Highlights

For children aged 11–15 years with the duration of ventricular arrhythmias from 1 to 2 years, the increased value of β-adrenergic reactivity of erythrocyte membranes (β-ARM) is characteristic in comparison with the group of healthy children of the same age, which indicates desensitization of β-adrenoreceptors. In the early postoperative period after the elimination of ventricular ectopic focus as a result of radiofrequency ablation β-ARM continues to increase. The possibility of using the β-ARM index to assess the state of the sympathetic part of the autonomic nervous system in the category of patients with methodological limitations of heart rate variability analysis was studied.

Abstract

Aim. To evaluate the activity of the autonomic nervous system by changes in β-adrenoreactivity of erythrocyte membranes (β-ARM) in children with drug-resistant ventricular arrhythmia (VA) before and three days after radiofrequency ablation (RFA).

Methods. The study included 11 children aged 13 [11;15] years old with drug-resistant ventricular arrhythmia, who had documented ventricular extrasystoles (VE) with ectopic activity exceeding 10%, including those accompanied by episodes of ventricular tachycardia (VT) (ZHA group). The control group consisted of 11 children 14 [12;16] years old who did not have the pathology of the cardiovascular system. Determination of β-ARM of erythrocytes in blood samples was performed using the BETA-ARM AGAT reagent kit (AGAT LLC, Russia).

Results. At the time of hospitalization in the VA group the β-ARM indicator was significantly (p = 0.026) higher than the values in the control group. 3 days after RFA in children with VA the median β-ARM increased by 62.3% compared to the initial values in the group (p = 0.027).

Conclusion. Children with VA and an arrhythmological history of more than 1 year are characterized by a predominance of activity of the sympathetic division of the autonomic regulation of the cardiovascular system. The systemic nature of the predominance of sympathetic influence is manifested in an increase in the β-ARM index relative to control values. In the early postoperative period, after the elimination of the ventricular ectopic focus as a result of RFA, an increase in β-ARM occurs, which indicates desensitization of adrenergic receptors, which also contributes to a decrease in the influence of the sympathetic system. The study demonstrated the possibility of using the β-ARM indicator to assess the response of the sympathetic system in a category of patients with methodological limitations in HRV analysis.

Highlights

Right ventricular outflow tract stenting in children with the tetrad of Fallot as a palliative stage allowed to perform radical correction of the malformation effectively and safely afterwards.

Abstract

Aim. Evaluation of short-term and long-term results of a phased correction of the tetrad of Fallot (ToF) with stenting of the right ventricular outflow tract (RVOT) in comparison with a one-stage radical correction (RC) of the defect.

Methods. Two groups of patients with classical ToF were formed. Group 1 (n = 25; median age 72 days) was initially represented by children with ToF with a more severe clinical status, many of them were premature (median weight 3.8 kg), with more pronounced cyanosis; there were prenatal lesions of the central nervous system, brain malformations, intrauterine development delays. The children of group 1 underwent the first stage of RVOT stenting, and the second stage of RC ToF. Group 2 (n = 25) was represented by older patients, with a higher body weight and SpO2 level, and they underwent a single-stage RC of the defect.

Results. The application of a step-by-step ToF correction approach with RVOT stenting in low-weight newborns with severe hypoxemia demonstrated an equivalent effect on SpO2 dynamics, reverse remodeling of the heart when compared with a less severe cohort of patients who underwent simultaneous RC of classical ToF. After RVOT stenting in children from group 1, the median SpO2 increased from 80% to 94.5%, the median Z value of the pulmonary artery (PA) trunk of the from 16.1 mm to 16.9 mm, the median index of end-diastolic volume (EDV) of left ventricle (LV) from 23.07 mm/m² to 57.6 ml/m². Initially, groups of children who were not equivalent in their clinical status practically leveled off in terms of their indicators after RVOT stenting with patients undergoing simultaneous RC of ToF. In group 2, at the time of the RC of defect, the median SpO2 was 94%, the median Z value of the PA trunk was 15.4 mm, and the median index of EDV of LV was 57.6 ml/m². RC ToF in children from group 1 with a phased strategy of correction of the defect was no less successful than in children who underwent simultaneous RC. In the long-term follow-up period, children after RC ToF from groups that were obviously unequal in their initial status were practically comparable in clinical characteristics, features of cardiac remodeling, and achievement of endpoints. In assessing the long-term results, we focused on such endpoints as: death from all causes (3 in the RVOT stenting group and 1 in the simultaneous RC group), re-operations for the underlying disease were not performed in any case, cardiac conduction disorders requiring the installation of a cardiac pacemaker (one child in each group), acute cerebrovascular accident was observed in only one child from group 2. And there were no significant differences between the two groups in the frequency of reaching the endpoints during the annual, three-year and five-year follow-up period.

