Highlights

• The results of a one-time study are covered. The possibilities of self-registration of an electrocardiogram by patients for diagnosing symptomatic cardiac arrhythmias in everyday conditions have been demonstrated.

Aim. To study the possibilities of remote monitoring of an electrocardiogram by self-registration method for the diagnosis of paroxysmal cardiac arrhythmias and verification of the genesis of subjective complaints.

Methods. The study was conducted with Russian-made devices. 95 patients participated in the study. The inclusion criterion was referral to remote monitoring of an electrocardiogram in order to verify cardiac arrhythmias. A special memo was developed for the patients. The receiving server was prepared. Patients were trained for ECG self-registering at home, ECG Dongle equipment was provided.

Results. An open single-center single-stage (cross-sectional) study was conducted. The average age of the patients was 44 ± 17.1 (Me = 45 [30.0; 58.0] Me [Q25; Q75]). The possibilities of remote monitoring of an electrocardiogram by the self-registration method for the diagnosis and verification of paroxysmal cardiac arrhythmias have been highlighted. The methodology and features of the patient’s organization of examination at the outpatient stage are described in detail. Statistical processing of 332 ECGs was performed. Symptomatic cardiac arrhythmias, including paroxysmal ones, were verified in 43 subjects. The most common causes of symptomatic ECG registration at home were atrial (17.9 ± 4.2%) and ventricular extrasystole (10.7 ± 3.4%). Paroxysmal cardiac arrhythmias (atrial fibrillation, atrial tachycardia, paroxysms of reciprocal atrioventricular tachycardia, orthodromic atrioventricular tachycardia in WPW syndrome) were detected in 16 patients (19.0 ± 4.3%).

Conclusion. The method can be used if the patient is an experienced user of a smartphone. In order to obtain high-quality research results, careful patient instruction, e-mail and mobile Internet access at the monitoring object are required.

Highlights

• One of the factors that significantly contribute to the severity of the disease in patients with acquired valvular heart disease is the presence not only intracardiac hemodynamic disorders, but also preoperative pulmonary hypertension.
• Patients with acquired mitral valve disease and preoperative pulmonary hypertension showed significant positive dynamics in the quality of life in many parameters within the first month after surgery. However, patients without pulmonary hypertension were more compensated at baseline and noted functional limitations in the postoperative period.
• Factors associated with deterioration in quality of life and emotional status before and after surgical correction of acquired mitral valve disease were identified as the presence of preoperative atrial fibrillation and male gender.

Summary

Aim. To analyze a perioperative quality of life and emotional state of patients with acquired mitral valve disease (AMVD) who underwent surgical correction, as well as to assess the contribution of preoperative pulmonary hypertension (PH) to the perioperative dynamics of these parameters.

Methods. The study included 103 patients with AMVD of noninfectious origin, who were hospitalized for elective cardiac surgery. 61.2% of patients had PH before surgery. Quality of life (SF-36) and emotional state (HADS) analysis were conducted before surgery and on day 7, one month and one year after surgery.

Results. Patients with AMVD and preoperative PH showed significant positive dynamics in the quality of life in many parameters within the first month after surgery. However, patients without PH were more compensated at baseline and noted functional limitations in the postoperative period. It was found that an increase in the age of a patient with AMVD by 1 year is associated with a decrease in the initial level of the physical component of health by B-coefficient = –0.21 (p = 0.014). The presence of atrial fibrillation before the correction of the AMVD was associated with a decrease in the physical component of health on day 7 (B-coefficient = –10.92; p = 0.03) and decrease in the mental component of health on day 30 after surgery (B-coefficient = –12.66; p = 0.006). Male gender is associated with increased levels of anxiety and depression at all control points with lower level of mental health than women with AMVD.

Conclusion. Factors associated with a deterioration in quality of life and emotional status both before and after surgical correction of acquired mitral valve disease were identified as the presence of preoperative atrial fibrillation and male gender.

Highlights

The regions of the Russian Federation differ significantly in the dynamics and ratio of the number of coronary artery bypass grafting and coronary artery angioplasty, which is associated not only with the indications for the use of these methods.

Absract

Aim. To assess the dynamics and variability of the number of myocardial revascularization operations for ischemic heart disease (IHD) in the constituent entities of the Russian Federation for 2014–2023; possibilities of modifying the accounting and analysis of data.

Methods. The data of Rosstat for 2014–2023 from the federal statistical observation form (FFSN) No. 14, table 2000 – information on the number of operations for ischemic heart disease performed in hospitals of the Russian Federation were used.

Results. An increase in the number of myocardial revascularization operations was revealed: (the average regional total number of coronary artery bypass grafting (CABG) operations plus angioplasty increased in 2023 compared to 2014 by 33.6 ± 27.5%). Regional variability in the number of CABG and angioplasty increased; their ratio in 2014 was 7.4 ± 2.2 and 38 ± 23 in 2023. Only in 21 regions more than 300 CABG surgeries were performed per year for all 10 years, of which 5 regions performed more than 1000. The COVID-19 pandemic has affected the volume of operations for coronary heart disease (compared to 2019, in 2020 the number of operations performed decreased in 60 regions, in 2021 compared to 2019 in 32 regions).

Conclusions. Regions differ significantly in the volume of revascularization surgeries and the ratio of myocardial revascularization types. FFSN does not allow assessing the causes of differences and ongoing changes; specialized studies are needed.

