocardiography on day 1 after the surgery (χ2 = 0.27273, df = 1, p-value = 0.6015). Acute ischemic cerebrovascular accident occurred in 1 patient (3.5%).

Conclusion. The technique of controlled selective cerebro-myocardial perfusion is reproducible without any additional resource costs. We can confidently say that the time of surgery and cardiopulmonary bypass is much shorter than in case of using deep hypothermic arrest or isolated selective cerebral perfusion, as soon as there is less time needed for cooling and re-warming the body. Also, the time of cardiac arrest was reduced or completely eliminated (with isolated reconstruction of the aortic arch). The technique is effective and safely reproducible in both newborns and older children. The results for mortality and complications are encouraging but must be further evaluated and compared.

Highlights. Two-year results of stenting in patients with diffuse and multivessel coronary artery lesions performed using intravascular research and control methods (optical coherence tomography, blood flow fractional reserve) are presented. A low incidence of myocardial infarction, repeated interventions and a high level of survival, free from significant cardiovascular complications, were noted when using intravascular research methods in patients during percutaneous coronary intervention in comparison with the patients who did not undergo intravascular methods.

Aim. To evaluate the two-year results of percutaneous coronary interventions (PCI) in patients with diffuse and multivessel coronary lesions.

Methods. 128 patients were included in the study and divided into two groups. In group I (n = 62) PCI was performed using intravascular imaging methods, in group II (n = 66) no intravascular imaging methods (retrospectively) were used. The measurement of fractional flow reserve (FFR) in diffusely altered arteries was performed against the background of maximum hyperemia between stenoses by pulling the sensor starting from the distal segment. Initially, the most distal hemodynamically significant stenosis underwent the stenting. Then, a repeated measurement of FFR was performed and it showed if the further stenting was needed. The results of stenting, as well as the determination of the stent implantation area were carried out by the method of optical coherence tomography.

Results. 12 months after PCI the results of treatment were checked in all patients and after 24 months – in 106 patients (56 and 50, respectively, in groups I and II). The achievement of complete (functionally adequate, according to FFR measurements) myocardial revascularization was achieved in 93.5% of patients from group I, while the result in the control group was only 56% of patients. The average number of stenoses in the target non-occluded artery according to angiography and after FFR measurement was the following: in patients with two-vessel lesions – 2.95±0.65 and 1.82±0.88, respectively, and in patients with three-vessel lesions – 2.96±0.6 and 2.24±0.76, respectively (p = 0.0024). After 12 months of follow-up, significant differences were observed between groups I and II in the frequency of myocardial infarction (1.8 and 4.0%, respectively; χ2 = 5.172) and repeated interventions (3.6 and 16.0%, respectively; χ2 = 8.114). By the 24th month of follow-up, among the observed patients, the total frequency of myocardial infarction, repeated interventions and cardiac death were significantly higher in patients of group II compared with group I and they were 45.5 and 9.6%, respectively (χ2 = 14.784; p<0,0001).

Conclusion. Long-term results of PCI in patients with diffuse and multivessel coronary lesions using intravascular imaging methods (optical coherence tomography and FFR measurements) are characterized by low cardiac complications, compared with patients operated without imaging methods.

Highlights. Plasma separation and cytokine hemoperfusion effectively stop cytokine shock, but prolonged extracorporeal therapy in patients with COVID-19 has demonstrated effectiveness in reducing organ dysfunction without significantly affecting extent of lung parenchyma damage.

Aim. To assess the safety and efficacy of extracorporeal therapy in patients with COVID-19.

Methods. The study included 27 patients aged 67±9.7 [min 38, max 87] years with a laboratory-confirmed SARS-CoV-2 and bilateral polysegmental pneumonia, various concomitant chronic diseases who were admitted to Intensive Care Unit and received extracorporeal therapies. All patients had the mean NEWS score of 6.9±2.7 [min 4, max 9] and the mean SOFA score of 8.1±3.1 [min 3, max 16] at admission to the ICU. 19 patients (70.4%) had severe lung lesions over 75% according to the chest CT scans. 48 extracorporeal therapies were performed using the Multifiltrate (Fresenius Medical Care, Germany) and Aquarius (Nikkiso Aquarius RCA, Great Britain) medical devices. Indications for extracorporeal therapy initiation included cytokine storm associated with acute respiratory distress syndrome and septic shock.