Conclusion. The strategy of RVOT stenting followed by RC ToF in a severe group of children demonstrated comparable results compared with the results of simultaneous RC of ToF in a more stable group of patients during the hospital, annual, three-year and five-year follow-up period.

Highlights

• Anomalous origin of the circumflex coronary artery from the right sinus of Valsalva is the most common anomaly of the coronary arteries.
• In children, this anomaly still remains an unrecognized, unnoticed and misinterpreted pathology.

Abstract

Aim. The aim of the study was to evaluate the effectiveness of transthoracic echocardiography (TTE) in case of anomalous origin of the circumflex coronary artery from the right coronary right sinus of Valsalva in children.

Methods. During a routine examination at the Department of Emergency Cardiac Surgery and Interventional Cardiology of the Morozov Children's City Clinical Hospital of Moscow from January 2022 to August 2023, anomalous origin of the circumflex coronary artery from the right coronary sinus was detected in 10 children. The criterion for the diagnosis of anomalous origin of the circumflex coronary artery from the right sinus of Valsalva were RAC and bleb signs on TTE.

Results. According to TTE, all 10 children have crossed aorta signs in apical five- and four-chamber projection in the form of a tubular image above the plane of the mitral valve. Only 2 patients undergoing TTE presented with the bleb sign. 7 children underwent coronary computed tomography angiography, and 5 of these patients presented with an anomalous origin of the circumflex coronary artery from the right sinus of Valsalva and 2 patients with an anomalous origin of the circumflex coronary artery from the proximal segment of the RCA. According to CT data, all 7 patients had a retroaortic course of the circumflex artery without signs of narrowing or compression, the angle of divergence in all cases was less than 45°. 3 patients underwent coronarography before the RFA, the data of the study confirmed the diagnosis as well. All 10 patients (100%) had negative bicycle stress echocardiogram results.

TTE in experienced hands can provide valuable information about anomalies of the coronary arteries in children and thereby save time and reduce the cost of expensive diagnostic methods. Children with congenital heart defects and concomitant CA anomalies are at risk for coronary complications, since many of these patients are potential candidates for surgical intervention on the aortic valve/root throughout life. Therefore, timely diagnosis of CA anomaly before surgery is crucial for understanding the spatial interaction between the retroaortic coarse of the CA and the valve/root of the aorta.

Conclusions. TTE is a cost-effective and non-invasive tool for screening patients that has a vital role in the diagnosis of anomalous origin of coronary arteries in children. Patients with an enlarged aortic root and a divergence of the circumflex artery from the right coronary sinus at an acute angle should be under the supervision of a cardiologist for timely prevention of cardiovascular complications.

Highlights

The choice of method for revascularization of the ischemic lower limb remains an important issue in cardiovascular surgery. Of the available methods, the most effective, in our opinion, is revascularization of the limb using the deep femoral artery. In this case, it is necessary to carefully select the material for the expanding patch, which prevents the development of restenosis.

Abstract

Aim. To compare the effectiveness of autovenous and xeno-pericardial patches in revascularization of an ischemic limb using a deep femoral artery.

Methods. An analysis of the comprehensive examination and treatment of 30 patients with critical ischemia, who were divided into 2 statistically homogeneous groups of 15 people each, was carried out.  In the first group, an autovenous patch was used to repair the deep femoral artery, and in the second group, a xeno-pericardial patch was used. The short-term results of treatment were assessed by the number of postoperative complications, ankle brachial index and the clinical picture of the disease 1 month after surgery, whereas the long-term results were assessed by the deep femoral artery patency and the quality of life of patients.

Results. 6 complications of the same type were registered in 4 (13.3%) patients, two in each group. After 1 month, the ankle brachial index in the first group was 0.58±0.12, and in the second 0.61±0.13. All patients in both groups had relief of pain at rest, an increase in pain-free walking distance, and trophic disorders healed. After 5 years, the deep femoral artery in the first group remained passable in 11 (73,3%) patients, and in the second – in 15 (100%) patients. The physical component of the health of patients in the first group scored 41.7±3.4, in the second group – 48.6±3.4, and the psychological component of health scored 52.1±3.9 and 56.9±3.6, respectively.

Conclusion. Xeno-pericardial patches proved to be more effective in revascularization of an ischemic limb using a deep femoral artery compared with autovenous patches in the long-term postoperative period.

