Highlights. Patients with coronary artery disease undergoing coronary artery bypass grafting have a high prevalence of type 2 diabetes mellitus and prediabetes. The frequency of postoperative stroke and hospital stay is significantly higher in patients with impaired carbohydrate metabolism.

Insulin resistance markers are associated with a variety of perioperative characteristics, but according to multivariate analysis, only free fatty acids and HOMA-IR were independent predictors of hospitalacquired complications and long-term hospital stay

Aim. To analyze insulin resistance markers and their association with the preoperative outcome and in-hospital complications of coronary bypass grafting (CABG) in patients with type 2 diabetes mellitus (DM 2), prediabetes and normoglycemia.

Methods. The study included 383 consecutive patients undergoing CABG at the same center. Glycemic status, free fatty acids (FFA), fasting insulin, glucose, lipid profile of all patients were determined before surgery and the following insulin resistance indices (IR) were calculated: HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), QUICKI (Quantitative Insulin Sensitivity Check Index), Revised QUICKI, McAuley. Patients were divided into 2 groups: the group that included patients with carbohydrate metabolism disorders (CMD), type 2 diabetes mellitus and prediabetes (n = 192), and the group of patients without CMD (n = 191). Perioperative characteristics of patients, postoperative complications and their association with insulin resistance markers were analyzed.

Results. FFA and calculated indices of insulin resistance such as HOMA-IR, QUICKI, RevisedQUICKI, and McAuley correlated with the following perioperative characteristics: the duration of surgical intervention and cardiopulmonary bypass, lipid levels, coagulation index, left ventricular dimension and myocardial diastolic function, etc. The analysis of in-hospital complications revealed that the frequency of postoperative stroke (p = 0.044) and hospital stay after CABG >30 days (p = 0.014) was significantly higher in patients with CMD. According to the results of multivariate analysis, the predictors of the composite endpoint (hospital stay after CABG>10 days and/or significant perioperative complication) were as follows: female sex (odds ratio (OR) 2.862, 95% confidence interval (CI) 1.062-7.712, p = 0.036); age (OR 1.085, 95%CI 1.027–1.147, p = 0.003); duration of cardiopulmonary bypass (OR 1.146, 95%CI 1.008–1.301, p = 0.035); body mass index (OR 1.125, 95% CI 1.035–1.222, p = 0.005), left atrial dimension (OR 5.916 95% CI 2.188–15.996, p<0.001); any CMD (OR 1.436, 95%CI 1.029–2.003, p = 0.032), type 2 DM (OR 2.184, 95%CI 1.087–4.389, p = 0.027), FFA levels (OR 5.707, 95%CI 1.183–27.537, p = 0.029) and HOMA–IR index (OR 1.164, 95%CI 1.025–1.322, p = 0.019).

Conclusion. FFA, HOMA-IR, QUICKI, Revised-QUICKI, and McAuley correlate with a variety of perioperative characteristics of patients undergoing CABG, but multivariate analysis revealed that only FFA levels and the HOMA-IR can be used as predictors of in-hospital complications and prolonged hospital stay.

Highlights. The association between vitamin D levels and estimated glomerular filtration rate and triglyceride levels was revealed in people with cardiovascular risk factors aged older than 50 years. Vitamin D deficiency was more frequently noted in patients with acute coronary syndrome. They also were more likely to have abdominal obesity and type 2 diabetes mellitus, indicating the association between vitamin D deficiency and metabolic syndrome. The high prevalence of both vitamin D deficiency and metabolic syndrome in the population necessitates further larger-scale studies to identify the relationship between vitamin D levels and cardiovascular risk factors.

Aim. To assess the level of vitamin D in people older than 50 years with the presence/ absence of carotid artery atherosclerosis.

Methods. The single-stage observational study was conducted, the study included 70 outpatients over 50 years of age, of which 17 (24%) were men and 53 (76%) were women. The mean age of the patients was 66 (60; 72) years. All examined patients underwent history taking, anthropometry, biochemical examination of blood plasma with the determination of lipid spectrum, glucose, creatinine and estimated glomerular filtration rate, echocardiographic examination. The presence of carotid atherosclerosis was determined by ultrasound examination of the carotid arteries. The study of the level of 25-OH vitamin D in blood serum was carried out by enzyme immunoassay (25-OH vitamin D ELISA).

Results. It was found that about half (46%) of the  examined  persons  have  insufficient  levels of vitamin D in the blood plasma, while its deficiency (less than 20 ng/mL) was determined in 9% of patients. Individuals with carotid atherosclerosis had slightly lower levels of vitamin D than those without it, but the differences did not reach statistical significance. In acute coronary syndrome survivors, there was a statistically significant decrease in vitamin D levels, the vast majority of these patients had diabetes mellitus and abdominal obesity. Statistically significant moderate relationships were found between vitamin D levels and triglyceride levels (r = –0.33; p<0.05) and estimated glomerular filtration rate (r = 0.26; p<0.05), which confirms the association of vitamin D deficiency with metabolic syndrome. No statistical regularity was found between the level of vitamin D and other laboratory biochemical parameters, as well as morphological changes in the heart and blood vessels.