Highlights

• Social status is an important component of the psychosocial risk factors identified in the European Guidelines for the Prevention of Cardiovascular Diseases (CVD). The educational level-related attitude to CVD health and prevention among gas and oil workers, with an increase in the length of service by the expeditionary shift method, seems to be a reliable indicator for the formation of a comprehensive CVD prevention program in the oil and gas production industry among this most in-demand and large organized population.

Absract

Aim. To determine the level of education among men engaged in expeditionary shift work, its 35-year dynamics and associations with attitudes to health and prevention of cardiovascular diseases while working at an oil and gas production complex in the Arctic region of Russia.

Methods. Epidemiological studies were conducted on two population slices in the thirty-five-year range by using the “random number” method to form representative samples of working men aged 25–54 in the expeditionary shift mode at industrial enterprises in the Arctic. The assessment of the level of education was carried out according to the parameters of higher and secondary education, the attitude to health and prevention of CVD was carried out according to the WHO MONICA-psychosocial algorithms.

Results. Thirty–five–year trends in the growth of the level of education among men working in the expeditionary shift mode have been established by age – mainly in the age category among young people aged 25–34 years; and experience – working in the Arctic for three years or less. With an increase in the length of service of the expedition shift to 4–9 years at the highest level of education, the lowest self-assessment of health was determined relative to the secondary education group with a higher responsibility for health, but clearly insufficient care for it. With the experience of working as an expedition shift for 4–9 years, the group with higher education demonstrated great confidence in the need to prevent heart disease.

Conclusion. Thus, the establishment of the dynamics of the level of education over a long period of time on the attitude of shift workers to their health at different levels of education should serve as a scientific basis for the development and implementation of preventive programs in the Arctic zone of the Russian Federation.

Highlights

• The theoretical novelty of the work consists in using the regional target indicator of the mortality rate from diseases of the circulatory system as an indicator for assessing the effectiveness of management decisions at the level of municipalities in the constituent entity of the Russian Federation.
• To counteract the growing burden of cardiovascular diseases (CVD), the project solution “Long and active life” is being implemented in all constituent entities of the Russian Federation, indicating regional target indicators (RTI). A regional program is also in effect in the Kemerovo Region. In the absence of unified approaches to assessing the effectiveness of health care management technologies within the framework of the regional program, extrapolation of the RTI in municipalities seems promising for solving such a problem.

Aim. To assess the characteristics of the population’s appeal to medical organizations and the prevalence of individual risk factors for CVD in connection with the effectiveness of health care management in the municipalities of the Kemerovo Region-Kuzbass for 2019–2023.

Methods. Data from the Federal State Statistics Service for the period 2019–2023 were used. regarding mortality due to CVD, disease codes: I00–I99, and federal statistical observation forms No. 30 and No. 131/o. Statistical processing was performed using descriptive statistics methods.

Results. The average effectiveness of the regional program in the municipalities was in the range from 111.8 to 176.4%. In four municipalities, it is observed that the number of visits due to diseases exceeds the regional values. In these municipalities, the following dominate in the structure of the studied factors: poor nutrition in a share from 32 to 40.3%; hypercholesterolemia – from 3.8 to 16%; smoking – from 5.3 and 8.9%. Low physical activity and alcohol consumption do not act as a leading risk factor in the region.

Conclusion. A relationship was established between the effectiveness of health care management technologies and the number of requests for help. In particular, low efficiency is associated with a higher proportion of visits for treatment purposes compared to preventive and outpatient observation; a higher prevalence of controllable risk factors for CVD (poor nutrition, hypercholesterolemia, and tobacco smoking).

Hightlights

• The theoretical novelty of the presented work is to expand knowledge about the specifics of the organization of medical care in the field of “medical rehabilitation” in the Siberian Federal District during the implementation of territorial programs of state guarantees of free medical care to citizens in the period 2019–2023.

Abstract

Aim. Comparative assessment of the provision of medical care in the “medical rehabilitation” profile provided in the Siberian Federal District (SFD) during the implementation of territorial Programs of state guarantees (TPSG) of free medical care to citizens for 2019–2023.

Methods. The study was carried out on the basis of data posted on the official websites of the Territorial Compulsory Medical Insurance Funds and the executive bodies of state power exercising powers in the field of healthcare. The following indicators were used: the number and organizational and legal structure of medical organizations, average standards of volume and financial costs per unit volume of medical rehabilitation, planned and actual volumes, financial support for medical care in the “medical rehabilitation” profile. A comparative assessment of the studied indicators was carried out using descriptive statistics methods.

Results. During the time period under study, there was an expansion of the conditions for rehabilitation within the framework of the TPSG, rehabilitation measures in the day hospital and outpatient settings were gradually added to the exclusively inpatient care. A steady trend of increasing the number of completed medical rehabilitation cases and their cost over a five-year period has been established. An exception was recorded only in 2021, when restrictions related to coronavirus infection were in effect and planned hospitalization was difficult. The changes in the volume and financial indicators approved by the TPSG of the subjects of the Siberian Federal District were as follows: in 2020, an increase of 24 and 29% (volume and financial support, respectively), in 2021, a decrease of 14 and 10%, in 2022, an increase of 67 and 36%, in 2023, an increase of 50 and 59%. The restriction of the participation of federal medical organizations in the implementation of the TPSG has led to a redistribution of the number of medical rehabilitation cases between organizations of other forms of ownership. During the study period, an increase in the volume and financial support of medical rehabilitation allocated within the framework of the TPGG in the Siberian Federal District was revealed by more than 2.5 times.

