Highlights

• To date, there is no single principle for postoperative physical rehabilitation of patients who have undergone surgical correction of acquired valvular heart disease.
• Patients participating in our comprehensive postoperative rehabilitation program, which included treadmill physical training during the early inpatient stage and outpatient training using remote rehabilitation technologies, were characterized by a higher level of exercise tolerance, lower NT-proBNP levels, higher adherence to physical training during the year after surgery compared to patients undergoing a standard postoperative rehabilitation program (dosed walking and therapeutic exercises).
• The obtained data actualize the necessity of using physical rehabilitation in patients with VHD at the early inpatient stage as a safe and effective tool for improving surgical outcomes. The use of remote rehabilitation technologies with monitoring of cardiac parameters and physical activity is a safe, effective and comfortable method of outpatient rehabilitation for patients with VHD.

Aim. To evaluate the efficacy and safety of a comprehensive postoperative rehabilitation program that includes physical training during the first inpatient period and outpatient rehabilitation using remote technologies one year after correction of acquired valvular heart disease (VHD).

Methods. The study included 40 patients who underwent successful cardiac surgical correction of acquired VHD with cardiopulmonary bypass. Exercise testing (CPET) was performed one week after intervention while patient received stable standard therapy of heart failure during uncomplicated postoperative period. Two groups of patients were formed: 1) control group with standard postoperative rehabilitation including measures of physical rehabilitation, such as gymnastics and graded walking (n = 23). 2) main group with standard postoperative rehabilitation (graded walking, gymnastics) and early physical training with daily treadmill walking starting from the 8th day after surgery lasting 14 days (n = 17). In main group the physical rehabilitation was continued on outpatient period using remote technologies. During the outpatient phase, patients were recommended to work with a mobile application for four months according to individually selected programs of physical rehabilitation. Safety of training was controlled by assessing cardiovascular system response to physical load using fitness bracelet during the daytime and self-performed six-channel electrocardiography (ECG) using ECG dongle before and after training at home. At the time of installation of the application until discharge from hospital, also as in dynamics 4 months and 1 year after, standard clinical-instrumental examination, CPET, transthoracic echocardiography, and assessment of serum levels of myocardial strain markers (NT-proBNP, sST2) were conducted.

Results: Patients participating in the developed complex rehabilitation program involving treadmill training during the inpatient stage and outpatient training using remote technologies demonstrated higher tolerance to physical activity, lower values of NT-proBNP level, and greater adherence to physical exercises over the one year compared to those undergoing standard postoperative rehabilitation.

Conclusion. The obtained data highlight the necessity of applying physical rehabilitation in patients with VHD at the early inpatient stage as a safe and effective tool for improving surgical outcomes. Using remote rehabilitation technologies with monitoring of cardiac function parameters and physical activity is a safe, efficient, and comfortable method for outpatient rehabilitation in pts with VHD.

Highlights

The management of patients with chronic heart failure (CHF), with its high mortality and hospitalization rates, is a pressing issue. Active patient monitoring through telephone visits conducted by medical personnel has proven effective in managing the risk of adverse events in this patient population.

Aim. To evaluate the effectiveness of remote patronage by nurses (brothers) of patients with CHF using telephone “visits”.

Methods. 108 patients were included: group 1 – active control using telephone “visits”, group 2 – traditional follow-up. Telephone “visits” were conducted weekly for 1 month after inclusion in the study, then once a month for the next 5 months. After 1 year, the patient's status was assessed: “alive/dead”, the number of requests for medical help due to decompensation of heart failure.

Results. During the 6 months of follow–up, the following were registered: in the active control group – 10 emergency medical team calls, 5 hospitalizations, 25 outpatient visits to a cardiologist, there were no deaths; in the traditional follow-up group – 18 NSR team calls, 16 hospitalizations, 29 outpatient visits to a cardiologist. The proportion of patients taking 4-component therapy increased: in the active control group – up to 74.1%, in the traditional follow–up group – up to 22.2% (p < 0.0001). The proportion of patients taking 3 or more drugs in the active control group was more than 90%, in the traditional follow–up group – 46.3% (p < 0.0001). After 1 year, there were 3 deaths in the active control group and 5 deaths in the traditional follow–up group. Calls to the NSR team were 12 and 17, episodes of hospitalization were 10 and 19, outpatient visits to a cardiologist were 13 and 19 (in the active control and traditional follow–up group, respectively). A decrease in the proportion of patients taking 4-component therapy: in the active control group – from 74.1% to 27.8%, in the traditional follow-up group – from 29.6% to 16.7%.

Conclusion. Telephone “visits” have a high potential in managing the risks of adverse events in patients with CHF.

Highlights

• In the era of rapid population aging, frailty has become one of the most significant public health concerns because of the increased risk of adverse outcomes, such as functional decline, greater medical resource utilization, and higher mortality rates.
• In low- and middle-income countries, there is a growing need to identify and monitor the dynamics of frailty in order to develop measures to maintain a high quality of life for ageing populations.

Aim. To study the changes in indicators of pre-frailty and frailty syndrome in patients within three years after primary elective coronary artery bypass grafting.

Methods. The study included 387 patients with multivessel coronary artery disease before undergoing direct myocardial revascularization. Various diagnostic approaches were used to identify pre-frailty and frailty syndrome, such as a multi-stage diagnostic algorithm from the frailty recommendations of the Russian Public Organization «Russian Association of Gerontologists and Geriatricians» (2020), the «PRISMA-7» questionnaire, the criteria for the Fried frailty phenotype, and the 5-factor modified frailty index (mFI-5). Statistical processing of the results was carried out using the IBM SPSS Statistics 26.0.0 software.