Conclusion. Insufficient content of vitamin D in blood plasma is more common in individuals with a history of acute coronary syndrome, among them diabetes mellitus and abdominal obesity are more often detected, which confirms the relationship of vitamin D deficiency with metabolic syndrome.

Highlights. The article presents a novel and unique method for assessment of left ventricular systolic disfunction using electrocardiography and photoplethysmography data. This method will improve and simplify the detection of cardiovascular diseases.

Aim. To evaluate left ventricular (LV) systolic function using electrocardiogram (ECG) and photoplethysmogram (PPG) signals recorded by a single-channel ECG and PPG-based monitor.

Methods. The prospective study included 489 patients over 18 years old with various cardiovascular diseases. All participants underwent echocardiography to determine the main indicators of LV systolic function: LV ejection fraction (EF), LV outflow tract velocity time integral (LVOT VTI), and global longitudinal strain (GLS). Moreover, all patients underwent 1-lead ECG and PPG recording using a single-channel ECG and PPG-based monitor (CardioQvark). The obtained data were analyzed, and ROC curve analysis was performed.

Results. We have identified ECG and PPG parameters associated with a decrease in LV contractile function. During the analysis, the ECG, T-wave amplitude (TA) and RonsF parameters showed the highest diagnostic accuracy. With EF below 55%, the area under the ROC curve (AUC) was 0.822, sensitivity (Se) 80%, specificity (Sp) 69% in EF below 55% in TA; in RonsF AUC was 0.743, Se 81%, Sp 77%. With EF below 40%, AUC was 0.915, Se 85%, Sp 83% in TA, and in RonsF AUC was 0.844, Se 82%, Sp 82%. Diagnostic accuracy of ECG signals in case of LVOT VTI lower than 16 cm was measured: TA (AUC 0.755, Se 82%, Sp 70%), RonsF (AUC 0.620, Se 77%, Sp 72%). PPG signals were not significantly associated with reduced EF; however, the pulse wave parameters were associated with lower LVOT VTI: in DP-B0 AUC was 0.687, Se 71%, Sp 74%. The combination of ECG and PPG signals was significantly associated with EF below 40% (RonsF * DP-SEP (AUC 0.877, Se 86%, Sp 85%). ECG and PPG signals were not associated with LV GLS.

Conclusion. Assessment of LV systolic function can be performed by analyzing ECG and PPG signals recorded using a portable single-channel CardioQvark monitor.

Highlights. A large number of studies are devoted to changes in connective tissues in persons with familial hypercholesterolemia. Studies that are focused on these changes in patients with dyslipidemia without family history of dyslipidemia are few, and most of them are based on ultrasound methods. The data presented in the article make it possible to timely assess the presence of minor changes in the Achilles tendons and thereby obtain additional information about the mechanism of lipid deposition in various tissues.

Aim. To determine structural features of the Achilles tendon in men with dyslipidemia and atherosclerosis.

Methods. The study included 138 men aged 45–65 years with or without atherosclerosis of the common carotid artery or the abdominal aorta and their aortic branches verified by multislice computed tomography.

Results. In individuals with atherosclerosis, the frequency of calcification of the Achilles tendon was 2.5 times higher than in individuals without atherosclerosis. In individuals with carotid artery atherosclerosis, the cross-sectional area of the Achilles tendon was 1.2 times larger than in individuals with abdominal aortic atherosclerosis. In individuals with carotid artery atherosclerosis, the density of the Achilles tendon was 1.1 times higher than in individuals with abdominal aortic atherosclerosis. In individuals with carotid artery atherosclerosis, the frequency of calcification of the Achilles tendon was 2.0 times higher than in individuals with abdominal aortic atherosclerosis. An increase in the cross-sectional area of the tendon and its density, regardless of other factors, including the localization of the atherosclerosis, is directly associated with the total blood cholesterol. The presence of lipid and calcium deposition in the tendons, regardless of other factors, is directly associated with the total blood cholesterol and some of its fractions. The presence of lipid deposition in the tendons is inversely associated with the level of level of phosphate in the blood. The thickening of the tendon and the increase in its density is directly associated with the age of men.

Conclusion. The study results revealed that persons with dyslipidemia and atherosclerosis present with changes in the connective tissues – in the structure of tendons, regardless of family history.

Highlights. This article presents a comparative analysis of the results of PCI of bifurcation coronary lesions using the Szabo technique and provisional stenting in patients with chronic coronary artery disease.

Background. Coronary bifurcation and ostial stenosis are difficult to treat and require precise stent positioning in order to prevent restenosis and thrombosis.

Aim. To perform a comparative analysis of the outocmes of percutaneous coronary interventions (PCI) of coronary bifurcation lesions using the Szabo technique and provisional stenting in patients with chronic coronary artery disease.