Conclusion. The results of the subjects’ fulfillment of planned indicators of the volume of provision and financial support reflect the subject's ability to organize rehabilitation measures. To improve the situation with the provision of medical care in the “medical rehabilitation” profile, work should continue in the following areas: training and retraining of specialists, infrastructure development, increased funding, and harmonization of applicable rehabilitation standards and protocols.

Highlights

The comorbid course of ischemic cardiovascular diseases with indications for surgical revascularization and untimely surgical correction of blood circulation in chronic ischemic heart disease and lower limb ischemia, asymptomatic stenosis of the common/internal carotid artery ≥ 70% cause high risks of developing adverse cardiovascular outcomes – acute coronary syndrome, acute cerebrovascular accident, critical ischemia of the lower extremities and death. The improvement of the surgical stage of treatment for comorbidity of ischemic cardiovascular diseases based on the tactics of single-stage revascularization of various arterial basins using X-ray endovascular technology contributes to the timely availability of surgical care and the medical and economic efficiency of the healthcare organization.

Abstract

Aim. To evaluate the medical economic effectiveness of single-stage revascularization of various arterial pools (RVAP) in patients with comorbidity of chronic ischemic cardiovascular diseases (CICVD) and indications for surgical revascularization.

Methods. A multicenter research (n = 6) was in 2004–2024. The research subjects were patients (n = 854) with comorbidity of chronic ischemic heart disease (CIHD) and limb ischemia (CLI) 2B-4 st., asymptomatic stenosis ≥ 70% of the common/internal carotid artery (CCA/ICA), with indications for RVAP in accordance with the clinical guidelines of the Russian Federation. The average age of patients was 74.1 ± 7.4 years. Patients of the main group A (n = 106) underwent single-stage RVAP, and patients of the control group B (n = 748) underwent two-stage RVAP, a stage interval – 3.2 ± 8.25 days. Endovascular technology was used for RVAP. To evaluate the safety, clinical, angiographic, social, financial and economic effectiveness of medical care with RVAP. The follow-up period for evaluate of results was 1 and 3 years. The methods of content analysis, statistical, mathematical, comparative analysis were applied. For statistical analysis the program Statistica 6.0 (StatSoft Inc., USA) was applied.

Results. Patients in groups A and B were comparable in terms of age and sex, prevalence of CICVD with indications for RVAP and risk factors of cardiovascular complications (CVC). Indications for revascularization in 2 and 3 arterial pools were established in 94.6% (n = 808) and 5.4% (n = 46) of patients, respectively. The structure of 2-pool revascularization: for CLI 3–4 st. and CIHD (n = 539, 63.1%) – single-stage (n = 84, 15.6%) and two-stage (n = 455, 84.4%); for CLI 2B st. and CIHD (16.2%, n = 138) – single-stage (n = 5, 3.6%) and two-stage (n = 133, 96.4%); with CLI 3–4 st. and unilateral stenosis ≥ 70% of CCA/ICA (8.4%, n = 72) – single-stage (n = 8, 11.1%) and two-stage (n = 64, 88.9%); with CIHD and unilateral CCA/ICA stenosis ≥ 70% (4.1%, n = 35) – single-stage (n = 7, 20%) and two-stage (n = 28, 80%); with CLI 2B st. and unilateral stenosis ≥ 70% of CCA/ICA (1.76%, n = 15) – single-stage (n = 2, 13.3%) and two-stage (n = 15, 86.7%); with bilateral stenosis ≥ 70% of CCA/ICA (1.05%, n = 9) a two-stage endovascular procedures was performed. Three-pool revascularization tactic was performed in patients with CLI 3–4 st, CIHD and unilateral stenosis ≥ 70% of CCA/ICA (5.4%, n = 46). One-year results were assessed in all patients in group A and 89.7% (n = 670) in group B. Three-year results were assessed in all patients in group A and 81.3% (n = 608) patients in group B. In all cases, clinical and angiographic effectiveness of RVAP was achieved, there were no complications. The period of hospital treatment in patients of group A was 1.2 ± 2.6 days, group B 2.9 ± 4.15 days. In 1st year of follow-up the indications for repeated revascularization arose due to the progression of CLI in 1 patient of group A and 3 patients of group B and the return of angina pectoris to 2–3 FC in 2 patients of group B. During 3 years of follow-up the remaining patients did not have repeated revascularizations and CVC, which was facilitated by continuous controlled dispensary care according to the developed algorithm. The average bill and direct costs for one-stage RVAP were 487.4 ± 15.1 rubles and 158.6 ± 12.8 rubles, for two-stage – 634.8 ± 18.7 rubles and 196.9 ± 16.2 rubles, for three-stage – 816.8 ± 18.1 rubles and 276.1 ± 24.9 rubles, respectively. Three-year survival in both groups is 98.7%.

Conclusion. The scientific practical novelty and theoretical significance of the findings on the safety, medical, social, economic and financial effectiveness of complex medical care in patients with comorbidity of CICVD with indications for surgical care and using single-stage RVAP, can become the basis for improving clinical recommendations in patients with cardiovascular diseases, with the accumulation of analytical data.