Results. Generally, each patient received at least one extracorporeal therapy. 11 patients underwent 2 to 6 sessions. Isolated plasma separation and hemoperfusion helped to reduce vasopressor / cardiotonic support, slightly improved ventilation parameters, with a significant, but not long-term decrease in the levels of inflammation markers. Combining different modalities of extracorporeal therapy that provide rapid elimination of agents, controlled temperature response and hydration, maintaining homeostasis and detoxification, appeared to be most optimal. Extracorporeal therapy did not improve the volume of lung parenchyma or lung parenchyma damage. However, 19 (70.4%) patients who received extracorporeal therapy transitioned from mechanical ventilation to spontaneous breathing, whereas 8 (29.6%) patients had severe lung lesions (over 75%) according to the repeated chest CT scans. The mean length of stay in the ICU among survivors was 9±3.5 [min 4, max 22]. The 28-day mortality and in-hospital mortality rate was 25.9% (7).

Conclusion. Prolonged extracorporeal therapy in patients with SARS-Cov-2 has demonstrated efficacy in relieving organ dysfunctions and shock states, but did not significantly affect the remaining lung parenchyma damage.

Highlights. The basis for improving the quality of medical care is the arrangement of algorithms for clinical processes. The choice of a clinical and organizational solution for cardiovascular diseases in groups of older age patients at the stage of primary healthcare is a complex medical and economic task that requires maintaining the balance of efficiency, safety and quality of life in the "patient – risks – survival – economic efficiency" system. The development of an algorithm for making clinical and organizational decisions concerning cardiovascular diseases in elderly patients to improve the effectiveness of primary healthcare is an urgent health issue.

Aim. To develop and evaluate the effectiveness of the algorithm for making clinical and organizational decisions at the primary healthcare stage for elder patients with cardiovascular diseases.

Methods. The bases for the study were conducted in 2016–2020 at the Vascular Surgery Department of Peoples Friendship University of Russia and the Central Clinical Hospital “RZD-Medicine”. The object of the study was the patients with cardiovascular diseases (n = 422), mean age 76.11±7.2 years old. The subject of the study was cardiovascular surgeons (n = 4) experienced in surgical and endovascular technology. The algorithm was based on the content analysis of scientific publications (n = 27), clinical practice, the organizational and technological algorithm of PHC (primary healthcare) developed by Abramov A.Yu. and the colleagues in 2020 and the recommendations for the care of the elderly people with polymorbidity developed by the American Geriatric Society (2012). The medical, social and clinical effectiveness as well as the economic results of inpatient treatment were evaluated. The periods before and after the implementation of the algorithm in 2016–2017 and 2018–2020 were compared. Content analysis, analytical, statistical, mathematical, comparative, and expert research methods were applied.

Results. The developed PHC (primary healthcare) algorithm contributed to the high level of accessibility of endovascular care (100%). Cardiovascular surgeons positively assessed the possibility of providing surgical care in 100% of cases and patient adherence to surgical treatment (99.5%). In 2016–2017 and 2018–2020 the surgical activity of the vascular surgery department significantly increased from 7 to 98.9%, the average bed-day decreased from 9.5 to 6.8 days and the postoperative bed-day from 7.2 to 4.12 days, the frequency of repeated hospitalizations in the hospital decreased during the year from 3.1±0.2 to 1.6±0.4 times, the incidence of primary acute myocardial infarction from 12 to 0% and relapses of critical ischemia of the lower extremities from 36 to 2%. The average cost of direct medical costs for the treatment of one patient during the year in the main and control groups did not differ significantly, 4 086$ (USA) и 3 887$ (USA), respectively.

Conclusion. The PHC development and experience algorithm indicates the increase in the medical, social and clinical effectiveness of medical care for cardiovascular diseases in patients of older age groups and helps to reduce the direct costs of inpatient care.

Highlights. Probably causal mutations of QT interval prolongation in genes associated with LQTS were found in men of the Siberian population.

Aim. To detect and study mutations in individuals with borderline prolongation of the QT interval in Siberian males.

Methods. The study was conducted on the material of the international project HAPIEE in the period from 2003 to 2005 and screening of young people aged 25–44, performed in Novosibirsk. The total sample of men was 1353 people aged 25 to 69 years. From each age subgroup (25–29, 30–34, ..., 65–69 years old) 2–3 samples with the highest QT values were selected . The study group consisted of 30 men who subsequently underwent sequencing of a panel of genes. The search for mutations was carried out in genes associated with long QT syndrome (LQTS): KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, CACNA1, SCN4B, KCNJ5, ANK2, CAV3, SNTA1, AKAP9, CALM1 and CALM2. All identified single nucleotide variants were verified by direct Sanger sequencing.