Results. The results of the analysis of the clinical and anamnestic characteristics of the sample revealed a classic portrait of patients with multivessel coronary artery disease, the majority of patients were men (73.1%), the median age was 65 [59; 69] years. The incidence of pre-frailty among patients with coronary artery disease ranged from 15.0 to 42.4%, and the incidence of frailty syndrome ranged from 22.5 to 71.6%. Within three years after elective coronary bypass surgery, according to several diagnostic approaches, the manifestations of pathological aging of the body can increase by an average of 5.0–10.0%, whereas using European «PRISMA-7» questionnaire revealed significant differences (p = 0.045).

Conclusions. The progression of frailty in patients with coronary artery disease three years after direct myocardial revascularization varies on average from 5.0 to 10.0% according to the results of the study.

Highlights

• The main cause of death in patients with heart failure with low left ventricular ejection fraction is its acute decompensation.
• Remote outpatient monitoring of patients with low left ventricular ejection fraction, based on telephone monitoring aimed at assessing early symptoms of fluid retention, can significantly reduce the incidence of acute decompensation of heart failure and emergency hospitalizations.

Background. The results of registry studies indicate that the main cause of death in patients with heart failure with low left ventricular ejection fraction (LVEF) is acute decompensation of heart failure (EDF).

Aim. To evaluate the results of outpatient remote monitoring using a calculator for assessing the risk of CHF in patients with NSFV.

Methods. 65 patients with CNFV who were observed at the HF Center were randomized into a telephone monitoring group (TM) and a control group. The TM group consisted of 35 patients aged 63.2 (52; 71) years, 30 (85.7%) men, LVEF 29.7 (24.3;36.7)%, the control group consisted of 30 patients with CNnF, aged 65.1 (54; 73) years, 19 (63.3%) men, LVEF 33.1 (26.8; 39.1)%. The compared groups were comparable in terms of gender, age, LVEF, and therapy. A monthly telephone survey was conducted in the TM group using a special questionnaire aimed at detecting early symptoms of fluid retention and acute cardiovascular events. The results of the survey were recorded in a patented calculator program for determining the risk of acute respiratory failure. Depending on the number of points scored, the risk of CHF was assessed as very high, high, moderately elevated, and low, which implied certain medical decisions (calling an ambulance, making an appointment with a doctor, increasing the dose of a diuretic, continuing prescribed treatment). The control group was observed by a cardiologist without undergoing TM. To evaluate the results of using the calculator, the frequency of development of CHF, acute coronary syndrome (ACS), hospitalizations and deaths in the compared groups was analyzed during two years of follow-up.

Results. During the follow-up period, cases of CHF were significantly less frequent in the TM group compared with the control group, 14 (40%) vs. 21 (70%), p = 0.031; emergency hospitalizations, both primary, 18 (51.4%) vs. 6 (17.1%), p = 0.033, and repeated, 24 (80%) vs. 16 (46.7%), p = 0.005; ACS, 9 (25.7%) vs. 16 (53.3%), p = 0.043. Planned hospitalizations, on the contrary, were more often registered in the main group, in 12 (34.3%) and 5 (16.7%) patients, respectively, p = 0.049. There were no differences in deaths between the groups: 1 (2.8%) vs. 2 (6.6%, p = 0.466.

Conclusion. Remote outpatient follow-up of patients with acute heart failure, based on telephone monitoring aimed at assessing the risk of acute decompensation of heart failure, can significantly reduce the risk of developing heart failure and the frequency of emergency hospitalizations.

Highlights

Ethnic specificity matters in echocardiographic parameters of hypertensive patients, necessitating population‑specific reference values beyond Euro‑American standards. Urbanized Shors with hypertension demonstrate distinct patterns of left ventricular remodeling and diastolic function compared to non‑indigenous residents, highlighting the role of ethnicity in cardiac adaptation to hypertension. Metabolic and hemodynamic determinants of left ventricular hypertrophy differ between Shors and non‑indigenous groups, suggesting ethnic variations in the pathophysiology of hypertension‑related cardiac changes.

Aim. To compare echocardiography indicators in urbanized patients with arterial hypertension of the Shor and non-indigenous ethnic groups living in the Gornaya Shoria region.

Methods. The study included patients with arterial hypertension: 58 Shors (20 men and 38 women) and 50 non-indigenous residents (15 men and 35 women) of Gornaya Shoria. All underwent an echocardiographic study with an assessment of the left heart parameters. We assessed the left ventricular hypertrophy (LVH) severity, left ventricular (LV) geometry and diastolic function in the ethnic and sex groups.

Results. Shors with hypertension no showed a significant difference in left ventricular dimensions compared to Caucasian. Severe abnormal LVH was associated in the Shors with glucose levels (OR 3.24, 95% CI 1.56–6.7, p = 0,001), and in Caucasians with systolic (p = 0.021) and diastolic (p = 0.011) blood pressure, and heart rate (p = 0.033). The Shor men were more likely to have normal LV diastolic function (p = 0.029) and LV concentric remodeling (p = 0.023), and less often to have normal LV geometry (p = 0.015) compared to non-indigenous men.

Conclusion. In this study, no significant differences in left ventricular size were observed in urban Shors with hypertension compared to Caucasians. Severe abnormal LVH and concentric LV remodeling were specific to Shors males, which should be taken into account when assessing the impact of hypertension in this ethnic group.

Highlights

The study was the first to identify a specific phenotype of muscle status in patients on the waiting list for heart transplantation: pronounced weakness of the lower extremity muscles (a decrease in strength by 30–70%) compared to other categories of cardiac surgical patients. The study also revealed the systemic nature of muscle involvement, with a close correlation between the strength of the symmetrical muscle groups in the lower extremities, which highlights the need for personalized rehabilitation programs, including the use of electromyostimulation to address these impairments.

Aim. To compare the muscular status of patients on the heart transplantation (HT) waiting list with that of other cardiac surgery patients.