Highlights

• The number of therapeutic endovascular interventions on coronary arteries in Russia has increased significantly over the observed period of 2019–2023.
• There is an uneven distribution and use of angiographic units, which may be the reason for insufficient performance of X-ray endovascular interventions and/or ineffective use of expensive equipment.
• Despite the increasing number of percutaneous coronary interventions in the Russian Federation, clinical and economic difficulties remain in the treatment of various forms of coronary heart disease. Analysis of the dynamics of myocardial revascularization indicators allows monitoring the implementation of treatment measures in the regions of Russia and identifying ways to further improve their effectiveness.

Abstract

Aim. To study the dynamics of the number of therapeutic percutaneous coronary interventions (PCI) performed in the subjects of the Central, Volga and North Caucasian Federal Districts of Russia for the period 2019–2023.

Methods. The sources of information were data provided at the request of the A.N. Bakulev National Medical Research Center for Cardiovascular Surgery of the Ministry of Health of the Russian Federation, official statistics (statistical observation forms No. 14; 30); materials obtained during field events in the supervised regions; statistics of the Organization for Economic Cooperation and Development, literature data.

Results. During the observed period, the number of regional vascular centers in the supervised subjects of the Russian Federation increased by 54.2%. However, the distribution of angiographic equipment in the subjects remains uneven, which led to different efficiency of its use: from 0.7 interventions (excluding planned coronary angiographic studies and interventions on other vessels) per one angiographic unit in the Republic of North Ossetia-Alania and the Karachay-Cherkess Republic to 3.4 in the Kostroma Region. In the studied federal districts the total number of therapeutic PCI increased by an average of 1.5 times: from 89 863 to 135 009 operations. Compared with 2019 the number of PCI per 100 thousand population in 2023 increased by 54.1% (from 137.15 ± 45.04 to 211.41 ± 61.51 operations): in the Central Federal District the number of PCIs was 184.0; in the Volga Federal District – 225.0; in the North Caucasus Federal District – 149,8 per 100 thousand population. Compared to 2019 hospital mortality after PCI increased by 6.7% (from 2.85% in 2019 to 3.05 in 2023): in the Central Federal District mortality increased from 3.69% to 4.10%, in the Volga Federal District – from 2.67% to 3.44%; in the North Caucasus Federal District – decreased from 1.98% to 1.70%

Conclusions. In the studied federal districts in 2019–2023 the number of PCI increased by 1.5 times. At the same time mortality increased by 6.7%, which requires measures to eliminate it. There is an uneven territorial distribution of angiographic equipment, which may be the reason for its ineffective use.

Highlights

• The study demonstrates the possibility of successful repeated endovascular intervention in case of dysfunction of a previously implanted bioprosthesis, which opens up new prospects in the treatment of patients with complications after aortic valve replacement.
• The study showed the high efficiency and safety of the method: technical success was achieved in all 8 cases, while no deaths, strokes or other serious complications were recorded during the 12 months of follow-up.
• The clinical effectiveness of the method is confirmed by the positive dynamics of EchoCG parameters (reduction of pressure gradient, disappearance of severe regurgitation, reduction of LV hypertrophy) and improvement of patients’ condition.

Aim. To evaluate the safety and effectiveness of transcatheter prosthetics of the aortic valve (TPAK) using the valve-in-valve method in patients with bioprosthesis dysfunction in the aortic position based on the analysis of the results of the first endovascular reprosthetics procedures at the Scientific Research Institute of Complex Problems of Cardiovascular Diseases (NII KPSSZ).  

Methods. The present study included 8 patients with aortic bioprosthesis dysfunction who underwent valve-to-valve transfemoral access during this time period. Of the 8 valve-to-valve surgical procedures, 7 endovascular interventions were performed due to the development of dysfunctions of biological prostheses in the aortic position after open surgery and in 1 case after the primary surgical procedure. Average STS Score = 8.4%. The main types of dysfunction were primary tissue failure with rupture of xenospores and the formation of insufficiency (n = 5) and calcium degeneration of the biological valve with the appearance of a stenotic effect (n = 3). The endpoints were evaluated for efficiency and safety and were divided into 3 blocks: 1) Clinical results; 2) Complications; 3) EchoCG data. The results were evaluated 30 days after the intervention and after 12 months.

Results. The average duration of aortic valve function after primary arthroplasty until the first signs of dysfunction was 5.3 (3.1; 11.9) years. After valve-to-valve TPA with transfemoral access, death from all causes, cardiovascular death, periprocedural death, stroke, TIA, myocardial infarction, vascular complications, cardiac complications, bleeding (on the BARC scale), arrhythmological events, prosthetic dysfunction requiring reoperative, infectious endocarditis were not noted not in any case. The technical success of TPAC, which was assessed only during the period of hospitalization, was noted in all cases. Only one patient (16.67%) was hospitalized for CHF decompensation at the 12-month follow-up stage with satisfactory indicators of aortic bioprosthesis function according to EchoCG. According to the EchoCG data between the period before reprosthetics and 12 months after, there was a significant positive trend in terms of maximum velocity and maximum gradient per AC. At the same time, the changes in the average velocity and average gradient were not significant. Grade III–IV transprosthetic regurgitation before reprosthetics was observed in 4 patients (50%), and in dynamics it disappeared (only grade I regurgitation or its complete absence is noted), as well as regurgitation on grade III–IV MK was observed in 5 patients (62.5%), and in dynamics it disappeared (regurgitation is noted only of I and II degrees). LV hypertrophy became less pronounced in dynamics (average myocardial mass index after TPAK = 109.5 g/m²).