Highlights

• Preservation of native aortic root geometry improves transvalvular hemodynamics (optimal opening and closing of the flaps, minimal transvalvular gradient and minimal energy loss) in comparison with classical prosthetics with cylindrical valve-containing conduit, as demonstrated in the experiment.
• When comparing postoperative parameters using root-conserving and root-bearing prosthetic techniques in comparable groups, confirmation of the experimental data was found.
• Preservation of native aortic root geometry in Bentall-type surgeries offers advantages in the form of better left ventricular remodeling (reduced myocardial mass and end-diastolic volume).

Abstract

Background. Currently, various modifications of this operation have been proposed, and valve-containing conduits of different designs are produced – with linear aortic prosthesis and with sinus prosthesis (so-called Valsalva-graft), with mechanical prosthesis and with biological prosthesis. The search for an optimal valve-containing conduit, implantation of which would be associated with greater freedom from prosthesis-dependent complications, is ongoing. Preservation of natural transprosthetic hemodynamics is one of the priority objectives of conduit design. Therefore, this study investigates the role of aortic prosthesis geometry in hemodynamics.

Aim. To evaluate whether the geometry of an ascending aortic valve-containing prosthesis affects transvalvular hemodynamics by comparing a linear valve-containing conduit with a native aortic root.

Methods. We recreated transvalvular hemodynamics in WETLAB and compared transvalvular hemodynamic parameters in two surgeries-flap + native root surgery and flap + linear prosthesis surgery-in a pulse duplicator (ViVitro Labs Inc., Canada). Ten conduits (23 mm in size) were prepared, and hemodynamics measurements were continued for 10 cycles of opening-closing.

Experimental data were also compared with postoperative results for similar operations with and without aortic root preservation.

Results. In the first stage, it was found that, all other things being equal, the geometry of the native porcine aortic root provided better aortic leaflet function than the linear prosthesis. In the aortic root-preserved operation, the valve opening area was larger and the closing velocity was lower, resulting in less resistance to opening and less energy loss at closure. At the second stage, we studied the clinical results of operations in which the aortic root was preserved and in which it was replaced by a linear prosthesis (the compared groups were comparable in terms of the size of the fibrous ring and left ventricular dimensions; only hemodynamic parameters were evaluated, since otherwise these operations could not be compared). Results comparable to the experimental ones were obtained. It turned out that these differences had clinical significance – the reverse remodeling of the left ventricle was faster when the aortic root geometry was preserved.

Conclusion. When creating valve-containing prostheses to replace aortic root structures, native geometry should be mimicked to achieve the most natural transvalvular hemodynamics.

Highlights

As evidenced in literature, mitral valve (MV) repair for mitral regurgitation has many advantages, however, elderly patients have an extremely low risk of valve tissue degeneration, thus making the use of this type of surgery in this patient population controversial.

Aim. To analyze the role of bioprostheses in the older age group of patients undergoing mitral valve replacement and compare the results to mitral valve repair outcomes.

Methods. The study included elderly patients (over 65 years old) with mitral regurgitation who underwent mitral valve repair and annuloplasty using the biological annuloplasty ring NeoRing (Neokor CJSC, Kemerovo) or the annuloplasty ring RIGID (NPP MedInj CJSC, Penza) (n = 19) at the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo, Russian Federation). To select pairs from a larger group of UniLine recipients for a sample of patients with annuloplasty rings, pseudorandomization (propensity score matching) was performed using the STATA 13.0 software package (StataCorp, USA) by identifying nearest neighbors.

Results. Patients of both groups did not experience thromboembolic and hemorrhagic complications during in-hospital period or 1-year follow-up period. At the same time, in the MV repair group, there was one case of new-onset atrial fibrillation, as well as two in-hospital cardiac deaths (due to myocardial infarction, and during surgery for recurrence of mitral regurgitation grade ≥ 2). One nonvalvular death (covid pneumonia) was recorded in the groups of UniLine recipients during the 1-year follow-up period.

Conclusions. Taking into account that in the vast majority of Russian clinics MV replacements prevail over MV repairs, elderly patients undergoing mostly MV replacement and receiving bioprostheses can be justified because the outcome is comparable to results of MV repair, primarily due to the lack of need for long-term anticoagulant therapy and comparable stable hemodynamic results in both groups.