Methods. The study included 213 patients divided into three groups: Group I (n = 30) – HT candidates; Group II (n = 122) – patients prior to scheduled cardiac surgery; Group III (n = 61) – patients with a complicated postoperative period. Muscular status was assessed using the Lafayette MMT 01165 isokinetic dynamometer (knee and foot extensors/flexors) and the DK 100 dynamometer (handgrip strength). Echocardiography was performed in all groups; volume sphygmography (vascular stiffness and hemodynamics) – in Group I.

Results. Group I had a higher proportion of males (p = 0,042) and revascularization rate (p ≤ 0,027) vs. Groups II/III. Patients in Group I showed enlarged heart dimensions and critically low LVEF (22%; p < 0,001). Group I demonstrated significant lower limb muscle weakness vs. Groups II/III (p < 0,001): knee extensors – 30,1–40,2% lower; knee flexors – 35,8–36,4% lower; foot extensors – 69,4–69,9% lower; foot flexors – 37,8–44,2% lower. Handgrip strength did not differ between groups (p > 0,100). Regression analysis confirmed systemic muscular involvement (strong interrelationship between symmetrical muscle groups, p < 0,001).

Conclusion. Patients on the HT waiting list show severe lower limb muscle weakness compared to other cardiac surgery patients. Multiple regression analysis revealed that right knee extensors associate only with contralateral muscles. Findings will inform personalized electromyostimulation programs for HT candidates.

Highlights

• In the era of rapid population aging, frailty has become one of the most significant public health concerns because of the increased risk of adverse outcomes, such as functional decline, greater medical resource utilization, and higher mortality rates.
• Deficiency of total vitamin D (25-OH) is a common condition that may be one of the potential modifiable risk factors for the development of frailty among the elderly population.

Aim. The work aimed to examine the association between the severity of frailty and serum total vitamin D (25-OH) levels in patients with coronary artery disease (CAD) undergoing elective percutaneous coronary intervention (PCI).

Methods. A single-center cohort study included 174 patients with CAD who were admitted for elective PCI. The mean age was 67.38 ± 8.31 years; 61.5% patients were male. The Age No Hindrance questionnaire was used to screen for prefrailty and frailty (≤ 2 points: no frailty, 3–4 points: prefrailty, 5–7 points: frailty). Total vitamin D (25-OH) levels were assessed by enzyme immunoassay.

Results. The incidence of prefrailty and frailty in patients with CAD according to Age No Hindrance scores was 38.0% (n = 66) and 8.6% (n = 15) respectively. Given the low incidence of frailty in the study sample, patients with prefrailty and frailty comprised a single group (46.6%, n = 81). Frailty was significantly more likely in older women with CAD before elective PCI. Frailty in patients with CAD was associated with significantly lower serum total vitamin D (25-OH) levels compared to non-frail patients (20.02 ± 7.36 (17.53–22.51) ng/mL vs. 23.91 ± 8.92 (21.02–26.81) ng/mL, р = 0.044). A correlation analysis revealed a moderate association between Age No Hindrance scores and serum total vitamin D (25-OH) levels in (mainly female) patients with stable CAD (ρ = –0.390, p = 0.024).

Conclusions. The study revealed significant associations between the severity of frailty according to Age No Hindrance scores and serum total vitamin D (25-OH) levels in patients with CAD before elective PCI.

Highlights

One third of elderly patients with coronary atherosclerosis have adverse musculoskeletal and fat profile. The most common type of disorder affecting muscle, fat and bone tissues includes an isolated osteopenia or sarcopenia, and less often a combination of disorders such as osteosarcopenia, sarcopenic and osteosarcopenic obesity.

Aim. To identify variants of body composition disorders (BCD) affecting muscle, fat and bone tissues in elderly patients with atherosclerosis of vascular beds.

Methods. The single-center cohort study included 720 patients with coronary artery disease. The inclusion criteria were: age 60 years and older with coronary atherosclerosis, selected for surgical myocardial revascularization. Among the variants of musculoskeletal and fat status disorders, osteopenic syndrome (osteopenia/osteoporosis), sarcopenia, osteosarcopenia, sarcopenic and osteosarcopenic obesity have been verified.

Results. The mean age of the patients was 68.7 (64.0; 74.0) years, males were the majority (67.1%). The average score on the SARC-F questionnaire did not differ significantly in the groups of patients with various BCD. 33.6% of patients with coronary atherosclerosis had BCD, including isolated osteopenia or osteoporosis (23.9%) and sarcopenia (3.2%), whereas combined disorders in the form of osteosarcopenia (2.9%), sarcopenic (2.1%) and osteosarcopenic obesity (1.5%) were somewhat less common. Male patients were 1.2 times more likely to not have BCD compared to female patients. The logistic regression analysis demonstrated statistical significance only in the group with the detected osteopenia. The risk of this type of disorder was associated with an increase in age (OR = 1.05, 95% CI: 1.04–1.08, p = 0.008) and a history of MI (OR = 2.4, 95% CI: 1.1–4.9, p = 0.018). At the same time, male gender was associated with a reduced risk of developing this condition (OR = 0.32, 95% CI: 0.2–0.5, p = 0.00001).

Conclusion. One third of elderly patients with coronary atherosclerosis had BCD. The overwhelming majority had isolated osteopenia or osteoporosis and sarcopenia, whereas combined disorders in the form of osteosarcopenia, sarcopenic and osteosarcopenic obesity were less common. SARC-F score did not differ significantly among the groups of examined patients with various BCD, thus reducing the diagnostic value of this tool in detecting musculoskeletal disorders in cardiac patients. The factors that increase the risk of osteopenia and osteoporosis include age and prior myocardial infarction, whereas male gender reduces this probability.

Highlights

• Hospital data of patients who received revascularization of the brain and myocardium in the scope of carotid endaratherectomy and percutaneous coronary intervention were analyzed.
• The development of hybrid revascularization technology in terms of carotid endaratherectomy and percutaneous coronary intervention over the course of thirteen years has been analyzed.