Conclusion. After valve-to-valve TPA with transfemoral access performed at the KPSSZ Research Institute, favorable results were shown after 30 days and 12 months. The low number of intra- and postoperative complications, the positive dynamics of the clinical status of patients and structural and functional parameters assessed by EchoCG led to a positive conclusion on the safety and effectiveness of the presented method of treatment of patients with aortic bioprosthesis dysfunction.

Highlights

• Primary arterial endothelial cells show an expression of ≈ 40 cytokines, including ≈ 25 molecules overexpressed ≥5-fold at pro-inflammatory endothelial dysfunction.
• Despite primary arterial endothelial cells expressed a variety of cell adhesion molecules, only ≈ 5 of them are overexpressed ≥5-fold at pro-inflammatory endothelial dysfunction.
• Primary human coronary artery endothelial cells exhibit higher basal expression of pro-inflammatory cytokines in comparison with internal thoracic artery endothelial cells.

Aim. To compare expression of the genes encoding pro-inflammatory cytokines and cell adhesion molecules in primary human coronary artery endothelial cells (HCAEC) and human internal thoracic artery endothelial cells (HITAEC) for the assessment of pro-inflammatory activation in the ECs isolated from atherosusceptible and atheroresistant arteries.

Methods. Following the dot blotting profiling, we quantified the expression of the genes encoding pro-inflammatory cytokines (MIF, IL6, CXCL8, CCL2, CCL5, CCL20, CSF2, CSF3, CXCL1, CXCL5, CXCL10, PTX3) and cell adhesion molecules (VCAM1, ICAM1, SELE, SELP) by RT-qPCR. We further performed an extended analysis of gene expression by interrogating three RNA sequencing datasets.

Results. We found ≈ 40 pro-inflammatory cytokines expressed in HCAEC and HITAEC. Baseline expression with TPM_Ctrl > 2.5 was detected for 24 genes: MIF, CCL2, PTX3, IL32, CXCL1, TGFB1, LTB, CXCL8, CSF1, CCL14, TGFB2, IL33, CXCL16, CXCL2, IL1A, CSF3, IL6, IL17D, CXCL3, CXCL6, IL12A, CXCL5, TGFB3, and CXCL12. In addition, 24 genes (CSF2, CCL5, CCL20, CXCL5, CXCL8, CXCL3, CXCL11, IL1A, CXCL6, IFNE, CCL16, CXCL2, LTB, LTA, IL23A, CSF1, CXCL1, CXCL10, CSF3, IL6, IL32, TGFB1, CCL2, and IL7) had fold change ≥ 1.50 in dysfunctional ECs as compared with the control ECs. Three genes encoding cell adhesion molecules (VCAM1, ICAM1, and SELE) had fold change > 2 and TPM_{Ctr l}> 2.5. In comparison with HITAEC, HCAEC had higher expression of pro-inflammatory genes (MIF, IL6, CCL5, CSF3, CXCL1, and SELP) indicating higher pro-inflammatory status.

Conclusion. HCAEC have higher expression of pro-inflammatory genes comparing to HITAEC, in concert with the higher atherosusceptibility of CA.

Highlights

• Analysis of balloon-expandable, self-expanding and mechanically expandable transcatheter heart valve prostheses over the past 20 years has revealed evolutionary technological and design changes in devices aimed at improving biocompatibility, reducing calcification, reducing the diameter of the device profile in a compressed form on the delivery system, as well as increasing the reliability and durability of their operation.
• Promising directions for further improvement of transcatheter prosthetic heart valves have been identified.

Abstract

The analysis of literature data over the past 20 years on the designs of transcatheter prosthetic heart valves for the treatment of cardiovascular diseases is based on sources available to the authors – scientific publications included in the list: Scopus, Web of Science, PubMed, RSCI. The study of trends in the design and changes in the designs of transcatheter prosthetic heart valves over the past 20 years has revealed a number of significant improvements. The use of cobalt-chromium and molybdenum-rhenium alloys instead of stainless steel has increased the strength and performance characteristics of the support frames of balloon-expandable prostheses. Self-expanding prostheses adapt better to the patient's anatomy and reduce the risk of paraprosthetic leakage by optimizing radial forces and increasing cell sizes. Despite the fact that mechanically expandable prostheses were withdrawn due to difficulties with the delivery system, initially, the devices had a unique locking mechanism and provided high installation accuracy, as well as repositioning and complete extraction capabilities. Improving biomaterial processing technologies and improving the geometry of valve linings reduce the risk of calcification and paraprosthetic leaks. Collectively, the applied design changes contribute to improved biocompatibility, reduce the risk of calcification, and ultimately increase the reliability and durability of transcatheter prosthetic heart valves.

Highlights

• This literature review covers classical and modern concepts of the pathophysiology of microcirculation, the disorders of which underlie most critical conditions. Such complications can develop in patients after various surgical interventions and lead to the development of multiple organ failure, which still has many unresolved problems in its treatment.
• The development of a standard for monitoring microcirculatory and mitochondrial dysfunction will improve the outcomes of critical patients and prevent organ hypoperfusion in the perioperative period and during treatment in intensive care units.

