Highlights

Patients with stable coronary artery disease, borderline coronary artery stenoses (BCAS) and increased thickness of epicardial adipose tissue (EAT) are characterized by development of cardiovascular diseases (CVD) at a younger age and higher levels of proinflammatory markers compared to patients without increased thickness of EAT (in case of comparable obesity class, diabetes type, angina grade and apolipoprotein B levels).

Aim. To study the features of the course of stable coronary artery disease with borderline coronary artery stenoses (BCAS) depending on the epicardial fat thickness.

Methods. 201 patients with stable angina of 1–3 grade with BCAS (50–70%) were included in the study. The 1^st group consisted of 57 (28,4%) patients with high EAT levels, the 2^nd group consisted of 144 (71,6%) patients without normal EAT levels. The results of biochemical blood tests and systemic inflammation markers (high-sensitivity C-reactive protein, IL 1, 6, 8, 10, TNF-a, cystatin С, MMP-9, NTproBNP) concentration were evaluated. The epicardial fat thickness was determined by echocardiography. All patients underwent coronary angiography.

Results. The general EAT thickness was at 6.00 [5.00; 6.50] mm in the 1^st group and at 3.00 [2.30; 4.00] mm in the 2^nd group (p<0.001). Hypertension (p<0.001), CAD (p<0.001), and myocardial infarction in particular (p = 0.003) were detected at a younger age in the 1^st group. There were no significant differences in terms of prevalence of obesity, diabetes mellitus, angina grade and type of prescribed medication. Patients in the 1^st group showed higher levels of NTproBNP (p = 0.002) and hsCRP (p = 0.027). Moreover, patients in the 1^st group had a higher Apo-A1 levels (p = 0.023) and a lower Apo B/Apo-A1 ratio (p = 0.019). Proinflammatory cytokine levels were comparable, however anti-inflammatory cytokine IL-10 levels (р =0.005) and the frequency of elevated IL-10 levels (p<0.001) were lower in the 1^st group. Higher cystatin C levels and the frequency of elevated cystatin C levels (p<0.001) were observed more often in patients with high EAT levels.

Conclusion. Patients with stable CAD, borderline coronary artery stenoses and high EAT levels can be characterized by cardiovascular diseases detected at a younger age and higher levels of proinflammatory markers compared with patients with normal EAT levels in case of comparable obesity class, diabetes mellitus, angina grade, and Apo B levels.

Highlights

The severity of pneumonia and the presence of cardiovascular diseases have a negative impact on the physical aspect of quality of life. Women`s quality of life indicators tend to be worse than men`s. Regular work activity is a factor that improves the physical aspect of the quality of life.

Abstract

Aim. To analyze the relationship between the quality of life (QoL) and the psychological and somatic state of patients 3 months after Coronavirus disease 2019 (COVID-19) pneumonia.

Methods. The study is a part of the “Prospective Follow-up Study of Patients after COVID-19 Pneumonia” that involves data on 351 patients (age 53±11) 3 months after hospitalization. Women accounted for 51% of all patients. Cardiologist and clinical psychologist examined cardiovascular and psychological health of patients. We assessed QoL by using the SF-36 survey, and psychometric properties by using the GAD-7, PHQ-9 and PSS-10. We estimated the severity of the COVID-19 using the discharge summaries information.

Results. The prevalence of stress symptoms (27,4% vs 5,1%, p = 0,030) and depression (18,00 [13,00–25,00] vs 20,00 [15,00–24,00], p = 0,032) were higher in patients with cardiovascular disorders. Moreover, QoL was lower in this group of patients in all subscales except for “Mental health” and “Mental health aspect”. Women were more 3 times more likely to experience psychological and emotional disorders compared to men (29,1% vs 16,2%, ОR = 2,615 95%; 95% CI 1,695–4,035; p<0,001). At the same time, all QoL indicators in women were significantly lower. For example, the average score on subscales “Mental health aspect” was equal to 47,17 [41,33–51,35] in women and 50,16 [46,65–52,35] in men (p<0,001), and the average score on subscale “Physical health aspect” was equal to 66,32 [60,71–72,62] in women and 63,82 [56,04–70,93] in men (p = 0,003). The QoL scores on physical health subscales were higher in patients with mild and moderate lung lesions. Scores on the “Social functioning” subscale were higher in unmarried patients (87,00 [62,50–100,00] in married patients and 100,00 [75,10–100,00] in unmarried patients; p = 0,017), and scores on the subscale “Physical health aspect” were lower in unemployed patients (48,73 [44,43–52,31] in employed patients and 44,84 [41,32–49,73] in unemployed patients; p<0,001).