Methods. The retrospective single-center observational study included 791 patients. In accordance with the performed bifurcation PCI technique, the patients were divided into two groups: 42 patients in the Szabo group and 749 in the provisional stenting group. Propensity score matching was performed for endpoint analysis, as a result of which 42 patients were selected out of 749 patients in the provisional stenting group, comparable in baseline characteristics with 42 patients in the Szabo group. Study endpoints were cardiac death, myocardial infarction, and repeat revascularization. A composite endpoint (MACE) including all of the above was also evaluated.

Results. The median follow-up in the provisional stenting and Szabo groups was 1.3 and 1.4 years, respectively. There were no significant differences between the groups in terms of mortality, myocardial infarction, repeated revascularization and composite endpoint (MACE 23.80% provisional stenting and 19.04% Szabo, p = 0.594).

Conclusion. Thus, Szabo is technically simple and safe technique for stenting coronary bifurcation lesions in patients with chronic coronary artery disease, which is not inferior in terms of efficiency to provisional stenting.

Highlights. For the first time, the method of standardized low resolution electromagnetic tomography – sLORETA was used to assess the neurophysiological correlates of the success of cognitive rehabilitation using dual task to recover the brain functions affected by ischemia during cardiac surgery.

The patients who were successfully rehabilitated have demonstrated lower postoperative values of resting state theta activity within the right hemisphere, indicating the transfer effect, which is an important component of successful cognitive rehabilitation.

Aim. Visualization and monitoring of brain ischemia is important for the diagnosis of cerebrovascular diseases. The aim of the study was to evaluate the possibilities and applicability of the method of standardized low resolution electromagnetic brain tomography – sLORETA for analyzing brain electrical activity in patients undergoing cognitive rehabilitation using dual tasks to recover impaired brain functions during ischemia associated with cardiac surgery.

Methods. The study included 16 male patients (45–75 years old) who were admitted for planned coronary artery bypass grafting (CABG) to the Clinic at the Research Institute for Complex Issues of Cardiovascular Diseases. Clinical and neurophysiological examinations were performed 2–3 days before CABG and 1 week after surgery. All patients underwent cognitive rehabilitation that started at postoperative day 3 or 4 and lasted until discharge, the outcome was assessed as well. Monopolar EEG (62 channels) was recorded at rest in a sitting position with eyes closed in a light- and noise-insulated room using a Neuvo SynAmps2 Amplifier. Data processing of EEG background activity for sLORETA analysis was performed using the EEGLAB in MATLAB software (The MathWorks, Natick, MA, USA). The sLORETA algorithms were used to calculate dynamic cross spectrum and current source density within the analyzed frequency range (4–6 Hz). Statistical analysis of current source density indicators was carried out by using the method of statistical non-parametric mapping in the sLORETA software package, and the difference between the current source density in the pre- and postoperative period (after cognitive rehabilitation) was calculated as well.

Results. Cognitive rehabilitation was successful in 44% (7 patients) of cases. The differences have been revealed between the groups with successful and unsuccessful cognitive rehabilitation by using sLORETA. The group with unsuccessful cognitive rehabilitation demonstrated higher current source density estimates in theta rhythm compared with the successful rehabilitation group, it was most pronounced (t>- 8.42; p<0.004) in the right hemisphere – Brodmann area 22, temporal lobe and superior temporal gyrus.

Conclusion. The sLORETA method demonstrated the positive effect of cognitive training on changes in the spatial patterns of brain activity in patients undergoing onpump CABG. The successful cognitive rehabilitation was associated with lower postoperative resting state theta activity within the right hemisphere, indicating the transfer effect, which is an important component of successful cognitive rehabilitation.

Highlights. It is the first pseudorandomized comparative study of xenopericardial frame and half-frame bioprostheses treated with diepoxin in the aortic position use and its direct results.

Aim. A comparative assessment using the Propensity Score Matching method of the in-hospital clinical and hemodynamic results of the semi-framed epoxy-treated xenopericardial prosthesis “T-ara” and the framed epoxy-treated xenopericardial prosthesis “UniLine” (“NeoKor”, Kemerovo, Russia) for isolated aortic valve replacement implantation.

Methods. 33 recipients of the “UniLine” prosthesis were selected by Propensity Score Matching method in a ratio of 1:1 to 33 observations from the “T-ara” group according to the compliance criteria: gender, age, body surface area, end-diastolic volume of the left ventricle (LV) and the pre-operative presence/absence of the aortic regurgitation.