Highlights

• When modeling mineral stress, a closed biochemical system shows the following calcium distribution ratio among biochemical compartments: freely circulating ions (Ca2+) – 50%, bound to albumin (CPM) - 20%, bound to and phosphorus (CPC) - 30%.
• The ratio of ionized to protein- or phosphorus-bound calcium was 1:1 and corresponded to the physiological ratio of ionized to bound calcium in circulating blood, indicating the physiological relevance of the simulations performed.
• Even under supraphysiological mineral stress, natural mineral depots (CPM and HRC) maintain the calcium-binding capacity of the biochemical system at the physiological level (50%), and the ratio of the relative calcium capacity of the CPM and HRC under conditions of supraphysiological mineral stress indicates the priority role of the HRC as a buffer system limiting the uncontrolled increase in ionized calcium in case of disturbance of the mineral balance of the blood.

Abstract

Aim. To conduct a comparative analysis of calcium content in various biochemical compartments: 1) ionized (freely circulating, unbound) calcium; 2) calcium-albumin CPM (protein-bound calcium); 3) calcium phosphorus complexes (CPC).

Methods. In order to prepare a biochemical system for the parallel synthesis of CPM and CPC, supraphysiological mineral stress was modeled by supersaturating a NaCl saline solution containing a physiological concentration of albumin with calcium (CaCl2) and phosphorus (Na2HPO4) ions. Separation of calcium-containing biochemical compartments was carried out by ultracentrifugation (to isolate CPM) and ultrafiltration (to separate CPM and the pool of free ions). Calcium concentration was measured using a colorimetric method based on the reaction of orthocresolphthalein complexone with calcium ions in an alkaline medium.

Results. When modeling mineral stress, a closed biochemical system was obtained in which calcium ions were freely distributed in three states: circulating in free form (Ca2+) or being part of the CPM (colloidal primary depot) or PSC (corpuscular secondary depot). The distribution of calcium in the form of freely circulating ions (Ca2+) and when bound to albumin (CPM) and phosphorus (CPC) was 50%: 20%: 30% (5: 2: 3), respectively. The ratio of ionized to protein- or phosphorus-bound calcium was 1:1 and corresponded to the physiological ratio of ionized to bound calcium in circulating blood, indicating the physiological relevance of the simulations performed. The formation of HRC absorbed 10 to 20% of the total albumin.

Conclusion. Even under supraphysiological mineral stress, natural mineral depots (CPM and HRC) maintain the calcium-binding capacity of the biochemical system at the physiological level (50%), and the ratio of the relative calcium capacity of the CPM and HRC under conditions of supraphysiological mineral stress indicates the priority role of the HRC as a buffer system limiting the uncontrolled increase in ionized calcium in case of disturbance of the mineral balance of the blood.

Highlights

Scientific novelty and practical significance of the presented work is seen in the relationship between the development of medical equipment management system and quality management in health care institutions and medical science. The application of the principles of international ISO 9001:2015 to the system of medical equipment management, which has its own special features in this industry makes the author’s approach unique. The role of the process approach in ensuring the sustainable functioning of medical equipment is shown in the study. The performance of the medical equipment management system based on the principles of international standard ISO 9001:2015 has been analyzed. The positive dynamics in terms of achieving the target performance indicators of this process in 2013–2021 is revealed.

Aim. To analyze the experience of applying the process approach in the management of medical equipment based on the principles of the international standard ISO 9001:2015.

Methods. The basis of the study was “Research Institute for Complex Issues of Cardiovascular Diseases” (NII KPSSZ). The object of the study is the quality management system of the Research Institute for Complex Issues of Cardiovascular Diseases. The subject of the study is the process of equipment and measuring instruments management. The main methods of this study were: system analysis, unity of historical and logical. The period of the study was 2013–2021.

Results. The process approach in medical device management is considered within the framework of the quality management system of NII KPSSZ. During the study period there was an increase in equipment units by 2.58 times (from 976 to 2520 units, respectively, 2013–2021), which led to an increase in scheduled maintenance (SM) by 4.25 times (due to the introduction of pre-checking maintenance). The relative number of repairs to the total amount of equipment in different years amounted to 33.4–54.3% or on average 40.3%, the increase in current repairs of medical equipment relative to 2013 in 2021 amounted to 2.68 times. There is a positive dynamic in terms of decrease in the number of comments and increase in the number of proposals to improve the process during 2013–2021.

Conclusion. The analysis of performance indicators in the period under the study indicates the determining role of the quality management system in ensuring the sustainability and stability of the medical equipment management system. The implementation of research tasks allowed the authors to form a holistic vision of the role of the process approach in solving the problem of finding effective organizational solutions that ensure the quality and safety of medical care. The presented experience can be replicated for any medical organization.