Conclusion. Тhe presence of cardiovascular disorders and severity of the COVID-19 pneumonia affected the physical aspect of QoL. QoL in women is worse compared with men. Regular work activity improves the physical aspect of QoL. There is a decrease in social activity in married patients after COVID-19 compared to unmarried patients.

Highlights

The non-contrast perfusion MR sequence pCASL (pseudocontinuous arterial spin labeling) is a technique that allows specialist to quantify and trace the changes in cerebral blood flow in the early post-stroke period. At the same time, there is a change in perfusion indices not only in the ischemic stroke area, but also in visually intact areas of the ipsilateral and contralateral hemispheres of the brain, which indicates the involvement of the blood supply area and the brain as a whole in the pathological process. The obtained data on the dynamics in perfusion, verified by the results of cognitive tests, open up the prospect of a comprehensive study of stroke as a complex brain disease with the possibility of predictive assessment of rehabilitation.

Aim. To assess the dynamics of microcirculatory changes in the brain in the early post-stroke period by non-contrast perfusion MRI.

Methods. The study included 42 patients with acute ischemic stroke. The patients were examined by 3T MRI using the following sequences: DWI-EPI, 3D FLAIR-SPIR, T2-TSE, T1W 3D-TFE, and pseudocontinuous arterial spin labeling (pCASL) on 1–3 days, 7–10 days and 3 months later after the manifestation of acute ischemic stroke. The cerebral blood flow (CBF) was obtained in 4 supratentorial regions of the brain: in the ischemic stroke and contralateral areas, as well as in a visually intact area of the ipsilateral and contralateral hemispheres (mL/100g/min).

Results. In the ischemic stroke area, CBF increased from 19.86±5.69 (mean+Std) to 27.57±4.86 by first to the second examination, which was associated with the infusion therapy, local inflammatory response and compensatory reperfusion. By the 3^rd examination CBF decreased to 14.48±3.66 (Student t-test, p<0.05), which reflects cystic and atrophic transformation of the affected area. In visually intact white matter of the ipsilateral and contralateral hemispheres, CBF increased from hypoperfused to normoperfused from the first to the third examination. There was a significant decrease (p<0.001) in tissue blood flow (by 54% for the 1^st, 38% for the 2^nd, 67% for the 3^rd examination) in the ischemia area relative to intact parts of the brain.

Conclusion. The pCASL allowed us to assess CBF in the post-stroke period in the ischemic area and in visually intact area, nevertheless, it requires additional pre- and postprocessing of data to obtain quantitative values. At the same time, we observed changes in perfusion in the ischemic stroke area, and in the visually intact areas of the ipsilateral and contralateral hemispheres of the brain, indicating the involvement of the cerebral blood flow and brain as a whole in the pathological process.

Highlights:

• The mid-term echocardiographic outcomes of aortic valve replacement with autologous pericardium presented in the literature are limited to the basic parameters related to transvalvular hemodynamics;
• This study is the first in the world to conduct a comprehensive detailed analysis of echocardiographic parameters after neocuspidization using autologous pericardium, both in comparison with standard replacement and between different age populations;
• Aortic valve neocuspidization using autologous pericardium adult patients of any age group in comparison with mechanical replacement in the mid-term period is characterized by a higher effective orifice area, significant dynamics of left ventricular myocardial mass regression, low potential for the preservation of significant mitral regurgitation.

Abstract

Aim. To analyze echocardiographic parameters after aortic valve replacement using autologous pericardium in various age groups of the adult population.