Results. Hospital mortality in the “T-ara” and “UniLine” groups was 3.03 (n = 1) and 6.06% (n = 2), respectively, p = 0.920. Non-fatal complications in the “T-ara” and “UniLine” groups was 7 (21.2%) and 18 (54.6%), p = 0.163. The incidence of postoperative heart failure and arrhythmias was higher in “UniLine” recipients (p = 0.001). The average stay in the intensive care unit was longer in the “UniLine” group than in the “T-ara” group, p = 0.05. Postoperative end-systolic and end-diastolic dimensions and volumes (and the corresponding indexes) of the LV,       as well as the myocardial mass and its index in both groups had no statistically significant changes in relation to preoperative data. The comparative assessment of left ventricular remodeling parameters depending on the prosthetic size revealed no significant differences. The average pressure gradient in the “T-ara» and “UniLine” group of size 21mm was 12.2±7.4 and 12.2±5.0 mm Hg. (p>0.050). The average pressure gradient in the group “T-ara” and “UniLine” size 23–25 mm was 10.2±4.1 and 9.9±0.3 mm Hg, p>0.050. The regression degree of LV myocardial mass index in the groups did not have significant differences.

Conclusion. At the hospital stage, the semi-framed epoxy-treated biological prosthesis “T-ara” has a similar clinical and hemodynamic profile with the framed biological prosthesis “UniLine”. The frequency of postoperative heart  failure  and cardiac arrhythmias is statistically significantly higher in the “UniLine” group (framed bioprostheses).

Highlights. The results of an online survey of Kemerovo students regarding nutrition, physical activity, smoking, drinking alcohol, and maintaining a healthy lifestyle are presented.

University students do not always follow the principles of healthy living due to poor nutrition, low physical activity and high consumption of tobacco and alcohol products.

Aim. To evaluate dietary habits and modifiable cardiovascular risk factors in tertiary students in Kemerovo.

Methods. The pilot study included 136  university students (aged 20-21  years)  residing in Kemerovo who filled out online questionnaires. The questionnaires were comprised of questions about the preferred diet, lifestyle, level of physical activity, the presence of behavioral risk factors for non-communicable diseases (smoking, drinking alcohol). Additionally, the respondents` subjective opinion about their own healthy lifestyle (HLS) was evaluated.

Results. The obtained data demonstrates a high prevalence of meat and sausage consumption (60%) and a low frequency of vegetables and fruits consumption (26%) among tertiary students. Simultaneously, most of the respondents have restricted the intake of savory snacks and consumption of sweet carbonated drinks. Almost a third of students skip breakfast and regularly visit fast food restaurants. Most of the respondents do not consider replacing red meat with fish or poultry, or using more low-fat dairy products and fruits instead of confectionery in their diet. A third of young people (33%) aged 20-21 have smoked or are currently smoking cigarettes, and more than half (63%) have consumed or regularly consume alcohol. Moreover, a very low percentage of students (7%) devote their time to regular physical activity. The analysis of the respondents` subjective opinion of their lifestyle has revealed that most students do not fully comprehend the concepts   of “healthy lifestyle” and “healthy diet”, because their answers did not meet the criteria of healthy lifestyle. Only 57.7% of respondents who believe their lifestyle to be healthy are actually correct.

Conclusion. Tertiary students in Kemerovo do not always follow the rules of healthy lifestyle. It has been illustrated by their poor nutrition, low physical activity and frequent alcohol and tobacco use. Students associate healthy diet exclusively with not consuming sugary drinks, savory snacks, fast food, and having proper breakfast, which could be caused by the lack of general knowledge about a proper balanced diet.

Highlights. The level of professional competence of medical staff is important in rehabilitation of patients with cardiovascular diseases. It is important to build nurses' skills at all stages of professional development. The mentoring institute itself is integral to this process, as it ensures knowledge continuity and transfer of experience and best practices from more experienced staff to less experienced ones.

Aim. To analyze existing mentoring practices.

Methods. Using analytical method, content analysis and system analysis, we have analyzed domestic and foreign literature, as well as relevant regulatory and legal documentation for the period from 2017 to 2022.

Results. The objectives of mentoring programs implemented in the practice of domestic and foreign healthcare organizations were analyzed. Existing approaches to its implementation in relation to the role of the mentoring institution in the formation and development of professional skills of nursing staff were evaluated.

Conclusion. The analysis revealed a variety of approaches to the implementation of the mentoring programs for nursing staff. The study results highlight the significant role of mentoring in the formation of professional skills. It is proved that at each stage of mentoring process it is possible to gain knowledge and various skills necessary for medical staff to perform their duties independently.

Highlights. Methodology for the development of a system of indicators for the integral assessment of effectiveness and efficiency of cardiac care (cardiovascular surgery) in the subjects of the Russian Federation is proposed and tested.

Indicators, such as the length of stay, the number of operations on the heart and blood vessels, the number of ambulatory patients have high overall rating and consistency of expert opinions.

Aim. To develop a system of indicators for assessment of the effectiveness of cardiac care, cardiovascular surgery in particular, in the Russian Federation regions.

Methods. The study using expert surveys was conducted in the form of a structured interview. At the first stage, the primary selection of indicators was carried out using the annual public and field reports of the national medical research center. At the second stage, experts were selected and the level of expert competence was assessed. In total, out of 14 interviewed specialists, 10 were defined as experts. The average expert authority coefficient was 0.89. To quantify the degree of agreement between the experts` answers, Kendall's coefficient of concordance (W) was calculated. The significance of differences was assessed using the nonparametric Friedman test.