Highlights

The main ECG parameters associated with cardiovascular mortality in metabolic cardiomyopathy are P-wave changes, QT prolongation, ECG signs of left ventricular hypertrophy, depression and ST segment elevation, T-wave changes. These simple ECG markers are valuable signs of an unfavorable prognosis in patients with myocardial metabolic disorders.

Abstract

Cardiovascular diseases (CVD) are the leading cause of death globally, one of the initial manifestations of these diseases are metabolic changes in the myocardium.   Risk stratification in a young population makes would make it possible to timely identify such conditions and prevent their development, as well as their further progression. Electrocardiography is an effective, reliable, accessible and inexpensive method used in clinical practice and research. The aim of this article was to review electrocardiographic (ECG) features associated with manifestations of myocardial metabolic disorders, the mechanisms underlying these associations, and to briefly describe the main research findings in this area and consider the implications for clinical practice. The material and methods were literature sources analyzing metabolic changes in the myocardium and their electrophysiological manifestations, the following databases were used to search for relevant articles: elibrary.ru, pubmed.ncbi.nlm.nih.gov, researchgate.net. The results of the analysis showed that the main changes in ECG parameters associated with cardiovascular mortality in metabolic cardiomyopathy are P-wave changes, QT prolongation, ECG signs of left ventricular hypertrophy, depression and ST segment elevation, T-wave changes. Thus, simple ECGs-markers remain valuable indicators of an adverse prognosis for patients with metabolic disorders of the myocardium.

Highlights

• The literature review is dedicated to the 65^th anniversary of the first left ventricular aneurysm resection performed with cardiopulmonary bypass.
• The main stages of the development of surgical treatment of aneurysms are highlighted.
• The life and professional path of the leading specialists of the twentieth century who made an invaluable contribution to the treatment of patients with heart aneurysms are described.

Abstract

The article is devoted to a review of development of left ventricular aneurysm surgery, as well as a brief autobiographical review, from the first description by John Hunter in the 18th century to the stages of emergence and development of modern methods of left ventricular reconstruction both on the working heart and with cardiopulmonary bypass.

The review analyzes the stages of development of surgical treatment of left ventricular aneurysms: starting with the first description of the disease made by J. Hunter in the 18^th century, before the advent of modern methods of aneurysm surgery both off- and on-pump.

Highlights

This review presents current state-of-the-art of diagnosis and treatment of coronary artery calcification.

Abstract

Coronary artery calcification occurs in about one third of all coronary artery lesions in patients with coronary artery diseases and is a problem in interventional cardiology due to technical difficulties. Percutaneous coronary intervention for coronary artery calcification is associated with a high risk of perioperative complications, adverse cardiovascular events in early and long-term follow-up compared with the results of treatment of patients without arterial calcification. One of the most important predictors of a favorable outcome after implantation of a drug-eluting stent is the optimal cross-sectional area of coronary stent. Intravascular imaging plays an important role in lesion assessment, selection of instruments and optimization of stent implantation, contemporary technologies modification of severe coronary artery calcification, as well as their combination, will probably lead to better procedural success and long-term results.

Highlights

The feasibility and safety of stereotactic radioablation of arrhythmias have been actively investigated over the last few years. Stereotactic radioablation is an innovative approach for the noninvasive treatment of sustained arrhythmias in high-risk patients. A comprehensive analysis of the advantages and disadvantages of this STAR in relation to AF will allow us to assess the future prospects for the development of this area. 

Abstract

Atrial fibrillation is the most common tachyarrhythmia. The prevalence of this arrhythmia continues to increase steadily due to the rapid demographic ageing of the population. In addition, patients with concomitant cancer are often affected by AF.

Despite the relatively benign course of AF, this arrhythmia is a risk factor for the development of a number of life-threatening and disabling complications, which significantly reduces the quality of life and increases the costs to the health care system.

For a long time, non-invasive methods of AF treatment were represented exclusively by antiarrhythmic therapy. It is important to note that in elderly and oncological patients, even paroxysmal AF is difficult to treat with medication, and catheter ablation and surgery are associated with high risks of procedural and early postoperative complications.

All this served to search for noninvasive methods of ablation of arrhythmogenic substrates of AF. For the first time, stereotactic radioablation was used in clinical practice to eliminate sustained ventricular tachyarrhythmias. Having accumulated sufficient experience, the scientists decided to consider the application of this non-invasive therapy in patients with AF. Currently, there are sporadic papers and clinical case series highlighting the efficacy and safety of stereotactic radioablation in the treatment of AF.

The main aim of the presented literature review was to highlight recent data on the capabilities and limitations of non-invasive radiotoxic stereoablation in patients with AF.