Methods. The multicenter prospective non-randomized cross-controlled study included 71 patients evaluated after surgical correction of aortic valve (AV) stenosis in the mid-term. The population (n = 71) is divided into the following populations: 1 – AVNeo Y (n = 24) – patients aged 19 to 50 years who underwent neocuspidization using autologous pericardium; 2 – AVNeo A (n = 23) – patients aged 51 to 79 years who underwent neocuspidization using autologous pericardium; Group 3 – AVR (n = 24) are patients aged 26 to 50 years who have undergone mechanical replacement. The end points were as follows: index of effective orifice area (EOA), left ventricular mass index (LVMI), peak gradient on AV, peak velocity on AV, pulmonary hypertension (PH), frequency of significant mitral regurgitation (MR), end-diastolic LV volume, LV ejection fraction.

Results. In the group 3 (AVR), the lowest EOA index was noted in comparison with the group 1 (AVNeo Y) (p < 0.01) and the group 2 (AVNeo A) (p = 0.02). Significant dynamics of LVMI decrease was observed in groups 1 (AVNeo Y) (p < 0.01) and 2 (AVNeo A) (p < 0.01). In the group 3 (AVR), there was also a decrease in the LVMI in the mid-term, but it went beyond the limits of reliability (p = 0.07). The peak gradient between the groups in the mid-term period was 8.5±2.7 mmHg in the group 1 (AVNeo Y), 8.5±2.6 mmHg in the group 2 (AVNeo A) and 15.6±4.1 mmHg in the group 3 (AVR) (p < 0.01). With respect to significant MR, there was a significant increase in its frequency in the group 3 (AVR) in comparison with other groups (p < 0.01). Moreover, in the group 3 (AVR), a more frequent occurrence of PH was noted in comparison with the group 1 (AVNeo Y) (p < 0.01).

Conclusions. AV mechanical replacement in young patients in comparison with neocuspidization using autologous pericardium in adult patients of any age in the mid-term period is characterized by a lower EOA index, the absence of significant dynamics of LVMI regression, a higher peak transvalvular gradient, and a high potential to preserve significant MR and PH.

Highlights

The prevalence of vascular injuries during military engagements can reach 20%. In the thigh, vascular injuries are the second most frequent type of injury. Vascular replacement using a graft is required in case of a femoral artery injury with length of more than 10 cm. If autologous blood vessels are not available for replacement, specialists resort to using a synthetic prosthesis. Selection of an appropriate prosthesis remains a priority for vascular surgeons.

Aim. To evaluate the outcome of vascular replacement using a biological prosthesis derived from bovine internal thoracic arteries for the treatment of femoral artery injuries.

Material and methods. The study involved 30 patients with femoral artery injuries. The analysis focused on the indicators of comprehensive examination and treatment of these patients, who were divided into 2 statistically homogeneous groups of 15 people each. In the first group, a biological prosthesis derived from bovine internal thoracic artery was used to replace the artery, and in the second group, a large subcutaneous vein was used. The results of treatment were evaluated by the number of postoperative complications, the durability of grafts and the quality of life of patients.

Results. There were no fatal cases. In the first group, 6 (40%) patients suffered postoperative complications, and in the second group – in 5 (33.3%) patients. After 5 years, 12 (80%) grafts remained functioning in the first group, and 13 (86.7%) grafts in the second group. The physical component of the health of patients in the first group was equal to 60.6 ± 3.2, in the second group – 62.5 ± 3.4, and the psychological component of health 58.7 ± 2.8, and 59.5 ± 3.1, respectively. There was no statistical reliability between the indicators of the groups (p > 0.05).

Conclusion. Biological prosthesis derived from bovine internal thoracic arteries for the treatment of femoral artery injuries is quite effective.

Highlights

The review analyzed the role of various preoperative indicators as predictors of long-term mortality in patients with myocardial infarction and coronary microvascular obstruction (no-reflow) that developed during percutaneous coronary intervention. As a result of a multifactorial analysis, taking into account the confounders available for evaluation, we have found that predilation serves as an independent predictor of death within two years.