Results. The following indicators are recommended as indicators for rating efficiency of cardiac care in the regions of the Russian Federation: mortality after heart surgery, vascular surgery and percutaneous coronary interventions; mortality from diseases of the circulatory system; the number of ambulatory patients; the ratio of the number of endovascular interventions to the total number of discharged patients who suffered from acute coronary syndrome.

Conclusion. The selected indicators can be used both for the rating of the constituent entities of the Russian Federation, and in the development of federal projects or ministerial target programs. The results of the study can also be used to organize a system for monitoring the effectiveness of the implementation of these projects and programs.

Highlights. Using the big data databases of provided medical services belonging to the Territorial Compulsory Medical Insurance Fund and the Unified State Healthcare Information System (USHIS), clinical and statistical analysis of ambulatory follow-up of patients with coronary artery disease was carried out, an algorithm was developed and the effectiveness of the presented information management technology was determined.

Aim. To assess and justify the developed information management technology for the quality management of ambulatory follow-up of patients with coronary artery disease (CAD) based on monitoring and analyzing electronic personified data on medical services.

Methods. In 2018 the Territorial Compulsory Medical Insurance Fund (TCMIF), the Medical Information and Analytical Center (MIAC) and healthcare organizations of the Orenburg Region implemented information management technology to assess the quality of ambulatory follow-up in patients with CAD, which is based on big data analysis of medical services and information integration “emergency medical services (EMS), hospital-TCMIF + MIAC-polyclinic”. To assess the effectiveness of the technology, the proportion of patients with myocardial infarction (MI), death from coronary artery disease, emergency hospitalizations and emergency calls for angina pectoris were compared. The study involved   two groups of patients: 13 208 ambulatory patients with angina pectoris and 4017 patients without follow-up, according to  the  TCMIF  reports  in  2017.  Out of the 13,208 patients with angina pectoris in 2019, 10,205 patients with continued follow-up presented with the same clinical endpoints. Patients with these unfavorable outcomes in proportion to the total number of patients in each group in 2017 and 2019 were compared as well.

Results. The developed and implemented information management technology led to an increase in the number of ambulatory patients with angina pectoris from 63 to 69%, with MI from 78 to 87%, and a reduction of emergency calls and emergency hospitalizations of patients with angina pectoris in the region in 2017 and 2019.

Conclusion. Information quality management of ambulatory follow-up of patients with coronary artery disease using electronic personalized data on medical services increases the number of ambulatory patients with angina pectoris and myocardial infarction, and decreases the number of unfavorable outcomes of patients with angina pectoris.

Highlights. Ineffective clinical management of primary health care in the form of staffing shortage and low competence within the model of cardiovascular surgeons further contribute to the progression and complication of cardiovascular diseases. Primary health care specialist for cardiovascular diseases acts as a functional basis for clinical and organizational management of the processes of primary and secondary prevention of cardiovascular complications, the development of patients' adherence to recommendations and the formation of a healthy lifestyle. Improving professional skills and competencies of cardiovascular surgeons providing comprehensive medical care – surgical and conservative (the functional medicine model) remains an urgent healthcare issue.

Aim. To develop a model of a PHC specialist (cardiovascular surgeon) in CVD and evaluate the clinical and managerial effectiveness of its implementation.

Methods. The study (2016–2022) was conducted at the clinical diagnostic center of the Central Clinical Hospital “Russian Railways-Medicine” (Moscow), “SM-Clinic” (Moscow) and Department of Health Organization, Medication Provision, Medical Technologies and Hygiene of the Medical institute RUDN University. The subject of the study is the competencies and skills of a cardiovascular surgeon in primary care. The development of a model of a PHC specialist was carried out on the basis of personal improvement and integration of professional competencies and skills of cardiovascular surgeons in the aspect of applying clinical management technology in CVD (Kicha D.I., Goloshchapov-Aksenov R.S., 2019). The study included patients over 65 years of age (n = 422). The mean age of the patients was 77±8.6 years. The subjects of the study were cardiovascular surgeons (n = 4) with ≥5 years of work experience. The effectiveness of the model was evaluated according to clinical and managerial indicators of achieving the goal in the implementation of the author's algorithm for the organizational and technological management of PHC (2020). The follow-up was 36 months. We compared the results of 2016–2018 – before the introduction of the model and 2019–2022 – period of use of the model. Research methods were as follows: content analysis, statistical, mathematical, analytical, comparative, expert. The t-White test was used to assess the significance. Differences in the compared parameters were considered significant at p<0.05.