Absract

Aim. To study the in-hospital outcomes of hybrid intervention in the volume of percutaneous coronary intervention and carotid endarterectomy in the context of thirteen-year dynamics of this technology in patients with severe atherosclerosis of the coronary and carotid bed.

Methods. From 2011 to 2023, 301 hybrid interventions (PCI + CEE) were performed in patients with combined significant lesions of the coronary and internal carotid arteries at the Kuzbass Cardiology Center. The choice of treatment strategy for patients was carried out by a multidisciplinary team involving a cardiologist, cardiovascular surgeon, endovascular surgeon and angioneurologist based on current clinical guidelines, local treatment protocols and a personalized approach. The study assessed the clinical, anatomical-angiographic and perioperative status of patients. In-hospital endpoints included death, myocardial infarction, acute cerebrovascular accident/transient ischemic attack, and repeated unplanned myocardial or cerebral revascularization.

Results. No fatal outcomes were identified in the analysis of the total sample of patients in the hospital period. The incidence of myocardial infarction was 2.3%, stroke – 2%, unplanned repeat myocardial revascularization – 0.7%, and bleeding – 2.4%. When comparing the two groups (2011–2017 and 2018–2023), no fatal outcomes were recorded in either group. The highest number of MIs was recorded in the early period of hybrid technology implementation (3.08% versus 1.8%). The frequency of repeated unplanned myocardial revascularization in the first group (early period) was slightly higher (1.54% versus 0%). However, in terms of the frequency of stroke, the second group (late period) was in the lead (0% versus 3.5%). In this regard, the final combined (MACE) point in the second group was higher (3.08% versus 5.3%).

Conclusion. Thus, hybrid myocardial and cerebral revascularization in the volume of PCI and CEE is a promising and safe method for treating patients with multifocal atherosclerosis, characterized by an extremely low probability of hospital mortality, and satisfactory indicators of the risks of other adverse cardiovascular events (MI and stroke). The implementation of the hybrid treatment strategy eliminates the risks of patient no-show at the second stage of revascularization for subjective and objective reasons, reduces the likelihood of a cardiovascular catastrophe while waiting for the second stage of treatment. Thirteen years of implementation of this technology in a single center demonstrates stable, sustainable and encouraging hospital outcomes and complication risks depending on the initial characteristics of patients.

Highlights

• 81 unique proteins were identified in the native heart valves affected by rheumatic heart disease.
• The identified unique proteins are involved in the organization of extracellular matrix and collagen fibrils, cell adhesion, the regulation of osteoblast differentiation, cell migration, and endothelial cell proliferation.
• When compared with native heart valves affected by calcific aortic valve disease, 24 upregulated and 9 downregulated proteins were identified in native heart valves explanted from patients with rheumatic heart disease.

Aim. To identify key proteins and signaling pathways involved in the pathogenesis of rheumatic heart disease (RHD).

Methods. Using high-performance liquid chromatography-mass spectrometry, we performed label-free proteomic profiling of native heart valves explanted from RHD patients (n = 3). Native heart valves affected by calcific aortic valve disease (CAVD) (n = 5) were used as a comparison group.

Results. 81 unique proteins involved in the organization of extracellular matrix and collagen fibrils, cell adhesion, the regulation of osteoblast differentiation, cell migration, and endothelial cell proliferation were identified in native heart valves obtained from RHD patients. Furthermore, when compared with native heart valves affected by CAVD, 33 differentially expressed proteins were identified in native heart valves affected by RHD (24 upregulated and 9 downregulated).

Conclusion. Proteomic profiling of native heart valves explanted from RHD patients revealed unique and differentially expressed proteins and signaling pathways involved in the development of this pathological condition relative to heart valves affected by CAVD. The obtained pilot data contribute to our understanding of the fundamental mechanisms underlying the RHD pathogenesis and can also be used to search for targeted molecular therapies for the correction of this pathology.

Highlights

• Despite postoperative acute kidney injury having a significant impact on early and long-term outcomes in children after cardiac surgery, its timely identification remains challenging. Urine oxygen tension monitoring could be an additional diagnostic tool aimed at the early detection of kidney dysfunction and allowing for earlier interventions to prevent further kidney injury progression.

Aim. To evaluate the prognostic value of measuring oxygen tension in urine to detect kidney dysfunction in children after cardiac surgery.

Methods. A prospective observational single-center study was conducted, including 60 children who underwent elective surgery for congenital septal heart defect. Postoperative renal dysfunction in children was detected according to the criteria of KDIGO (Kidney Disease: Improving Global Outcomes), additionally, the concentration of markers of kidney damage (NGAL, KIM-1, L-FABP, IL-18) in blood serum and urine was determined at three control points: baseline (after insertion of the urethral catheter), after 4 24 hours, 16 hours after the start of artificial blood circulation, as well as the oxygen tension in the urine at three control points: baseline value (after installing the urethral catheter), 10 minutes after removing the clamp from the aorta, 16 hours after the start of artificial blood circulation.

Results. The analyzed data showed that there was no correlation between the oxygen tension in the urine, determined on the blood gas composition analyzer, and the level of creatinine and biomarkers at any control points. It has been shown that a 2.2-fold decrease in this indicator after removal of the aortic clamp can serve as a predictor of AKI.

Conclusion. The presented analytical review demonstrates the prospect of measuring oxygen tension in urine as an additional diagnostic option in acute kidney injury associated with cardiac surgery in children. It has been shown that oxygen tension in urine can be used in the diagnosis of postoperative renal dysfunction, however, the use of specialized devices to track this indicator is preferable.

Highlights
This article is devoted to the study of the effect of ketamine on the cellular model of the neurovascular unit in modeling conditions similar to cardiac surgery.

Aim. To reveal the effects of ketamine on the cell model of the neurovascular unit within hypoxia and the impact of IL-6.