Abstract

Aim. To evaluate the role of various aspects of percutaneous coronary interventions (PCI) as predictors of long-term death in myocardial infarction (MI) and coronary microvascular obstruction (CMVO, no-reflow).

Methods. The unmatched case-control study included 232 patients with type 1 MI and CMVO developed during PCI. CMVO criteria were as follows: TIMI flow grade <3, Myocardial blush grade <2, ST segment resolution after PCI <70%. The “cases” group consisted of 54 (23.3%) patients who died within the next two years, the “controls” group consisted of 178 (76.7%) patients who survived. The analysis included the following indicators: predilation, high-pressure balloon post-dilation, vacuum assisted manual thromboaspiration, intra-aortic balloon pump, intracoronary administration of isosorbide dinitrate and verapamil hydrochloride, glycoprotein IIb/IIIa inhibitors and “potent” p2y12 inhibitors usage, bare-metal stents, stent implantation with exceeded rated burst pressure, 3 or more stents usage, PCI on more than one artery, the ratio of contrast agent volume to glomerular filtration rate (GFR) >3.0. A univariate comparative analysis of the groups regarding PCI aspects and potential confounders was performed (Mann-Whitney, Fisher). To control the confounders, a multivariate analysis was carried out (logistic regression).

Results. Differences were obtained for the following indicators: “predilation” – in 51 (94%) patients in the “cases” group and in 139 (78%) in the “control” group, p-value = 0.005; “intra-aortic balloon pump” – in 9 (17%) and 7 (4%) patients respectively, p-value = 0.003; “the ratio of contrast agent volume to GFR >3.0” – in 26 (48%) and 48 (27%) patients, p-value = 0.005. Multivariate analysis revealed that only predilation was an independent predictor of death within two years – odds ratio 7.38 (95% confidence interval 1.70–49.04, p-value = 0.005).

Conclusion. Predilation of the infarct-related coronary artery is an independent predictor of death within two years in MI patients who develop CMVO during PCI.

Highlights

We have evaluated the rigidity and distensibility of conduits in the long-term period using transthoracic echocardiography. The assessment of elastic properties will make it possible to predict degenerative changes in the conduit and choose the optimal prosthesis.

Abstract

Aim. To evaluate changes in the rigidity and distensibility of conduits in patients after the formation of an outflow tract into the pulmonary artery in comparison with the control group of “healthy” children.

Methods. The prospective non-randomized two-center study included 58 people with right ventricular dysfunction who underwent primary conduit implantation between the ages of 3 and 15 years. To assess the elastic properties of the pulmonary artery, a control group of 25 patients (healthy children who agreed to participate in the study) was introduced. The study was carried out at the Meshalkin National Medical Research Center and the Almazov National Medical Research Centre. All patients were divided into 4 groups: healthy children (n = 25), formation of the outflow tract with a pulmonary homograft (n = 28), and formation of the outflow tract with Contegra conduit (n = 19), formation with a xenopericardial conduit (n = 11).

Results. The only differences between the groups were the RV EDV index, RV CVD index, RV FIP, severe pulmonary regurgitation, and tricuspid regurgitation. There is a significant difference between the groups in the long-term period (after 12 and 24 months), both in terms of rigidity and elasticity. The only difference in the long-term period after 12 months was the degree of tricuspid regurgitation, which was significantly lower in the control group. After 24 months, the peak gradient between the right ventricle and the pulmonary artery was different, which was significantly higher in the group of xenopericardial conduits and the degree of pulmonary regurgitation, which was significantly lower in the control group.

Conclusion. The conduits show higher stiffness in the long-term period in contrast to the normal pulmonary artery, which may affect the durability of the conduits. 

Highlights

We have developed an integrated assessment framework for assessing regional quality of life of the population residing in the subjects of the Russian Federation in 2017-2021 that includes four indices: Social-geographical, Demographic, Economic and Industrial-environmental. The study results have confirmed the importance of the influence of regional quality of life on the health of the Russian population residing in the regions. Further assessment of the validity of the indices is needed to analyze the impact on individual health indicators and to study subjects in more depth, including within the framework of a specific nosology or nosology groups.