Results. The developed model of a PHC specialist included components of patient orientation, the time of primary and repeated outpatient consultations, competencies and skills, adherence to surgical care and long-term clinical management, informatization, automation and systematization of the PHC process, interdisciplinary integration, implementation of the PHC algorithm and assessment efficiency. The obtained performance of the model is confirmed by significant differences in the compared indicators for the periods of 2016–2017 and 2018–2022: an increase in the availability of surgical endovascular care for patients with advanced atherosclerosis from 7 to 100% and the commitment of cardiovascular surgeons to surgical care and long-term continuous clinical management for the basis of improving and integrating the skills and competencies of mastering surgical and endovascular treatment technologies (from 25 to 100%); decrease in the frequency of repeated hospitalizations of patients during 3 years from 33% to 13% (p<0.05) and ambulance calls from 9% to 0.13% (p<0.05), a decrease in the incidence of acute cardiovascular diseases – primary acute myocardial infarction from 12 to 0% (p<0.05) and recurrence of critical ischemia of the lower extremities from 36 to 0.1% (p<0.05). The 3-year survival of patients was 96%. The main cause of death (sudden) in 17 patients (mean age 85±1.03 years) was the progression of heart failure.

Conclusion. The developed model of a PHC specialist in cardiovascular diseases is an effective component that contributes to 96% survival rate of elderly and senile patients during 3 years of follow-up.

Highlights. We have proposed and patented a method for obtaining fully autologous fibrin without the use of exogenous thrombin, which can be implemented within the framework of a personalized approach in tissue engineering. Such fibrin, in addition to lower risk of infection and inflammation, possesses greater strength and resistance to degradation, as well as better hemocompatibility compared to fibrin polymerized with exogenous thrombin, which is an undoubted advantage when used as a coating for small-diameter vascular grafts.

Background. Autologous fibrin can be used as a coating to impart biomimetic properties to various polymers used in vascular tissue engineering. Traditionally, fibrinogen polymerization is performed with the addition of exogenous thrombin and calcium chloride. Our patented method of obtaining fibrin without the use of exogenous thrombin allows us to obtain a completely autologous material that does not have the risk of infection. The differences in methods polymerization can change the fibrin properties.

Aim. To compare the most important properties of vascular tissue  engineering  of fibrin obtained by various methods: using endogenous thrombin and exogenous thrombin in vitro.

Methods. The fibrinogen precipitate was obtained with ethanol  precipitation  method  using low concentration of ethanol. The content of fibrinogen in the precipitate was normalized to a final concentration in fibrin of 30 mg/mL. Polymerization  of fibrin polymerized with exogenous thrombin was performed by adding 50 U/ mL and 0.2% calcium chloride to the thrombin precipitate, fibrin polymerized  by activation of endogenous thrombin only by adding 0.2% calcium chloride. The strength properties of the samples were tested on a Z tensile tester (Zwick/ Roell). The structure of fibrin was studied using scanning electron microscopy,   a quantitative analysis of the size of pores and fibers, the density of branching points was carried out. The quantitative content of FXIII in plasma and the resulting precipitate was determined by ELISA. FXIII activity was studied by the formation of γ-γ crosslinks by SDS-PAGE, the resistance of samples to proteolytic and fibrinolytic degradation. The ability of fibrin polymerized by activation of endogenous thrombin and fibrin polymerized with exogenous thrombin to activate contact coagulation and platelet aggregation was evaluated.

Results. Thinner fibers predominated in the structure of the fibrin polymerized by activation of endogenous thrombin samples, while the samples were distinguished by greater strength and stiffness. The described features may be associated with  a more efficient activation of FXIII, which is confirmed by the formation of a larger number of γ-γ dimers in fibrin polymerized by activation of endogenous thrombin samples, as well as resistance to proteolytic degradation compared to fibrin polymerized with exogenous thrombin. Moreover, fibrin polymerized by activation of endogenous thrombin samples in vitro activated platelets less than fibrin polymerized with exogenous thrombin.

Conclusion. The method for obtaining and polymerizing fibrin using endogenous thrombin makes it possible to obtain a completely autologous material that has better physical and mechanical properties, resistance to proteolytic degradation and lower thrombogenicity compared to traditional fibrin polymerization.

Highlights. Heart failure in older age groups is an urgent medical and social issue. Mitochondrial dysfunction is a key link in the pathogenesis of heart failure. In this study we have demonstrated a decrease in mitochondrial respiratory function in old rats. In this age group, the development of heart failure is accompanied by a further decrease in respiratory control. An increase in the mitochondrial microviscosity in older animals may affect the activity of respiratory chain enzymes in heart failure.

Aim. To study the respiratory activity and mitochondrial membrane microviscosity of cardiomyocyte of rats of different ages with heart failure.

Methods. The study involved 22 2- and 15-month-old male Wistar rats. The animals were divided into 4 groups: 2 groups of intact animals of both ages (n = 12) and 2 groups of rats with isadrine model of heart failure (HF) (n = 10). HF was modeled by two subcutaneous injections of isoproterenol hydrochloride (170 mg/kg) at interval of 24 hours. Mitochondrial respiratory activity was assessed using respiratory control coefficient. The microviscosity of mitochondrial membranes was evaluated by eximerization coefficients of pyrene-based fluorescent probe in areas of protein-lipid and lipid-lipid contact. Comparative statistical analysis of independent groups was performed using the nonparametric Mann-Whitney test.