Abstract

The most important problem of intensive care measures for patients in the intensive care unit/operating room with the development of a systemic inflammatory reaction (associated with both aggressive surgery and shock, ischemia and reperfusion) is the obvious lack of effective clinical and laboratory diagnostic tools for the deterioration of microcirculation in organs and tissues (peripheral hypoperfusion). It is worth noting that the diagnosis and therapy of macrohemodynamic disorders that have already occurred does not guarantee improved microcirculation and sufficient relief of organ hypoxia, which is confirmed by current trends in maintaining high mortality rates in critical patients with shock and multiple organ failure. Therefore, it is necessary to develop new tools and strategies adapted to clinical use for the direct diagnosis of microcirculatory disorders in order to predict the development of multiple organ failure and timely targeted therapy. This review reveals in detail the main aspects of the etiology and pathogenesis of microcirculation disorders in critical conditions, the pathophysiology of the mechanisms of microcirculatory dysfunction, as well as the possible role of promising instrumental technologies for direct monitoring of microcirculation changes at the patient’s bedside. Taking into account the versatility and interrelation of the processes occurring in violation of microcirculatory hemodynamics and organ perfusion, the urgent need for the introduction of a clinically effective method of diagnosis and prognosis of the development of multiple organ failure in patients at risk for early and informed correction of therapeutic actions is emphasized. The review examines the potential methods of vital video microscopy and optical coherence tomography angiography for clinical use, their advantages and disadvantages for solving the problems of bedside direct diagnosis of microcirculatory dysfunction.

Highlights

• Diabetes mellitus is a severe, rapidly progressing disease. In the absence of high patient compliance, it is often associated with multifocal atherosclerosis, renal dysfunction, and acute cardiovascular events (myocardial infarction and stroke). Prevention of these complications and morbid conditions requires high patient commitment to the prescribed therapy, which is the main goal of managing a patient with diabetes mellitus.

Absract

The purpose is to present, by the example of a clinical case, relevant information for practicing physicians about the unfavorable, progressive, course of multifocal atherosclerosis in a patient with insufficient therapy of type 2 diabetes mellitus and having insufficient compliance with the prescribed drug therapy. The article describes a difficult case for doctors of an atypical course of acute coronary syndrome in such a patient and difficulties in choosing an effective method of myocardial revascularization. The presented clinical case illustrates the existing difficulties in managing patients with type 2 diabetes mellitus and atherosclerosis in real clinical practice. Attention is drawn to the need for early initiation of disease-modifying therapy and organ protection in type 2 diabetes mellitus, as well as to the need for screening for low adherence to prescribed treatment in such patients and its timely correction at all stages of treatment using digital technologies.

Highlights

• The “UniLine” study is a major domestic prospective, multicenter medical device investigation focusing on devices used in the surgery of valvular heart disease. This study is designed to provide a comprehensive assessment of the safety and efficacy of the domestic epoxy-treated xenopericardial prosthesis “UniLine” for treating isolated aortic and mitral valve defects, based on the long-term results of the use of this bioprosthesis in real clinical practice.

Abstract

The number of valve replacements using biological prostheses has been increasing in Russia and other countries. Primarily this is due to the development of domestic cardiac surgery, which has made it possible to soften age limits and increase the number of surgeries in people over 65 years old. In order to assess the effectiveness of the “UniLine” prosthesis in treatment of aortic and mitral valve defects, an open prospective multicenter study of the safety and efficacy of the “UniLine” epoxy-treated prosthesis made from xenopericardium in the treatment of isolated aortic and mitral valve defects was planned and initiated, the study design and rationale are presented.

Highlights

• Chronic heart failure is a serious complication in the treatment of tumor diseases due to the cardiotoxic effect of anticancer drugs, especially anthracyclines. The addition of trimetazidine to combination therapy of left ventricular dysfunction induced by anthracyclines, carvedilol and enalapril increases the effectiveness of secondary prevention of chronic heart failure.

Absract

Aim. To study the effectiveness of trimetazidine as part of treatment regimens for chronic heart failure (CHF) induced by cardiotoxicity of chemotherapy.

Methods. The study included 114 women (48,0 [46,0; 52,0] years) with CHF that developed 12 months after the end of chemotherapy for breast cancer using anthracycline drugs. All patients received therapy with carvedilol and enalapril. Control points for assessing the effectiveness of therapy are 12 and 24 months of observation. Criteria for an unfavorable course of CHF: an increase in the functional class of CHF by 1 or more during the observation period; hospitalization for HF 1 or more times during the observation period; progressive deterioration of structural and functional changes of the left ventricle during the study period.

Results. After 12 months of treatment for CHF with combination therapy of carvedilol and enalapril, trimetazidine was added to therapy in 47 patients. After 12 months of treatment with trimetazidine, the dynamics of the course of CHF were assessed. Before the appointment of trimetazidine during treatment with a combination of carvedilol and enalapril, patients experienced progression of structural and functional changes in the myocardium (decrease in left ventricular ejection fraction, increase in the size of the left atrium, end-systolic and end-diastolic size of the left ventricle), progression of CHF according to the 6-minute walk. After adding trimetazidine to the previous treatment, after 12 months of combination therapy, a significant increase in left ventricular ejection fraction (p = 0,004), a decrease in the size of the left atrium (p = 0,001), end-systolic (p = 0,045) and end-diastolic (p = 0,022) left ventricular dimensions. Also, during the therapy, the level of the N-terminal pro-B-type brain natriuretic peptide significantly decreased (p = 0,005), and the distance during the 6-minute walk test increased (p = 0,009): from 387 (335; 445) meters from 387 (335; 445) meters to 432 (408; 476) meters.

Conclusions. In cases of ineffective treatment of CHF induced by cardiotoxicity of chemotherapy, carvedilol and enalapril, the addition of trimetazidine to treatment is associated with a significant regression of clinical (6-minute walk test), laboratory (N-terminal pro-B-type brain natriuretic peptide) and echocardiographic signs of heart failure.