Highlights

The article presents a clinical case of successful treatment of a patient with aortic root aneurysm and pulmonary artery stenosis after radical three-stage repair of pulmonary atresia with ventricular septal defect.

Abstract

Aortic root aneurysm with aortic regurgitation is a rare cause of re-operation in patients who have had primary repair of pulmonary atresia with ventricular septal defect or tetralogy of Fallot. Recently, due to an increase in cases of primary radical treatment of congenital cardiac surgery and life expectancy of these patients, the number of cases of re-operation due to aortic root dilatation has also increased. One of the main reasons for long-term aortic regurgitation and of aortic root enlargement is the presence of a subaortic ventricular septal defect below the aortic valve, which deforms the aortic annulus geometry and changes intra-aortic hemodynamics. All of these factors make the aortic root surgical reconstruction just a question of time. This is a real challenge for both adult and pediatric heart surgeons, requiring a team approach. This article presents a clinical case of successful treatment of a patient with aortic root aneurysm, aortic regurgitation with concomitant pulmonary conduit restenosis and residual ventricular septal defect who underwent a three-stage repair of pulmonary atresia and ventricular septal defect.

Highlights

AF recurrence is a common complication of AF surgical treatment. This complication is influenced by a large number of factors. In this article, we propose a model that allows specialists to predict this complication in patients at high risk.

Abstract

Aim. To identify predictors associated with a high risk of atrial fibrillation in patients with sinus rhythm following mitral valve surgery.

Methods. The surgical treatment outcomes of 36 patients with mitral valve disease and sinus rhythm who underwent mitral valve surgery from 2013 to 2018 were analyzed.

Results. We have developed a prognostic model describing the risk of atrial fibrillation depending on the impact of risk factors. The presence atrial flutter before surgery increases the risk of developing AF by 9.06 times, an increase in left ventricle end-systolic size by 1 centimeter increases the risk by 20.12 times, an increase in the right atrium size by 1 centimeter increases the risk by 14.99 times, and the need for temporary cardiac pacing in the early postoperative period increases the risk by 14.47 times.

Conclusion. The proposed prognostic model can be used to select patients at high risk of developing AF after mitral valve surgery with sinus rhythm for prophylactic ablation.

Highlights

The relationship between the rotational mechanics of the basal left ventricular segments and the geometric model of the mitral valve in patients with hypertrophic cardiomyopathy depending on the gradient of obstruction in the left ventricular outflow tract is presented in the research.

Abstract

Background. Hypertrophic cardiomyopathy is a common genetically determined disease of the heart muscle. Outflow tract obstruction and mitral regurgitation are the principal features of the disease. Previously, it was believed that these phenomena were primarily caused by the static component of obstruction-interventricular septum hypertrophy. Recently, however, attention has been paid to its dynamic component – SAM syndrome, namely, the role of the mitral valve apparatus in the pathogenesis of the obstructive form of hypertrophic cardiomyopathy. The features of one of the components of the mitral valve apparatus – the basal segments of the left ventricle adjacent to the mitral valve fibrous ring – has not been sufficiently studied.

Aim. To evaluate the relationship between rotation and deformation of the basal segments of the left ventricle and 3D morpho functional parameters of the mitral valve in hypertrophic cardiomyopathy.

Methods. The study involved 106 patients aged 23 to 78 years: 65 patients with obstructive form of hypertrophic cardiomyopathy, 13 patients with non-obstructive form of the disease, 18 patients with arterial hypertension and left ventricular hypertrophy, and 10 patients without left ventricular hypertrophy and mitral valve lesions. The complex of clinical and instrumental research methods consisted of medical interview, physical examination, standard transthoracic echocardiography (expert-level ultrasound system Vivid E9 (GE Healthcare)), Speckle Tracking Imaging (2D strain) technology to assess the deformation and rotation of the basal segments of the left ventricle, transesophageal echocardiography and real-time three-dimensional visualization of the mitral valve from the transesophageal access followed by post-processing three-dimensional quantitative reconstruction of the mitral valve.

Results. Global strain and strain rate of the LV at the level of the basal segments, rotation and rotation rate in patients with hypertrophic cardiomyopathy, arterial hypertension with left ventricular hypertrophy and persons with an unchanged mitral valve did not differ significantly. In patients with the obstructive form of hypertrophic cardiomyopathy, global circumferential strain at the level of the basal segments of the left ventricle correlated with features of mitral valve annulus geometry (namely, anterolateral-posteromedial, commissural diameters and sphericity index of the mitral valve annulus) and the angle of the anterior mitral valve leaflet. Rotation at the level of the basal segments correlated with the anteroposterior diameter, height, sphericity index and area of the mitral valve annulus, as well as the length and area of the anterior leaflet, and the area of the posterior leaflet.