Results. A decrease in mitochondrial respiratory control in older rats was shown in comparison with young animals. In the HF model, inter-age difference increases, but at the same time, in younger rats, the development of HF is not accompanied by significant changes in mitochondrial respiratory control. An age dependent decrease in the microviscosity of mitochondrial membranes in the area of protein-lipid and lipid-lipid interaction was revealed. In younger rats, the development  of HF is characterized by a significant increase in microviscosity in the area of protein-lipid and lipid-lipid contact. In older rats, the development of the pathology is characterized by a significant decrease in microviscosity in the area of protein-lipid interaction.

Conclusion. Multidirectional age-related changes in cardiomyocyte mitochondria of rats with heart failure were revealed. It was shown that mitochondria in younger rats retain their functional activity in the HF model unlike older rats.

Highlights. Using ECHO and MSCT data, a numerical assessment of hemodynamic effects of paraprosthetic regurgitation following transcatheter aortic valve replacement was performed. A significant increase in the fluid flow, wall and viscous shear stresses in the area of regurgitation is shown. The modeling technique described in the paper can be used prospectively in assessing the optimal treatment modality in terms of predicting the quantitative characteristics of the flow, associated with the risks of destruction of red blood cells and thrombosis

Aim. To make a numerical assessment of hemodynamic effects of paraprosthetic regurgitation following transcatheter aortic valve replacement based on retrospective clinical data.

Methods. The study included echocardiography and multi-slice computed tomography data as input data for modeling one pulsation of a fluid similar in properties to blood. Reconstruction of the paraprosthetic fistula and the ascending aorta was performed in the Mimics medium (Materialise, Belgium). The obtained 3D models were processed in the Salome software (OPEN CASCADE SAS, France), after which they were exported to HELYX-OS (ENGYS, Great Britain) to build a finite element mesh. The flows were modeled using the OpenFOAM software package version 6 (The OpenFOAM Foundation Ltd, UK).

Results. The simulation result, expressed quantitatively and qualitatively in the form of diagrams of the measured parameters – fluid flow velocities, wall and viscous shear stresses, shows a significant increase in indicators in the area of paraprosthetic regurgitation. Thus, the velocity in the affected area was 1.9–4.2 m/s, which is 3.8 higher than the average value in the entire computational area. The wall shear stress value was up to 61 Pa in the critical area, which may indicate an increased risk of thrombus formation due to the initiation of the clotting cascade through the von Willebrand factor. The value of viscous shear stress, the main component of the destruction of red blood cells in laminar flow, amounted to 20–26 Pa, which, in general, is not enough for mechanical hemolysis.

Conclusion. The modeling technique described in the paper can be used prospectively in assessing the optimal treatment modality in terms of predicting the quantitative characteristics of the flow, associated with the risks of destruction of red blood cells and thrombosis.

Highlights. The new coronavirus infection necessitates mandatory vaccination of patients at high cardiovascular risk (in particular after myocardial infarction), including both COVID-19 vaccine and influenza vaccine, which represent an important condition for reducing mortality. At the same time, vaccination coverage among the population is still low, thus requiring a detailed analysis of clinical and pathogenetic components of this problem. The doctor's understanding of the most complex aspects of the problem will help achieve positive outcome in the treatment of patients who suffered from myocardial infarction, even before acquiring the data of specially planned studies.

Abstract. This review contains current data on the relationship of viral infections with an increase in the incidence of cardiovascular diseases, as well as on the role of vaccination in improving the prognosis after myocardial infarction. The literature search was carried out by using the websites of cardiological societies, as well as the PubMed, EMBASE, eLibrary databases using the following keywords: flu, influenza, new coronavirus infection, SARS-CoV2, COVID-19, vaccination, acute coronary syndrome. The pandemic of COVID-19 (COronaVIrus Disease 2019) dictates the need for urgent vaccination against COVID-19 and influenza in patients with cardiovascular diseases. The importance of this measure, as a clear condition in preventing further increase in mortality from cardiovascular diseases, should not be doubted. At the same time, the still remaining low percentage of vaccinations is one of the causal factors of high rates of morbidity and mortality from cardiovascular pathology.

Highlights. Radial artery is the second after internal thoracic artery by frequency of use among all of autogenous arterial conduits. Some modern studies indicate the superiority of this conduit to autogenous venous conduits; however, it remains an ongoing discussion.

The article presence an analytical review regarding the use of the radial artery as one of conduits during coronary artery bypass grafting. Historical and contemporary perspectives of its use are given, examples of large-scale studies and results are provided, including the “graft-artery junction” concept.