Results. Three rare variants in the LQTS genes have been identified: p.P197L of the KCNQ1 gene, p.R176W, and p.D1003GfsX116 of the KCNH2 gene.

Conclusion. In Caucasian men from the Novosibirsk population with borderline prolongation of the QT interval, probably causal substitutions in the LQTS genes – KCNH2 and KCNQ1, contributing to the prolongation of the QT interval, were found. To clarify the spectrum and frequency of occurrence of various mutations in genes, life-threatening arrhythmias in the population, additional studies are needed on extended samples.

Both arterial and venous conduits can be used for coronary bypass surgery. Arterial conduits have more advantages over venous conduits. The concept of “graft-artery junction” was created to help specialists understand the complex interaction between the chosen conduit and target coronary vessel, and assist clinicians in choosing the appropriate vascular conduit for coronary artery bypass grafting. Supposedly, the system is comprised of two parts. The first part is represented by the chosen conduit and its influence on coronary arteries. The existence of such influence has been proven by previous studies, some of which indicated that internal mammary artery has cardioprotective effects. Artery walls secrete such vasoactive substances as nitric oxide, prostacyclin, endothelial hyperpolarized factor, etc. The second part is represented by coronary arteries, their influence and specific mechanisms of atherosclerosis spreading (involving grafts). The number of studies devoted to this topic remains low, therefore, we have attempted to highlight this issue within this review.

Treatment of patients with multivessel coronary artery disease is percutaneous coronary intervention or coronary artery bypass grafting according to current European and American guidelines. Depending on the anatomical complexity of the coronary artery lesion, one of the methods is chosen, with usage of a risk scale based on the SYNTAX study. However, Syntax score is actively discussed as not an optimal risk scale, because of unmatched with modern clinical possibilities This article presents current, different opinions on anatomical and clino-anatomical risk scores, which allows to choose the optimal method of revascularization for patients with three-vessel disease and/or left main coronary artery lesions.

Highlights. The article presents current literature data on the results of surgical treatment of acute pulmonary embolism.

Abstract. The review article throws light on up to date approaches to the treatment of acute pulmonary embolism. The great variety of treatment methods and controversial results do not allow us to conclusively decide on which method to choose. Traditionally, pharmacological therapies have been favored over invasive methods because of the lower mortality rate. However, based on new studies, it can be established that interventional embolectomy is an effective option, showing good immediate and long-term results. Undoubtedly, additional studies are needed in order that surgical embolectomy developed from a rescue therapy of acute pulmonary embolism into a first-line or priority treatment.

Highlights. The combination of congenital aortic valve insufficiency and abnormal coronary artery discharge is rare. Taking into account the fact that coronary angiography is not indicated for young patients, there may be a risk of injury to the coronary artery during the correction of aortic malformation. The published case indicates the need for routine coronary angiography for all patients, regardless of their age, who are going to have aortic valve surgery.

Background. Anomalous origin from right sinus and pathway of circumflex coronary artery can complicate aortic valve and root procedures. Computed tomography scan with contrast and selective angiography help to recognize the malformation and protect circumflex artery. Herein we present the case of valve sparing root replacement in patient with bicuspid regurgitant aortic valve and anomalous origin of circumflex artery.

Highlights. A retrospective analysis of the patients’ data after Ozaki operation in four Russian Medical Centers was carried out. A comparative gender assessment of the immediate and medium-term results of Ozaki operation was performed.

Aim. Gender assessment of Ozaki operation immediate and mid-term results in patients with aortic valve (AV) pathology.

Methods. A retrospective multicenter study enrolled 251 patients (135 women, median age 66 (60–70) years old) who underwent Ozaki operation (2017–2020) was carried out in four centers in Russia. After propensity score matching, 92 patients were selected (mean age 65.8±10.8 years old). Two groups were formed in the gender structure: 46 females (average age 67.8±6.3 years old), 46 males (average age 63.8±15.4 years old). The main cause of AV dysfunction was severe aortic stenosis – in 86 (93.5%) cases. Chronic heart failure of III–IV functional class according to NYHA was observed in 26 (28.3%) patients. A bicuspid AV was in 24 cases (26.1%). The primary endpoint was hospital mortality. Postoperative complications and mid-term results (three-year overall survival and freedom from reoperation on AV) were assessed as secondary endpoints; the median follow-up period was 23 (18–33) months.