Abstract

Aim. To develop an integrated assessment framework for assessing regional quality of life of the population residing in the regions of Russia, followed by an analysis of its association with mortality rates in 2017–2021.

Methods. The publication “Regions of Russia. Socio-economic indicators” published by the Federal State Statistics Service for 85 subjects for the period from 2017 to 2021 was used as the source data material. Factor analysis, the principal component method, was used to identify hidden variables or factors, reduce the number of variables based on classification and determine the structure of relationships. To assess the validity of the developed indices, an analysis of their associations with mortality rates for 2017–2021 was carried out. A linear regression analysis of the effect of indices on mortality rates was carried out.

Results. The analysis revealed 4 distinct indices, which included 25 indicators. With an increase in the Social-geographical Index, there is an increase in total mortality by 3.8%, mortality from infectious and parasitic diseases by 36%, neoplasms by 8.8%, diseases of the circulatory system by 5%, respiratory organs by 10.6%, digestive organs by 12.3%, external causes by 23.3%. With an increase in the Demographic Index, there is a decrease in mortality from infectious and parasitic diseases by 12.9%, an increase in total mortality by 19%, mortality from neoplasms by 16.3%, diseases of the circulatory system by 21.4%, respiratory organs by 13%, digestive organs by 19.2%. With an increase in the Economic Index, total mortality decreases by 7.8%, mortality from neoplasms by 5.6%, diseases of the circulatory system by 10%, respiratory organs by 7.8%. With an increase in the Industrial-environmental Index, there is an increase in total mortality by 3.1%, mortality from infectious and parasitic diseases by 27.2%, and neoplasms by 3.3%.

Conclusion. We have identified the regional indices reflecting the current quality of life of the Russian population, the validity of which is confirmed by significant association with mortality in the regions. Further use of indices is possible for a detailed assessment of individual subjects, focusing on a specific index showing the most significant relationship with the health of the population.

Highlights

The appointment of omega-3 polyunsaturated fatty acids for the prevention of postoperative atrial fibrillation during coronary artery bypass grafting in patients with coronary artery disease requires a thorough analysis of the characteristics of a patient and an assessment of clinical and echocardiographic parameters, factors influencing surgical performance, inflammation, and oxidative stress. Moreover, the dosage of the drug impacts the risk of atrial fibrillation. Omega-3 polyunsaturated fatty acids in short-term therapy reduce the frequency of new episodes of this arrhythmia after the intervention, however, this effect is offset by the combined use of statins.

Abstract

The article presents the available literature data on the effectiveness of the use of omega-3 polyunsaturated fatty acids in the prevention of postoperative atrial fibrillation in patients with coronary artery disease during coronary artery bypass grafting. Possible mechanisms of the drug’s antiarrhythmic action are highlighted, including its anti-inflammatory and antioxidant effects. The reasons for the decrease in the activity of omega-3 polyunsaturated fatty acids in combination with HMG-CoA reductase inhibitors are discussed.

Highlights

The article presents a modern understanding of the main links of the functional circulatory regulation system and its response to exogenous hypoxia, as well as describes the data available on molecular mechanisms of vasoprotection and cardioprotection involved in response to hypoxytherapy in patients with arterial hypertension and coronary artery disease.

Abstract

Hypoxic conditioning has taken an important place in the range of non-drug methods for stimulating the adaptive potential of a healthy person and patients with cardiovascular diseases. There are many approaches to the use of various methods of exogenous hypoxia, however, there is no consensus on the essence of sanogenetic mechanisms that provide a multi-level functional system for maintaining oxygen supply and blood circulation. Adaptive reactions of afferent, central and efferent links of the functional circulatory regulation system in hypoxia in a healthy person are described. The results of studies of physiological systemic reactions realized by respiratory and vegetative plasticity using interval (intermittent) hypoxia are presented. In patients with arterial hypertension and coronary artery disease, the facts of chemoreflective stimulation and modulation of lung ventilation, autonomic nervous system status, especially sympathetic activity of peripheral blood vessels and vagal activation of cardiac activity have been established. The main vaso- and cardioprotective properties of interval hypoxytherapy are based on the leveling of oxidative stress, inflammation, activation of angiogenesis, and a shift in the secretory activity of the endothelium towards vasodilating, antiproliferative, and antithrombotic mediators. We present the evidence for the role of shear stress and the state of glycocalyx, angiopoietin and adrenomedulline in the regulation of vascular tone, as well as cytoprotective properties of cytoplasmic and mitochondrial metabolic factors in the formation of ischemic tolerance of cardiomyocytes. The issues of the relationship between systemic (neuronal and humoral) reactions and structural and functional responses of target cells in providing adaptive/compensatory mechanisms for regulating blood circulation under the influence of exogenous hypoxia require further research and evaluation.