Methods. An in vitro neurovascular unit (NVE) model consisting of neurons, astrocytes, and endotheliocytes has been formed. The normoxia conditions were the oxygen fraction in the medium of 20%, hypoxia – 4%. To identify the effect of ketamine on the culture of the neurovascular unit, cells were cultured with serum obtained from three groups of patients at different points: after ketamine infusion for 16 hours at a dose of 0.1 mg/kg/hour, at a dose of 0.3 mg/kg/hour, and from patients who did not receive ketamine infusion. All three groups of cells were further cultured under conditions of normoxia and hypoxia.

Results. The fluorescence intensity of occludin-1 and claudin-5 did not differ between the groups with different ketamine levels and the control group, and there were no changes under hypoxic conditions. The fluorescence intensity for the expression of interleukin-1 and interleukin-6 receptors decreased in the ketamine group, and the effect increased with increasing ketamine dose. Under hypoxic conditions, the decrease in fluorescence intensity was more significant.

Conclusion. The effect of ketamine on NVU cells in an in vitro experiment did not significantly affect the expression of tight junction proteins under conditions of normoxia and hypoxia, however, it led to decreasing expression of interleukin receptors, which was more significant after exposure to hypoxia on NVU cells.

Highlights

Surface modification of biodegradable anti-adhesion membranes with polyvinyl alcohol improves the physical and mechanical properties and hemocompatibility of the products, but at the same time reduces the rate of biodegradation, which leads to calcification of the membranes during subcutaneous implantation in laboratory animals and requires the elimination of the negative impact.

Aim. To evaluate the effect of surface modification with polyvinyl alcohol on the biocompatibility of anti-adhesion biopolymer membranes manufactured by electrospinning.

Methods. Membranes were formed from a composition of poly (D, L-lactide-co-glycolide) (50:50) and poly (D, L-lactide-co-glycolide) (85:15), using 1,1,1,3,3,3-hexafluoroisopropanol as a solvent. Dexamethasone was added to impart anti-inflammatory activity. Membranes were formed by electrospinning, after which they were surface modified with a 0.5% aqueous solution of polyvinyl alcohol. Physicomechanical properties, hemocompatibility, biocompatibility, and in vivo degradation were assessed.

Results. PVA modification in the dry state was accompanied by an increase in the tensile strength and a two-fold increase in Young's modulus with a comparable elongation at break. Two-minute hydration returned the modulus to its original values. The hemocompatible properties of all sample groups met the safety criterion for hemolysis (≤ 2%). The number of adherent cells in PM/DM/PVA decreased severalfold compared to PM and PM/DM, and the strain index decreased to 1.4 versus 2.33–2.42. After 14 days, PM and PM/DM demonstrated active fiber erosion, while PP/DM/PVA retained a continuous PVA layer and less pronounced surface degradation. By 3 months, PM had completely degraded, PM/DM remained as small fragments surrounded by macrophages, and a calcification contour was visualized for PM/DM/PVA.

Conclusion. Modification of the polymer membrane surface with polyvinyl alcohol eliminated residual electrostatic stress and improved the physical, mechanical, and hemocompatibility properties. However, subcutaneous implantation in laboratory animals resulted in calcification of the samples. Therefore, further research is needed to evaluate optimization of the PVA layer to reduce the susceptibility to calcification.

Highlights

Testing of prototypes of small-diameter polymer vascular prostheses was conducted in accordance with the requirements of State Standards. The polymer vascular prostheses PCL/PU/GFmix/^Ilo/Hep demonstrated high resistance to mechanical and hydrodynamic impacts, confirming their potential for long-term use.

Background. Testing of vascular prostheses in accordance with State Standards is critically important to ensure their safety, efficacy, and quality, which directly impacts patient health.

Aim. To test prototypes of polymer vascular grafts for structural and mechanical properties in accordance with state standards.

Methods. Tubular vascular grafts were fabricated using emulsion electrospinning from a solution of polycaprolactone and polyurethane with a complex of pro-angiogenic factors in chloroform. A hydrogel coating containing iloprost and heparin was formed on the inner surface of the graft. The surface structure, planimetric porosity, water leakage pressure, and mechanical properties of the grafts were evaluated before and after multiple needle punctures. Statistical analysis was performed using GraphPad Prism 8.

Results. The polymer vascular graft was an elastic tube with a length of 8.0–10.0 cm. Scanning electron microscopy (SEM) revealed that the graft wall had a homogeneous structure without delamination. Both the external and internal surfaces exhibited a network of randomly oriented fibers forming interconnected pores. The relative planimetric porosity of the external side was 59.07 (51.23; 72.80) %, and that of the internal side was 63.43 (58.56; 63.76) %. The water leakage pressure was 240.0 (80.0; 300.0) mmHg. The tensile strength of the vascular grafts was 0.042 (0.041; 0.044) kN in the longitudinal direction and 0.068 (0.038; 0.073) kN/mm in the circumferential direction. After 8, 16, and 24 punctures with a 16G needle, the strength of the grafts decreased by 27.9, 30.88 and 47.06%, respectively (p > 0.05). The suture retention strength of the graft wall ranged from 0.70 (0.593; 0.99) g to 1.370 (0.84; 1.688) g, with no statistically significant differences between the central, upper, and lower sections of the graft (p > 0.05). No suture cut-through was observed.

Conclusion. Polymer vascular grafts with growth factors, modified to form a drug-eluting coating on the inner surface, demonstrated high resistance to physical external impacts such as large-diameter needle punctures and hydrodynamic pressure, suggesting potential success for long-term use.

Highlights

A promising area of tissue engineering is the creation of materials for the repair of damaged myocardium. The key advantage of a polyvinyl alcohol (PVA) – based material is the ability to change its properties to meet the requirements of biocompatibility, mechanical characteristics, and others.