Abstract. Radial artery (RA) is the second after internal thoracic artery (ITA) by frequency of use among all of autogenous arterial conduits in coronary artery bypass grafting (CABG), however it is used in less than 13% of cases. The story of RA as a conduit starts in the 1970s, when the famous French surgeon, founder of modern mitral valve repair Alain Frédéric Carpentier proposed to use it. During the development of cardiovascular surgery, RA was actively introduced as a conduit for CABG, and nowadays there are both supporters and opponents of its application. On the one hand, long-term results of CABG with RA are superior to CABG with autogenous venous conduits, whereas the patency of RA is comparable with ITA. On the other hand, RA demonstrates worse angiographic indicators, which could be explained by a diffuse narrowing resulting in complete occlusion; such phenomenon is entitled “string-sign”. Moreover, as in case with other conduits, the site of proximal anastomosis, and harvesting method (open or endoscopic) play an important role in the long-term RA functioning and its resistance to atherosclerosis in grafted coronary arteries, thus making RA a good target for studing and predetermining new perspectives of its use.

Highlights. The main approaches to the aortic root valve-sparing surgery of are reimplantation and remodeling;

The literature review demonstrates either the relative identity of the reimplantation and remodeling clinical outcomes, or the advantage of reimplantation in relation to long-term results.

Abstract. In recent decades, valve-sparring methods of aortic root replacement, including reimplantation and remodeling, as well as their modifications, have been developed and put into widespread practice. The effectiveness and durability of these two approaches is the subject of discussions in the modern cardiac surgery community. The global experience in performing remodeling and reimplantation procedures allows  for a comprehensive literature review to compare the results of these approaches.  The presented review is devoted to the comparison of surgical aspects and clinical outcomes of reimplantation and remodeling techniques, the analysis of the feasibility of restoring the physiological architectonics of the aortic root in valve-sparring operations using Valsalva grafts, as well as the assessment of risk factors for residual aortic insufficiency after such interventions. The search strategy included the analysis of international (PubMed, Scopus, Embase) databases for the following keywords: “reimplantation versus remodeling for aortic root valve-sparring procedures”, “David procedure versus Yacoub procedure”, “Valsalva graft for aortic root valve-sparring procedures”, “Valve-sparing aortic root repair with an anatomically shaped sinus prosthesis”. Literature analysis demonstrates either the relative identity of early and long-term results of reimplantation and remodeling procedures, or the advantage of reimplantation in terms of freedom from late mortality and residual aortic insufficiency. Preservation of the physiology of the aortic root by implantation of Valsalva grafts or remodeling provides better hemodynamics and reduces stress on the leaflets, however, these postulates run counter to the data of clinical studies analyzing postoperative outcomes and demonstrating the lack of advantages of Valsalva grafts over linear prostheses in terms of freedom from aortic valve surgery. Residual postoperative regurgitation of a mild degree, a decrease in the effective height below 9 mm and additional interventions on the leaflets are reliable factors of significant aortic insufficiency in the long-term period after valve-sparring operations on the aortic root.

Highlights. The article presents a review of literature data on the diagnostic role of endothelial dysfunction biomarkers. The review provides an overview of the main indicators, their significance in various pathologies, and presents possible therapeutic strategies for preventing endothelial dysfunction.

Abstract. Endothelial dysfunction is a characteristic feature of each stage of the cardiovascular continuum – a series of events from hypertension to the development of atherosclerosis and coronary heart disease, thrombus formation, myocardial infarction, and heart failure. Due to the prominent role of endothelial dysfunction in the pathogenesis of many vascular diseases, it is a significant therapeutic target. It is important to note that circulating markers of endothelial activation and damage characterize the severity of the disease and can be used to evaluate the efficacy of treatment and subsequent prognosis. The purpose of this review is to provide up–to-date data on endothelial function, discussing its clinical relevance in the cardiovascular continuum, the latest insights in molecular and cellular biology, and their implications for clinical practice, with a focus on new methods of therapeutic approaches for correcting endothelial dysfunction.

Highlights. Conducting minimally invasive aortic valve neocuspidization using autologous pericardium is a difficult task due to pericardial harvesting. Thoracoscopic harvesting of the pericardium provides a pericardial patch of sufficient size under visual control. Thus, thoracoscopic pericardial harvesting can transfer all advantages of minimally invasive cardiac surgery to aortic valve neocuspidization using autologous pericardium.

Abstract. Minimally invasive aortic valve (AV) replacement is associated with a decrease in the traumatic nature of the procedure, the length of hospital stay, severity of pain, and provides faster rehabilitation and better cosmetic look compared to the gold standard incision in cardiac surgery –median sternotomy. AV neocuspidization using autologous pericardium is safe, associated with excellent hemodynamic parameters in short- and medium-term follow up. However, this technique requires a large pericardial patch to later form new leaflets, thus complicating the use of minimally invasive approach with this type of intervention. We have addressed this issue by introducing thoracoscopic pericardial harvesting. We report two successful cases of minimally invasive AV neocuspidization using autologous pericardium harvested through a thoracoscopic approach with peripheral cardiopulmonary bypass.