Highlights

The article presents data on international practices regarding simultaneous coronary bypass surgery and esophagectomy. There are very few works devoted to this topic in the literature, whereas such patients can show up unexpectedly but cannot safely undergo multiple procedures. Studying the international practices will allow specialists to make the right decision in each individual case.

Abstract

Coronary heart disease (CHD) remains the leading cause of death from cardiovascular disease, accounting for nearly 50% of deaths. However, recent data show a significant change in the composition of patients with CHD: patients with a concomitant diagnosis of esophageal cancer, a disease for which a new generation of novel immune and targeted therapies has altered and significantly increased life expectancy, predominate. However, the treatment algorithm for such patients is not fully known. If myocardial revascularization is performed first, radical surgery regarding the tumor will be delayed. If first to perform surgical intervention on the esophagus, then the number of complications increases, which according to some authors is 30–40 times higher than in patients without cardiac disease. One-stage intervention and simultaneous surgery allows to avoid such problems. This article summarizes the world experience of such interventions.

Highlights

We present a clinical case of a patient with atrial fibrillation and a high bleeding risk according to HAS-BLED bleeding risk score who underwent thoracoscopic left atrial appendage (LAA) occluder implantation due to lack of endovascular access. Thoracoscopic amputation of LAA also can be performed in cases where an endovascular access cannot be achieved due to occlusion of the inferior vena cava or thrombosis of LAA. However, it is necessary to monitor the condition of the stump when conducting thoracoscopic amputation of LAA, and stop anticoagulation therapy only in case of non-embologenic stump.

Abstract

Atrial fibrillation is the most common rhythm disorder that can be conservatively treated using antiarrhythmic therapy, and anticoagulants can be used to prevent thromboembolic complications. However, prolonged use of anticoagulants is complicated by the risk of bleeding. Left atrial appendage (LAA) occluder implantation is an alternative way of preventing of thromboembolic and hemorrhagic complications. The article presents a clinical case of thoracoscopic LAA amputation after unsuccessful endovascular LAA occluder implantation in the patient with the inferior vena cava occlusion.

On June 24, 2023, a meeting of the Council of Experts was held in videoconference mode with the support of Merck LLC, dedicated to the choice of antihypertensive therapy in patients with arterial hypertension and obstructive sleep apnea syndrome.

Highlights

The article shows the positive impact of 3-year cardiology follow-up in patients with atherosclerosis of lower extremities.

Aim. To study the impact of outpatient cardiology follow-up in patients with peripheral artery disease on the prognosis and the frequency and outcomes of surgical interventions.

Methods. The study included 585 patients with peripheral artery disease who underwent outpatient follow-up - by a surgeon (n = 131) and a cardiologist (n = 454). The groups were compared according to the main clinical and anamnestic data and type of drug therapy. After 3 years, the incidence of adverse outcomes (nonfatal myocardial infarction, nonfatal stroke, new amputations and deaths) and factors associated with adverse outcomes in the selected cohort were evaluated.