Results. There was no statistically significant difference between the groups in the duration of surgery (275 minutes for females and 285 minutes for males, p = 0.4), cardiopulmonary bypass (98 minutes for females and 115 minutes for males, p = 0.3), aortic clamping (80 minutes for females and 93 minutes for males, p = 0.7). Hospital mortality among the studied patients did not differ: in the female group – 2.2% (1 case) and 0 in the male one, p = 0.9. There were no significant differences in postoperative complications: sepsis (2.2% in women and 0 in men, p = 0.9), superficial wound infection (8.7% in women and 6.5% in men, p = 0.9). Acute kidney injury, stroke, pacemaker implantation, resternotomy for bleeding were not observed in any patient. Three-year overall survival was 91.8% in females and 91.6% in males, p = 0.8; three-year freedom from reoperation – 94.4% for females and 100% for males, p = 0.1.

Conclusion. Ozaki operation is equally reproducible with the same hospital mortality, postoperative complications, and medium-term outcomes in both females and males.

Highlights. The article analyzes the features of cardiac remodeling and the outcomes of endovascular and minimally invasive closure of atrial septal defects in children.

Aim. To compare the features of cardiac remodeling (CR) and the outcomes of endovascular and minimally invasive closure of atrial septal defects (ASD) in children.

Methods. The study included 60 children with secundum ASD who underwent minimally invasive (MIC) or endovascular closure (EC) of ASD from the beginning of 2017 to the beginning of 2020. Patients were divided into two groups. The first group (n = 30) consisted of patients undergoing MIC, median age 5 years [2;12], and the second group (n = 30) consisted of patients undergoing EC, median age 5.5 years [1.7;13], p>0.05. The groups were comparable in gender, height, and body weight (p>0.05). The groups differed in the diameter of ASD. ASD defect size was 14 mm [7;30] in the MIC group, and 11.5 mm [7;22] in the EC group. The following indicators were assessed during hospital stay: the outcome of the intervention, residual shunt, hospital-acquired complications, and indicators that characterize CR before the procedure and 3-4 months after surgery.

Results. The analysis revealed that all children successfully underwent minimally invasive and endovascular closure of ASD (confirmed absence of residual shunt). Hospital-acquired and long-term complications were not detected. Data are presented as a median and percentile. In the MIC group all patients required blood transfusion, intraoperative blood loss was 445 mL [300;1290], while in the EC group the blood loss did not exceed 5 mL [5;15], p = 0.001. EC was much more advantageous in terms of length of hospital stay (LoS) compared to MIC; in the MIC group LoS was 8 [6;14] days, and in the EC group LoS was 3 [3;4] days, p = 0.001. LoS in the Department of Anesthesiology and Intensive Care after MIC was 24 [3;96] hours, while patients in the EC group did not need to be transferred to this Department, p = 0.001. In both groups, significant changes were observed during 3–4-month follow-up in the form of a decrease in the volumetric and dimensional parameters of the right chambers and simultaneous increase in the same parameters of the left chambers.

Conclusion. Minimally invasive and endovascular surgeries are effective and safe treatment modalities for ASD in children (median age of 5–5.5 years), which positively affect CR according to 3–4-month follow-up. At the same time, the advantages of EC regarding the intraoperative blood loss / blood transfusion, the need for mechanical ventilation, cardiopulmonary bypass, and LoS in the ICU and hospital are highlighted.

Highlights. In order to provide medical care to COVID-19 patients, medical workers had to work in conditions of extreme stress. The management systems adapted to such challenges contribute to the creation of more stable and organized structures that require substantial study concerning the medical personnel effectiveness and satisfaction of the job, taking into account the sphere of medical care.

Aim. To examine the impact of the pandemic on the staff activities in the sphere of cardiology.

Methods. The object of the study is medical organization personnel. The subject of the study is the GBUZ “KKKD” personnel opinion. The study periods are 2012 and 2021. Rating questions were coded with a five-point Likert scale. The mean value and standard deviation (M±SD), Pearson Chi-square, p (%) were calculated. The critical level of statistical significance was taken as p≤0.05.

Results. The study showed a significant increase in high estimates of the staff performance both at the unit and organization where the respondent worked. The high subjective ratings are confirmed by the objective data of GBUZ “KKKD” activity in 2021. However, the pandemic situation reflected on the personnel perception of their productivity: there is an increase of high productivity positive assessment both in a structural division and in the whole organization. 2021 survey revealed the conditions caused by the COVID-19 pandemic which affected the performance of the staff. Among the most significant ones are the following: the lack of necessary reagents, worsening of financial and living conditions, epidemiological restrictions, the lack of actions and orders coordination, heavy workload, fatigue and burnout, the reduction of salary, irresponsibility of patients and their removal to different departments, bureaucracy, the lack of information and staff interaction. The study also showed an increase in the proportion of respondents' answers regarding the inability to work more efficiently from 21.6% in 2012 to 29.4% in 2021, which may be caused by the work stress and the special working conditions during the COVID-19 pandemic. All the reasons why it was impossible to work efficiently during the pandemic were divided into three groups: managerial, personal and clinical-organizational.