Aim. To create cryogels based on polyvinyl alcohol and to study their structural, physico-mechanical, wetting properties and electrical conductivity.

Methods. PVA cryogels in 0.9% NaCl and PVA in deionized water were prepared using 1, 3, or 5 freeze-thaw cycles. The surface morphology of the cryogels was studied by scanning electron microscopy (SEM). The strength and elastic-deformative properties of the materials were determined using a universal testing machine (Zwick/Roell, Germany). The hydrophilicity of the cryogels’ surface was assessed by measuring the contact angle using the ImageJ software (National Institutes of Health, USA). Electrical conductivity was measured by the four-point probe method using a multimeter (EXCEL, China). Statistical analysis was performed using GraphPad Prism 8.0 software (GraphPad Software, USA). A p-value < 0.05 was considered statistically significant.

Results. A comprehensive analysis of SEM images and contact angle measurements of PVA hydrogels showed that using 0.9% NaCl and 1–3 freeze-thaw cycles create a highly porous, hydrophilic structure with thin pore walls. PVA_NaCl cryogels outperformed samples prepared with deionized water in terms of strength and elastic modulus. The highest mechanical properties were observed for PVA_NaCl after 3 cycles (strength 0.82 (0.742; 0.849) MPa, elongation 347.4 (307.6; 351.8) %, Young’s modulus 0.097 (0.092; 0.105) MPa). The electrical conductivity of PVA_NaCl reached 0.531 cm/s after 1 cycle but decreased with more cycles; PVA_H2O samples showed no conductivity.

Conclusion. PVA_NaCl cryogels with 0.9% NaCl exhibit good physico-mechanical and electrical properties close to those of myocardium. The results indicate the promise of PVA_NaCl cryogels with 1–3 freeze-thaw cycles as materials for myocardial tissue engineering.

Highlights

For the first time, the role of emotional intelligence (EI) in the effectiveness of multitasking cognitive training using virtual reality technology (VR) has been studied and it has been shown that a higher level of empathy is associated with improved memory and attention during training.

Aim. Cognitive training programs that use virtual reality technology (VRT) are becoming more and more popular. However, when designing and implementing such programs, it is essential to consider the emotional well-being of participants, as negative feelings resulting from an unsuccessful training experience may lead to a discontinuation of classes. In this regard, aim of the study was to clarify the role of emotional intelligence (EI) in the effectiveness of multitasking cognitive training using VRT in a group of practically healthy individuals.

Methods. The study involved 26 healthy individuals aged 24.2 ± 2.1 years (10 men and 16 women). Cognitive status was assessed before and after multitask training using the psychophysiological complex “Status PF”. Single session of multitasking training was conducted for 15–20 minutes, depending on the individual response of the subjects. Wilcoxon's test was used to compare indicators of cognitive function before and after training. Spearman's rank correlation was used to assess the relationship between components of EI and cognitive status.

Results. There was a significant improvement in reaction time after training, as demonstrated by the results of both the functional mobility test and assessment of brain performance. In these tests, the number of errors made increased, while the number of missed signals during the functional mobility test decreased. Additionally, there was an increase in the efficiency of the Bourdon and clock rotation tasks. An increase in the relationship between the CS and EI indicators was found, including with self-assessment of empathy, indicating an improvement in memory and attention when performing the Bourdon test with a higher EI.

Conclusion. The use of the developed multitasking training program using TVR in a group of young, practically healthy subjects helps to improve spatial skills and attention when performing the Bourdon test, as well as increase the functional mobility of nervous processes and brain performance, but with an accompanying increase in the number of errors. The increase in the relationship between cognitive status and emotional intelligence indicators discovered after the training indicates a significant contribution of emotional regulation to the formation of cognitive reserves to reduce the risk of postoperative cognitive deficit.

Highlights

A study was conducted that examined the relationship between personality type D, as well as other personality profile parameters, and psychophysiological reactivity when exposed to stress using a biofeedback complex for a number of physiological parameters that had not previously been monitored in similar studies. According to the results of the trial, representatives of personality type D have higher activation rates of the sympathetic-adrenal system of stress exposure compared to the rest of the population. When developing stress-limiting effects, these data should be taken into account. The possibility of using a set of psychophysiological parameters in biofeedback programs for individuals with personality type D requires further study.

Aim. To examine the influence of personality type D, depression level, preferred coping strategies on changes in psychophysiological parameters during mental stress tests.

Methods. The study involved 79 students of Kemerovo State Medical University aged 18 to 32 years (mean age 20.7 ± 2.4 years). The patients’ psychological status was assessed (DS-14, HADS, WCQ and CSI questionnaires) with an assessment of personality type D, depression level and prevailing coping strategies. Psychophysiological diagnostics was performed using the BOSLAB complex, electromyogram, electrocardiogram, body temperature, respiration, galvanic skin response and photoplethysmogram were recorded. The stress testing protocol included a mental arithmetic test and a Stroop test. The results of the stress tests were compared in groups with/without type D and depression.

Results. All subjects showed markers of sympathetic activation during stress testing to the following parameters: increased heart rate and shortening of R-R intervals (p < 0.001), increased skin conductivity (p < 0.001). There was a significantly greater increase in Indicator of the Adequacy of processes of Regulation (IAPR) when performing the mental arithmetic test (p = 0,026) and the Stroop test (p = 0,031) in individuals with personality type D. The presence of both type D and depression predisposed to the choice of maladaptive coping strategies.

Conclusion. A high prevalence of personality type D and depression was revealed among the surveyed cohort. Representatives of personality type D have higher activation rates of the sympathetic-adrenal system of stress exposure compared to the rest of the population. This should be taken into account when developing stress-limiting effects. The possibility of using a set of psychophysiological parameters in biofeedback programs for individuals with personality type D requires further study.