Conclusion. Rotation and deformation of the basal segments of the left ventricle correlate with indicators of the geometry of the mitral valve fibrous ring as assessed by three-dimensional quantitative reconstruction.

Highlights

No studies have been published comparing the treatment of abdominal aortic aneurysms in residents of the Central Asian region and Russia ≥80 years of age. Differences in the number of emergency and planned operations in the studied countries have been revealed. Thus, despite the predominance of planned operations in the total structure, the frequency of emergency operations related to AAA rupture is extremely high, which is associated with a large aneurysm diameter. In Tajikistan there is no difference in mortality between patients of different age groups, while in the Russian Federation this indicator is higher among persons up to and including 79 years of age. The number of comorbidities is high in both countries.

Abstract

Aim. To analyse the demography, the structure of comorbidity and mortality in the treatment of patients with AAA with an age priority of study up to 79 and over 80 years old in Russia and Tajikistan.

Methods. A retrospective, comparative study of patients with infrarenal AAA who underwent endovascular repair of abdominal aortic aneurysm (EAAA) or open AAA reconstruction during the period from 2011 to 2015 at the clinic of Russian State Medical University named after N.N. acad. I.P. Pavlov in Ryazan, Russia and in the RSCCS, Dushanbe, Tajikistan (2011–2017). The study included 226 patients, 60 from Dushanbe (Tajikistan) and 166 from Ryazan (Russia). The study examined age, gender, comorbidities: diabetes, coronary heart disease (CHD), hypertension, COPD, smoking, as well as abdominal aortic diameter and 30-day mortality.

Results. There are significantly more male patients with AAA in both countries. The number of comorbidities (CHD, hypertension, COPD, diabetes) per patient reaches 2.30 in Russia and 2.35 in Tajikistan. The number of patients older than 80 years in Russia was 11.4% and in Tajikistan 23.7% of the total number of patients operated on for AAA. In all countries, patients with AAA, inclusive, up to 79 years of age are statistically significantly more than patients 80 years of age or older. There are statistically significantly more patients under 79 in Russia. The age of patients after 80 is statistically significantly higher among patients from Russia. The number of emergency operations in all countries is significantly lower than elective operations, but still emergency operations were performed in almost one third of cases. In the group of patients up to 79 years old, the smallest number of emergency operations due to aneurysm ruptures was found in Russia. In the group of patients aged 80 years old and over, the smallest number of elective surgeries was found in Russia. The AAA diameter in patients from the two countries did not differ statistically significantly and amounted to 60.0 [48.0; 75.0] and 57.0 [54.0; 61.5] mm. in RF and RT, respectively (p > 0.05). In the age category up to 79 years old, there were statistically significantly fewer men in Tajikistan than in Russia. However, in the category after 80 years old there are statistically significantly fewer men in Russia than in Tajikistan. In Tajikistan, there was no difference in mortality between ages, however, in the Russian Federation it is higher in patients up to 79 years of age inclusive.

Conclusion. As the results of the study showed, the average age of all patients with AAA was elderly, and the number of patients older than 80 years was 11.4% and 23.4% in Russia and Tajikistan, respectively. The group of patients over 80 years of age, according to the criterion of average age, was older among patients from Russia. It is important that the number of emergency operations in all countries is significantly lower than planned, but emergency operations were performed in almost one third of cases. In addition, the number of high-risk comorbidities is high in both countries.

Highlights

The assessment of the anatomical significance of multivessel atherosclerosis of the coronary arteries – SYNTAX score takes into account the level and multiplicity of lesions by assigning higher scores for proximal stenoses and subsequent summation. Functional assessment of coronary blood flow – instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) uses one threshold value for all stenoses, and does not take into account their multiplicity.

Aim. To develop a new indicator for the integral assessment of the functional significance of multivessel atherosclerosis of the coronary arteries, taking into account the level and multiplicity of lesions.

Methods. The model for the integral assessment of the functional significance of a multivessel lesion was the sum of the transstenotic gradients (in our variant 1-iFR) of all stenoses >50%, weighted by the volume of the dependent LV myocardium, which was evaluated on the Duke jeopardy score: Σ(1-iFRi)*Nd, where Nd is the number of Duke dependent segmental arteries supplying blood to 1/6 of the myocardium. To bring the obtained values to the range 0–1 and the threshold level 0.89, the 1/(1+X) transformation was used, i.e. in the case of single non-proximal stenoses, the integral assessment index is equal to the value of the standard iFR. To test the ability of the indicator to take into account the level and multiplicity of lesions, we evaluated its relationship with SYNTAX in patients with multivessel coronary artery disease (>2 segments with stenoses >50%), including in comparison with standard iFR (minimum value). The VERRATA PLUS conductor and the Core module of the Phillips Azurion angiographic system were used for iFR measurements.