Results. The group of patients who were followed by cardiologist received optimal drug therapy more often compared with patients followed by surgeon: β-blockers (80.4% vs. 32.8%; p < 0.001), angiotensin converting enzyme inhibitors (61.0% vs. 38.2%; p < 0.001), statins (87.0% vs. 63.4%; p < 0.001). Within three years, fatal outcome was more common in the group of patients followed by surgeon (13.0% vs. 6.8%, p = 0.023). The factors that positively affected the prognosis of patients were cardiology follow-up (OR 0.34; 95% CI 0.17–0.7; p < 0.001), taking aspirin (OR 0.12; 95% CI 0.06–0.22, p < 0.001) and statins (OR 0.11; 95% CI 0.05–0.21; p < 0.001).

Conclusion. The results of this study confirm the need for more effective cardiology follow-up of patients with peripheral artery disease. This will improve the results of treatment and reduce the number of complications. Further research in this area can help determine the optimal strategies for follow-up and improve the quality of life of patients with peripheral artery disease.

Highlights

The presented literature review points to new questions associated with cognitive impairment in patients with congenital heart defects. We propose that cognitive and behavioral impairments in patients with CHD are common, but their development trajectory and degree of severity depend on the CHD subtype.

Aim. To study the features of auditory and verbal memory in young schoolchildren who underwent cardiac surgery.

Methods. The study included 104 children from 7 to 10 years old, who underwent on-pump cardiac surgery for congenital heart defects at the Research Institute for Complex Issues of Cardiovascular Diseases in the period from 2019 to 2022. We analyzed anamnesis data, clinical and hemodynamic picture, the risk of mortality from surgery according to the RACHS scale, and assessed the auditory and verbal memory according using methodical manual by T.A. Fotekova and T.V. Akhutina (block 1 series 3, block 2 series 1) during 1-year follow up.

Results. All children had presented with stage I chronic heart failure (functional class II) at the time of hospitalization. The outcome of surgery was mostly positive a year after the surgery: children had no heart failure symptoms or hemodynamic disorders, however, 80% of children had auditory and verbal memory impairments.

Conclusion. In addition to standard methods of examining children with congenital heart disease, it is necessary to introduce a comprehensive interdisciplinary approach that would include the assessment of neurocognitive status before and after surgery.

Highlights

The practical significance of the work lies in the fact that the presented aortography data visualization system is an effective tool for visually assisting surgeons during transcatheter aortic valve implantation interventions, supporting real-time operation mode. The proposed data preprocessing algorithm, which improves image quality with minimal performance costs, complements the system, allowing specialists to achieve the best result.

Abstract

Aim. The aim of this study is to develop a visual assistance system for transcatheter aortic valve implantation procedures.

Methods. To address the stated objective, our own dataset consisting of 35 videos of the intervention was used. The visualization system is based on the approach of detecting key points in aortography, utilizing “Object detection” technology with the application of YOLO family artificial neural networks. To achieve the best result, we proposed a method to enhance the quality of input data using convolutional neural networks, specifically the «Autoencoder» technology.

Results. The results of the study revealed that the convolutional autoencoder model is capable of restoring the informativeness of noisy input images from 40 to 75%, thereby increasing the accuracy of object detection in images. The presented real-time tracking system for facilitating TAVI procedures achieves a final accuracy of 51.9% according to the Mean Average Precision (MAP) quality metric. The visual assistance system can recognize and track key points indicating the location of the aortic root, delivery system, and heart valve prosthesis during surgery. The practical significance of the work lies in the fact that the presented aortography data visualization system is an effective tool for visually assisting surgeons during interventions, supporting real-time operation mode.

Conclusion. The proposed data preprocessing algorithm, which improves image quality with minimal performance costs, complements the visualization system, allowing specialists to achieve the best results.

Highlights

Transcatheter aortic valve replacement is an innovative trend in modern cardiovascular surgery. This minimally invasive image-guided endovascular technology is becoming more and more safe, nowadays it can involve a minimalistic approach in which the aortic valve replacement is performed without incisions, anesthesia and cardiopulmonary bypass - patients are conscious and spontaneously breathing. The article describes a paradigm shift in modern cardiology, in which the concept of treating patients with degenerative aortic valve stenosis has changed over the 20 years of existence of the transcatheter replacement, starting as a method used only in small number of extremely high-risk patients unsuitable for cardiac surgery and now being the most prevalent treatment modality in patients at intermediate and even low surgical risk. The main clinical and technical principles of transcatheter aortic valve replacement, as well as the prospects for the development of this technique, are highlighted.