Highlights

It has been demonstrated for the first time that multitasking cognitive training reduced the density of low-frequency current sources in the frontal and temporal regions of the brain involved in encoding memories and regulating general brain activity in patients after coronary artery bypass surgery.

Aim. To study the topological features of brain activity assessed using the standardized low-resolution brain electromagnetic tomography (sLORETA) method in patients with multitasking cognitive training after coronary artery bypass grafting (CABG).

Methods. A prospective study enrolled 100 patients admitted to the hospital for CABG, aged 45 to 75 years. All the patients were randomly assigned to a group with multitask cognitive training (MCT) or a comparison group without training (n = 50). The MCT protocol included a postural task performed simultaneously with cognitive tasks involving mental arithmetic, verbal fluency, and the unusual use of a common object. The MCT course was conducted daily, starting 3–4 days after CABG, and lasted 5–7 days. Standardized low-resolution brain electromagnetic tomography (sLORETA) was used to localize current density sources to assess the topography of changes in brain electrical activity.

Results. It was found that there was a decrease in the frontotemporal density of current sources at frequencies of 3–5 and 5–7 Hz after MCT during the early postoperative period CABG, compared to preoperative values (t > 3.43; p < 0.003 and t > 3.53; p < 0.007). Between-group differences were observed in the mediobasal regions of the brain; patients after MCT had a lower density of activity sources in the 3–5 Hz range compared to the group without training (t > -3.48; p < 0.04).

Conclusion. The MCT helped to reduce low-frequency activity in patients after coronary artery bypass grafting (CABG). Topographic features were associated with the frontotemporal and medial basal regions of the brain, which are involved in memory encoding and regulating general brain activity. These findings emphasize the significance of investigating neural mechanisms underlying the effectiveness of multitasking interventions in cognitive rehabilitation. The data obtained can be utilized to develop and conduct future research aimed at enhancing cognitive rehabilitation programs.

Highlights

The study, based on an analysis of literature sources and previous research results, examined the motor implementation of speech in adolescents who underwent surgery for congenital heart defects. For the first tine the presence of impairments in sound production was identified.

Aim. To study impairments in motor utterance in patients undergoing surgery for congenital heart defects.

Methods. The study was conducted at the Cardiac Surgery Department No. 2 of the Research Institute for Complex Issues of Cardiovascular Diseases and included a group of 27 adolescents aged 13–16 years who had undergone surgery for congenital (septal) heart defects using extracorporeal circulation. The study of sound pronunciation was conducted using the methodological manual by T.A. Fotekova and T.V. Akhutina. Statistical processing was performed using BioStat Pro software version 5.9.8.

Results. In the pronunciation test, respondents scored 350 points (86%) out of the maximum possible (405); in the sound-syllabic structure test, respondents scored 365 points (90%) out of the maximum possible; and in the word chain repetition test, they scored 152 points (38%). Respondents in the lower age range consistently scored lower. The test for the formation of the syllabic and sound structure of the word did not cause any difficulties, but the task of reproducing syllables caused significant difficulties, which allows us to speak about problems at the level of the serial organization of speech movements and phonemic perception.

Conclusion. The connection between speech disorders and congenital heart defects is demonstrated in thus research. Due to these data, we can conclude about influence congenital cardiovascular diseases on cognitive sphere of such patients. The proven association between cognitive impairment and congenital heart defects in children allows us to conclude that cardiovascular pathology affects a child's cognitive development. This, in turn, necessitates the inclusion of diagnostic measures in the treatment process to enable the timely detection of such disorders and also the provision of this cohort of patients with rehabilitation measures aimed at restoring this function. Further research will allow us to thoroughly examine the relationship between both the congenital defects themselves and the necessary surgical interventions on the cognitive status of children.

Highlights

Atmospheric air pollution is one of the key factors that significantly affect morbidity and mortality rates. The article presents an assessment of the pollution of residential areas and an analysis of the associations of air pollutants with the development of adverse events.

Aim. To assess the level of pollution in residential areas and identify associations between airborne air pollutants and adverse events.

Methods. Airborne air pollutant levels were analyzed for the period 2009–2020. A total of 2,982 respondents were included in the study to analyze the association between airborne pollutants and the risk of adverse events. Adverse events were assessed as new cases of dyslipidemia, obesity, diabetes, hypertension, myocardial infarction, stroke, arrhythmia, unstable angina, revascularization procedures, decompensation and/or verification of chronic heart failure, hospitalization for cardiac pathology, and death.

Results. Airborne air pollution levels are predominantly considered high. The most common contaminants exceeding the maximum permissible concentrations include benzopyrene, nitrogen dioxide, formaldehyde, and suspended solids. Pollutant levels were somewhat lower in rural areas compared to all city districts. Pollution levels were more pronounced in the Zavodskoy and Kirovsky districts, and to a lesser extent in the Leninsky and Tsentralny districts. At the prospective stage, despite the absence of differences in the incidence of heart attack, stroke, arrhythmia, or cardiovascular death, statistically significant differences were observed when combining the above-mentioned cases. A more unfavorable profile was revealed among respondents living in the Leninsky district. Residents of the village and Rudnichny district had a more favorable profile, while the opposite was true in the Zavodskoy and Kirovsky districts. An analysis of latent factors characterizing the combination of pollutants with the greatest impact on health revealed associations between the composition of atmospheric impurities and the development of adverse outcomes in prospective observation.

Conclusion. The air quality in the districts of residence was assessed as unfavorable; The content of impurities in atmospheric air is associated with the occurrence of new cases of hypertension, dyslipidemia, diabetes and obesity in previously healthy individuals, as well as with the risk of developing new cases of all cardiovascular events.

Highlights

• In this analytical review, it is proposed to consider the hemoperfusion method using columns containing polymyxin B as one of the promising extracorporeal methods for the treatment of sepsis in children and newborns.
• Based on the currently available relevant data on the clinical use of polymyxin hemoperfusion and the results of scientific research, the advantages of this method and possible complications of its use in extracorporeal sepsis management in children and newborns are shown.