Conclusion. The impact of the COVID-19 pandemic on staff performance is evident judging by the evaluation dynamics in two sociological studies. The prior factors of performance improvement and staff satisfaction include: expansion of social benefits, favorable moral-psychological climate and working conditions. The study shows that in order to achieve the main goals of medical organization in the conditions of insurmountable risk the personnel have a significant role in making organizational decisions.

Highlights. Congenital heart disease (CHD) is estimated to occur nearly in one per 100 newborns and a third of these babies are in need of corrective procedures. There is a downward trend in mortality associated with advances in surgical treatment and perioperative care. An increasing number of patients with corrected CHD are accumulating in the population. This article provides a literary review of the current state of long-term outcomes of CHD corrections and possible mechanisms for improving late outcomes.

Abstract The article analyzes the literature on long-term results of surgical treatment of congenital heart defects and possible mechanisms for their improvement. The bibliographic method was used. The analysis of domestic and foreign literary sources with a search depth of 20 years is carried out. The criteria for including publications were: access to full-text publications, original research, scientific and review articles. Exclusion criteria: abstracts and summaries of publications. The following search queries were formulated for the review: in English: late outcomes of corrections of congenital heart defects, in Russian: long-term results of corrections of congenital heart defects, long-term results after corrections of congenital heart defects. The used search engines are Science Direct, PubMed, Cyberleninka, E-library. The analysis of the literary data showed that the volume and duration of patients’ observation that underwent surgical correction of congenital heart defects remain controversial. In world and domestic practice modern digital technologies are used for the purpose of patients remote monitoring. Remote monitoring programs in the Russian Federation are used for such socially significant diseases as diabetes mellitus, bronchial asthma, as well as cardiac rehabilitation of adult patients. There are no similar programs for patients with congenital heart defects. There is a problem of patients remote monitoring after congenital heart defects surgical treatment. In Russia today there is no any comprehensive program for remote monitoring of children after congenital heart disease surgical correction. We believe that a universal remote monitoring system for managing this group of patients must be created.

Highlights. The article is a review of current literary data on the problem of acute decompensated heart failure. The review highlights the basic principles of the diagnosis and treatment, as well as the problems of their implementation into clinical practice.

Abstract Acute decompensated heart failure (ADHF) is a life-threatening condition that requires an emergency hospitalization for intensive treatment. Moreover, it is the event that worsens the patient's further prognosis. Frequent rehospitalizations for decompensation of heart failure reduce life expectancy and quality, and are also a significant economic problem in practical health care. The increasing number of patients with heart failure leads to the growing number of patients seeking medical help for acute decompensated heart failure. More than half of the patients are re-hospitalized within a year for the same reason. The predicted increase in the prevalence of CHF worldwide makes the management of such patients a global medical and social problem. Patients delay, low compliance and insufficient ambulatory monitoring are the factors that need to be influenced in order to improve the prognosis. The article is a review of literary data on the epidemiology of ADHF, diagnosis, treatment and outpatient observation of patients with acute decompensated heart failure. The problems of compliance, the prospects for modern methods of remote monitoring and the possibilities of new drugs are discussed in the article.

Highlights. Nowadays the only way to prevent a new coronavirus infection is vaccination. Overcoming such problems as a gradual decrease in the effectiveness of post-vaccination immunity and the emergence of new strains of SARS-CoV-2 is possible due to booster vaccination. The review highlights the current data on the effectiveness and immunogenicity of various booster vaccination regimens and prospects for studying this issue in the Russian Federation.

Abstract. The COVID-19 pandemic is going on, which makes it crucial to prevent the spread of coronavirus disease. Vaccination is the only way of specific prevention of COVID-19. The SARS-CoV-2 virus is continuously evolving and new variants appear. Moreover, the effectiveness of protective immunity after vaccination tends to decrease over several months. Booster vaccination may be the solution to these problems. The booster is an extra vaccination that helps to reactivate the immunity against COVID-19. Booster doses can be homologous (the same as the primary vaccine) and heterologous (different from the primary vaccine). It is of current interest to study heterologous vaccination as the injection of different vaccines may result in a more intense immune response. Furthermore, the same vaccine may not be available at the time of booster vaccination. This review is aimed at summarizing the key research findings in the field of booster vaccination against COVID-19.