Highlights

Digital transformation is a prerequisite for the development of a modern healthcare system. The introduction of digital technologies into the quality management system (QMS) of the therapeutic and diagnostic process (TDP) plays an important role in ensuring the quality and safety of medical activities.

Resume

Aim. To form, implement and evaluate the features of the information management system for TDP in the provision of high-tech medical care (HMC) (using the example of the Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” (NII KPSSZ).

Methods. Methods of analysis and synthesis, logical, systematic approaches, databases of the Russian Science Citation Index, Google Scholar, Pubmed search engines are used. A SWOT analysis was conducted, 13 respondents (managers) were interviewed.

Results. NII KPSSZ has implemented digital technologies in all stages of the management of the medical care (MC) process. At the patient selection stage, a contact center using IP telephony capabilities is being developed (the number of calls has increased 5.5 times in 3 years). The main stages of inpatient medical care are implemented through the medical information system (MIS), which is part of the unified information system of Kuzbass, the use of telemedicine technologies on a digital platform at the federal level and a regional centralized subsystem (2023 – 242, 2024 – 2 472 consultations). The completion of treatment, the transfer of statistical information about the patient, and payment for the provision of medical care are carried out through the unified state health information system. The improvement of the TDP QMS provides its own digital developments: software (software) that allows developing algorithms for the actions of medical personnel in various clinical situations (more than 30 documents); a module in the IIA for registering undesirable events; an automated risk management system, the process of conducting internal audits; control of the execution of orders through the “Events and Solutions” software.

Conclusion. The study demonstrates the experience of digital transformation of the QMS of the federal center that provides TDP. To increase the efficiency of the institution's functioning, it is advisable to form a digital TDP management model. The use of strategic analysis tools makes it possible to determine the development directions of digital transformation.

Highlights

• Coronary artery bypass grafting (CABG) on a functioning heart using a Heartstring device and a non-aortic touch technique demonstrates comparable results in postoperative complications, including the incidence of strokes, perioperative myocardial infarction, acute kidney injury, and hospital mortality.
• The use of the Heartstring device is associated with a longer duration of surgery and a more frequent need for hemotransfusion, which may be due to a higher revascularization index in this group.
• Both techniques are safe and effective, and the choice of approach should be based on the individual characteristics of the patient, the anatomy of the coronary arteries and the technical capabilities of the surgical team.

Abstract

Aim. To compare the immediate outcomes of off-pump coronary artery bypass grafting (CABG) using the Heartstring device and the no-touch aorta technique.

Methods. This retrospective study included data from 2 550 patients who underwent off-pump CABG using either the Heartstring device or the no-touch aorta technique at the Federal Center for Cardiovascular Surgery (Astrakhan, Russia) between April 2009 and December 2022. Inclusion criteria: age ≥ 18 years, off-pump CABG using the Heartstring device or the no-touch aorta technique. Exclusion criteria: conversion to on-pump CABG, combined procedures with carotid artery surgery, minimally invasive access, or use of a side clamp. After propensity score matching (nearest neighbor method, 1:1), two comparable groups were formed: the Heartstring group (n = 742) and the no-touch aorta group (n = 742). Outcomes assessed included perioperative myocardial infarction, stroke, acute kidney injury, wound infection, postoperative atrial fibrillation, re-exploration for bleeding, blood transfusions, and in-hospital mortality.

Results. The median age of patients was 61 years (56–65 years; p = 0.296). The proportion of males was 76.1% in the Heartstring group and 83.4% in the no-touch aorta group (p < 0.001). The incidence of atrial fibrillation was 8.2% vs. 11.2% (p = 0.054), history of stroke was 8.6% vs. 7.3% (p = 0.337), and prior percutaneous coronary intervention was 7.8% vs. 8% (p = 0.923), respectively. The median left ventricular ejection fraction was 55% (50–59%) in both groups (p = 0.175). Operative time was longer in the Heartstring group (155 (130–180) minutes vs. 140 (110–170) minutes; p < 0.001), likely due to a higher revascularization index (3 (2–4) vs. 2 (1–3); p < 0.001). Bilateral internal mammary artery grafting and complete arterial revascularization were more frequent in the no-touch aorta group (29.9% vs. 3.1%; p < 0.001 and 68.6% vs. 2%; p < 0.001, respectively). Postoperative complications and in-hospital mortality did not differ significantly between the groups, except for a higher rate of blood transfusions in the Heartstring group (23.2% vs. 15.6%; p < 0.001). The incidence of perioperative myocardial infarction was 1.5% vs. 0.5% (p = 0.117), stroke was 0.7% vs. 0.8% (p = 1.0), acute kidney injury was 1.5% vs. 0.8% (p = 0.329), wound infection was 1.6% vs. 0.5% (p = 0.07), postoperative atrial fibrillation was 10.8% vs. 9.8% (p = 0.377), and re-exploration for bleeding was 0.7% vs. 1.2% (p = 0.422). In-hospital mortality was 0.5% vs. 1.1% (p = 0.386).

Conclusions. Both techniques demonstrated comparable results in terms of postoperative complications and in-hospital mortality. The use of the Heartstring device was associated with longer operative times and a higher need for blood transfusions, likely due to a higher revascularization index.