Abstract

The review highlights the problem of sepsis management in children and newborns by one of the methods of extracorporeal hemocorrection using special columns containing polymyxin B, which allows for the sorption of lipopolysaccharides, cytokines and inflammatory mediators, which are usually increasing in case of infectious complications. This method has not been well described in the literature sources worldwide, being represented mainly by certain clinical cases, taking into account the technical difficulties of using extracorporeal contours in premature newborns with low body weight, which makes it difficult to conduct multicenter studies with a large number of patients, as well as limited data on the use of polymyxin hemoperfusion in children. The review presents the main technical characteristics of polymyxin columns registered for use in the Russian Federation, and describes the benefits and disadvantages of the method itself. The effectiveness of polymyxin hemoperfusion in specific cases of sepsis management has been shown, and a comparative analysis of the available global data on the problem of sepsis in children and newborns has been conducted. Taking into account the heterogeneity of definitions, the problem of sepsis management with the using of polymyxin hemoperfusion requires further research to implement its widespread clinical use, which has not yet been recommended in global guidelines.

Highlights

• The main methods of assessing macrocirculation, such as invasive and noninvasive blood pressure, indicators of hemodynamics of the small circle of blood circulation, indicators of invasive measurement of cardiac contractility, used in daily practice to monitor the adequacy of systemic perfusion, represent only a small fraction of the actual state of macro- and microcirculation. The main trend in the development of monitoring is the assessment of the conjugacy of circulation at different levels – the conjugacy of micro- and macrocirculation. The possibility of using a combination of standard methods for assessing systemic blood flow and the availability of online methods for examining the state of the microvascular bed, as well as biochemical markers of the endothelial bed, makes it possible to approach intensive care more appropriately.

Abstract

Clinical recommendations for the intensive care of critical conditions are mainly based on the principles of correction of systemic hemodynamic parameters using infusion media, cardiotonic and vasopressor support. However, the effectiveness of this approach, apparently, requires further research of other pathogenetic therapies, since clinical studies conclude that successful restoration of macrohemodynamical parameters against the background of the use of conventional therapy regimens often does not lead to successful restoration of microcirculatory blood flow. Microcirculation disorders are the central link of pathological processes in the body. Popular methods for assessing the state of tissue microcirculation are represented exclusively by surrogate methods. They largely do not coincide with the actual state of microcirculation. The purpose of our review was to search for modern and affordable methods of direct observation and assessment of microcirculation (dark field microscopy, laser Doppler flowmeter, optical coherence tomography) and biochemical markers of endothelial dysfunction that allow us to move from simple implementation of trivial algorithms to the real beginning of personalized intensive therapy aimed at resolving tissue hypoxemia and resolving critical condition.

Highlights

Effective vascular grafts with diameters less than 4 mm remain unavailable on the market for cardiovascular surgery applications. Biodegradable grafts featuring prolonged resorption and regenerative potential are considered a viable alternative. The comprehensiveness of risk assessment for such grafts in preclinical trials is contingent upon the selected animal model.

Abstract

There is still no effective vascular prosthesis with a diameter of less than 4 mm on the market of products for the needs of cardiovascular surgery. A biodegradable vascular prosthesis with prolonged resorption and regenerative capacity may be an alternative. The completeness of determining the risks of failure of biodegradable prostheses of small-diameter vessels subjected to preclinical tests directly depends on the animal model chosen for such tests. This literature review presents the main trends in recent years in the selection of animal models for preclinical testing of biodegradable vascular prostheses of small diameter and evaluates the effectiveness of tests in the context of species-specific features of the most popular small and large animal models.

Highlights

• This analytical review aims to examine the features of the epidemic process of healthcare-associated infections in cardiac surgery.
• Based on the data described, risk-oriented technologies are considered an effective system for preventing infectious adverse events.

Abstract

The review is dedicated to a comprehensive analysis of the epidemic process of healthcare-associated infections in cardiac surgery. Despite the rapid development of high-tech and minimally invasive methods for treating circulatory system diseases, the problem of infectious complications after heart surgery remains extremely acute. Cardiac surgery patients present in severe condition, and the surgeries themselves carry a high risk of complications, characterized by significant prevalence, mortality, and colossal economic damage. The main forms of healthcare-associated infections, their pathogens, as well as risk factors and modern prevention approaches are described in detail. Priority is given to risk-oriented technologies as the most effective system for preventing adverse events in cardiac surgery.

Highlights

Sequential extracorporeal therapy is a multi-organ support strategy for the treatment of critical illnesses that pathogenetically addresses the underlying cause of organ failure. This article reports a rare case of sequential extracorporeal therapy, which significantly prolonged the life of a patient with severe multiple organ failure after orthotopic heart transplantation.

Abstract

This article describes a clinical case of a 52-year-old man with ischemic cardiomyopathy, chronic left ventricular aneurysm, multiple myocardial cicatricial changes, diabetes mellitus and postcholecystectomy syndrome, who underwent orthotopic heart transplantation. After surgery he had developed sepsis and septic shock due to nosocomial pneumonia, pancreatic necrosis, acute renal and liver failure. Postoperative period was complicated by a crisis of rejection of the donor heart and pulmonary embolism. We used therapeutic plasma exchange, prolonged renal replacement therapy with the use of CytoSorb, Jafron and Toraymyxin sorption columns, as well as extracorporeal membrane oxygenation in the treatment process. As a result of progression of multiple organ failure, the patient died, but thanks to targeted use of extracorporeal technologies it was possible to prolonge the patient's life for 42 days. Consistent use of various methods of extracorporeal therapy has demonstrated its effectiveness, but further studies are needed to standardize their use in the aim to determine the target group of patients and select the optimal technology.