Results. The study included 42 patients, 29 men and 13 women, aged 65.3 ± 8.9 years, with multivessel coronary artery disease, SYNTAX score = 11.5 ± 2.7. The calculated values of integral iFR were expected to be less than the minimum standard iFR: 0.71 ± 0.11 versus 0.81 ± 0.14, respectively, p < 0,001. Integral iFR demonstrated significant inverse dependence on SYNTAX, p = 0,34, p < 0,05, whereas the standard iFR did not depend on SYNTAX. The number of patients with non-significant standard iFR, but significant integral iFR was 23.5% compared to patients with significant standard iFR. In accordance with the nature of the calculations, there were no cases of significant standard iFR and insignificant integral iFR.

Conclusion. The obtained data demonstrated the possibility of taking into account the level and multiplicity of stenoses when assessing the functional significance of coronary artery lesions using the iFR method.

Highlights

The developed prediction model is a simple and accurate method for assessing the postoperative risk of cardiovascular complications in a large population of patients undergoing non-cardiac surgery. Its widespread use will optimize perioperative management tactics and improve surgical results.

Aim. To develop a model for predicting cardiovascular risk in patients undergoing abdominal surgery and compare its accuracy with foreign analogs validated on a domestic cohort of patients.

Methods. The multicenter prospective study included 8 241 patients over 18 years of age undergoing elective abdominal surgery. The following postoperative complications were assessed: acute myocardial infarction, stroke, cardiac arrest, cardiogenic pulmonary edema, pulmonary embolism, and 30-day mortality. First of all, we compared baseline characteristics of patients with and without complications, and factors, associated with surgery and anesthesia. Next, we performed a logistic regression analysis to assess the contribution of factors to the development of postoperative cardiovascular complications. Following that, we developed a model for predicting postoperative cardiac risk based on the data of multivariate logistic regression analysis. Finally, we compared the obtained model with other prediction models found in the literature.

Results. Out of 8241 patients, 53 patients (0.64%) presented with cardiovascular complications (62 cases): cardiac arrest in 39 patients (0.47%), cardiogenic pulmonary edema in 4 patients (0.049%), stroke in 3 patients (0.036%), pulmonary embolism in 9 patients (0.11%), and acute myocardial infarction in 7 patients (0.084%). 36 patients (0.43%) had lethal outcome. Retrospectively, the obtained model assigned 2251 patients to the high-risk group for developing cardiovascular complications, the incidence of cardiovascular complications in the group was 2.1%. The low-risk group consisted of 5 990 patients; the incidence of cardiovascular complications in the group was 0.13%.

Conclusion. Eight independent variables associated with postoperative cardiovascular complications were identified: high and moderate surgical trauma, smoking, statin use, Stange test less than 40 seconds, American Society of Anesthesiologists functional class 3, intraoperative need for vasopressors and transfusions. The cardiovascular risk prediction model has good predictive power (AUROC = 0.880).

Highlights

• Coronary artery bypass grafting outcomes in women remain worse compar to men.
• The review covers key studies addressing the results of coronary revascularization in women.

Abstract

Over the past 60 years, coronary artery bypass grafting (CABG) has evolved into a well-refined, safe, and effective procedure that has demonstrated a steady decline in postoperative complications. However, historically, women have experienced worse postoperative outcomes compared to men. Female sex is an independent factor for intraoperative, short-term, and long-term mortality following CABG. This article presents an overview of studies comparing the outcomes of CABG between men and women, touches on the reasons for unfavorable outcomes in women, as well as the future scientific perspectives of this problem.

Highlights

This article describes not only the contribution of surgeons from different countries and the evolution of the method, but also the contribution of domestic specialists. The article makes us wonder whether mitral valve reconstruction with autopericardium is really a promising technique. Further study of the long-term results and improvement of the technique are necessary.

Abstract

Mitral valve replacement with autologous pericardium is a new perspective method of treatment, which can be used for a wide range of mitral valve diseases when its reconstruction is not possible. Thanks to this method, there is no need for lifelong administration of anticoagulants, and optimal coaptation of the leaflets is provided. This review describes historical aspects of mitral valve replacement with autopericardium, mentions the first interventions, reflects the evolution of autopericardium mitral valve replacement technique.