Highlights

• Dysfunctional endothelial cells are characterized by the pathological shedding of endothelial receptors markers and reduced release of endothelial basement membrane components and subendothelial extracellular matrix proteins into the cell culture medium.
• Primary human coronary artery endothelial cells demonstrate an elevated shedding of integrins, an increased production of platelet aggregation and activation components, and reduced release of basement membrane components into the cell culture medium as compared to human internal thoracic artery endothelial cells.
• Primary human internal thoracic artery endothelial cells have higher resistance to endothelial dysfunction triggers in comparison with human coronary artery endothelial cells.

Abstract

Aim. To compare the secretome from intact and dysfunctional primary human coronary artery endothelial cells (HCAEC) and human internal thoracic artery endothelial cells (HITAEC).

Methods. Here we investigated the secretome of HCAEC and HITAEC treated with either PBS (intact ECs, n = 6 per EC line) or calciprotein particles (dysfunctional ECs, n = 6 per EC line) in the serum-free medium for 24 hours. To achieve this task, we performed acetone precipitation of proteins from the cell culture supernatant, tryptic digestion of proteins to peptides (15 µg per sample), protein identification by high-performance liquid chromatography-tandem mass-spectrometry, and bioinformatics analysis of endothelial phenotype markers, endothelial basement membrane components and subendothelial extracellular matrix proteins, angiogenesis pathways, platelet activation and aggregation pathways, and response to oxidative or endoplasmic reticulum stress. Concentration of pro-inflammatory cytokines in the cell culture supernatant was measured by multi-analyte profiling (xMAP).

Results. Cell culture supernatant from dysfunctional ECs had increased levels of endothelial cell receptor soluble forms and reduced quantities of endothelial basement membrane components and subendothelial extracellular matrix proteins. Cell culture supernatant from HCAEC contained increased levels of integrins (similar to dysfunctional ECs) and platelet activation and aggregation proteins, as well as reduced amount of basement membrane components. Treatment with primary calciprotein particles provoked the release of 12 and 5 pro-inflammatory cytokines, respectively. Treatment with secondary calciprotein particles induced production of 30 and 10 pro-inflammatory cytokines in HCAEC and HITAEC, respectively.

Conclusion. Secretome of HCAEC is more similar to dysfunctional ECs whilst HITAEC have higher resistance to pro-inflammatory endothelial activation.

Highlights

• Sudden cardiac death (SCD) in children and adolescents engaged in sports is a rare but serious event that demands special attention from both medical and athletic communities. The main causes of SCD include cardiomyopathies, coronary artery anomalies, channelopathies, congenital heart defects, and aortopathies. Physical exertion can trigger fatal arrhythmias, especially in predisposed individuals.
• Modern approaches emphasize individualized risk assessment using ECG, stress testing, cardiac imaging, and, when necessary, genetic testing. Instead of strict restrictions, a shared decision-making model is promoted, taking into account both clinical data and the athlete’s personal goals.
• Emergency preparedness plays a key role: availability of defibrillators, CPR training, and established response protocols are essential. This personalized approach helps ensure safety while preserving the quality of life for young athletes.

Abstract

Sudden cardiac death (SCD) in children and adolescents is a rare but potentially catastrophic event, particularly in the context of athletic activity. Despite its low incidence, SCD significantly impacts strategies for screening, clearance, and monitoring of young athletes. The aim of this review is to summarize current data on the epidemiology, etiology, risk factors, and clinical management of pediatric patients at risk of sudden cardiac arrest during physical exertion. The most common causes of SCD in the pediatric population include hypertrophic cardiomyopathy, coronary artery anomalies, dilated and arrhythmogenic cardiomyopathies, inherited channelopathies (including long QT syndrome and catecholaminergic polymorphic ventricular tachycardia), as well as congenital heart defects and aortopathies. This review emphasizes the underlying pathophysiological mechanisms linking exercise to arrhythmogenesis and highlights the importance of individualized risk stratification using ECG, exercise testing, cardiac imaging, and genetic evaluation. Contemporary guidelines from major professional organizations (AHA/ACC/AMSSM/HRS/PACES/SCMR) increasingly advocate for a shared decision-making approach, moving away from blanket restrictions. This model considers both clinical risk and the athlete’s personal goals and values. Emergency preparedness in athletic settings is also discussed, including staff training and the strategic placement and maintenance of automated external defibrillators. This review aims to inform a personalized, evidence-based approach to sports eligibility for children and adolescents with cardiovascular conditions, helping to ensure a careful balance between safety and quality of life through collaborative planning, education, and emergency readiness.

Highlights

• The development of a Total Artificial Heart (TAH) represents a complex engineering challenge aimed at creating a long-term replacement for the terminally failing heart. Primary efforts focus on ensuring reliable pump function and biocompatibility.
• The article examines key technical aspects of TAH, including pump design, material selection, and control systems, based on an analysis of current developments and scientific literature. Particular attention is paid to addressing hemocompatibility issues.
• One of the major technical challenges in creating a TAH remains ensuring efficient and safe long-term energy supply for the implanted device. Finding solutions in this area is critically important for the success of the technology.

Abstract

The article examines critical engineering aspects: the design of miniature, highly reliable pump systems (rotary/pulsatile); the development of exceptionally biocompatible materials preventing thrombosis and calcification; the creation of efficient blood flow control systems with autonomous adaptation to patient needs; and the integration of advanced energy sources and wireless transmission systems. Particular attention is paid to minimizing hemolysis and achieving hemodynamic compatibility.