Abstract

Transcatheter aortic valve replacement technique was first implemented about 20 years ago, in April 2002. A quarter of a century ago, specialists involved in image-guided surgery would have never believed that they would perform transcatheter interventions on heart valves. Transcatheter interventions are an alternative to open-heart surgery for acquired heart disease. Transcatheter heart valve replacement or repeat transcatheter aortic valve replacement, which do not require incisions, cardiopulmonary bypass, and in some cases general anesthesia, to this day continue to be perceived as revolutionary and breakthrough, saving the lives of many patients. The article presents the main milestones in the development of image-guided endovascular surgery and transcatheter aortic valve replacement technique, the number of which in the United States and several European countries increases by 10–15% annually, reaching hundreds of thousands per year. The etiology and pathophysiology of aortic stenosis, the technique of transcatheter aortic valve replacement and the outcome of this promising minimally invasive procedure are presented.

Highlights

• We have identified regional peculiarities of traditional and non-traditional cardiovascular risk factors.
• We have defined and characterized clinical and organizational characteristics of the specialized care, prevention, and treatment of diseases of the circulatory system in the Kemerovo region - Kuzbass.
• Moreover, we have described the principles of innovative organizational models for improving care for patients with diseases of the circulatory system, focused on the needs of outpatient organizations.

Abstract

The review presents the main research findings obtained at the Department of Optimization of Medical Care for Cardiovascular Diseases of the Research Institute for Complex Issues of Cardiovascular Diseases over the past 13 years of work. The uniqueness of the obtained data lies in the fact that we have identified regional peculiarities of cardiovascular risk factors in residents of an industrial region (using the Kemerovo region data). Data on monitoring of health and risk factors served as the basis for the development of innovative organizational models for improving care for patients with diseases of the circulatory system from the stage of primary care to tertiary care using a systematic and integrated approach, and situational analysis. Management decisions within models are based on international quality standards that reaffirm that risk-based management, the role of personnel and the work environment are the integral to the improvement of performance and the achievement of the main goals of medical organization. Using the project approach, we have implemented management tools for internal quality control and safety of patients and personnel.

Highlights

The review presents the analysis of data on the physiological role and mechanisms of adiponectin in atherogenesis, and considers the prospects of transferring of existing knowledge into clinical practice.

Abstract

The review is focused on the issues associated with the physiological role and signaling mechanisms of adiponectin. Data on the pathways and molecular mechanisms of adiponectin associated with atherogenesis was obtained using animal models with atherosclerosis, samples of atherosclerotic plaques and normal human arteries, cultured endothelial cells, macrophages and vascular smooth muscle. The perspectives of transferring of existing knowledge into clinical practice are discussed as well.

Highlights

Surgical correction of cardiovascular deformities is inextricably linked with the use of prostheses. The development and clinical testing of biological prostheses has been conducted under the guidance of the Member of Russian Academy of Sciences Leonid Barbarash at the Kuzbass Cardiology Center for more than 50 years. The uniqueness of the developed products lies in the use of a new biological tissue preservative – ethylene glycol diglycidyl ether, and an integrated approach involving the development and manufacture of products, study of long-term replacement outcome, causes of prosthetic dysfunction and genetic aspects of the use of bioprostheses in patients.

Abstract

This article highlights the main achievements in the development of biological prostheses for cardiovascular surgery under the leadership of the Member of Russian Academy of Sciences L.S. Barbarash since the 1980s. Throughout this period, Leonid Barbarash and his team have developed and mass-produced various designs of bioprosthetic heart valves and tissue preservation methods, arterial grafts, and patches. The article presents the results of developing next-generation vascular biodegradable grafts capable of complete remodeling and stimulating endothelialization after the implantation into the vascular bed. Moreover, we conducted a series of genetic studies evaluating the significance of gene polymorphisms of various pathogenetic pathways involved in the pathological calcification of native heart valves and their prostheses.