[First experience of application of assist circulation device using biventricular type "excor"]

The frequency of use of assist blood device as the "bridge" to the heart transplantation increased in last years. An assessment of results of first 7 implantations of assist circulation device using biventricular type "Excor" was made. The implantations were performed in Federal Almazov centre of the heart, blood and endocrinology. An observation period after implantation was since 11 till 301 days. The heart transplantation of 4 patients was carried out in different terms after implantation. One of the patients passed away on the fifth day due to the pulmonary embolism. Another patient died on the eleventh day after the implantation because of multiple organ failure against the background of severe chronic cardiac failure. The waiting list of heart transplantation includes 2 patients.

[Results of plasty of postinfarction left ventricular aneurysm performed on the working heart]

The results of plasty (124 patients) of postinfarction left ventricular aneurysm performed on the working heart are presented in this article. It is shown, that the upgrade of existing surgical techniques, which are directed to the creation of the optimal left ventricle shape, could improve the clinical results after plasty of postinfarction left ventricular aneurysm. It's important to arrange the conditions, which allow avoiding a negative influence on contractility function of the myocardium. The desired conditions could be obtained, if the plasty is performed on the working or fibrillating heart provided that the patient has a consistent aortic valve.

[An experience with cardiac transplantation with a single stage reduction of the left atrium cavity and correction of valvular disease]

The immediate and long-term results of cardiac transplantation with a reduction of the left atrium and correction of valvular diseases were performed on 4 patients with atriomegalia and associated valvular disease of the heart. There were no cases of hospital lethality. Within 7 days after operation the patients had a tendency to reducing the mean value of the left atrium. Within 38 months the tendency to normalization of the sizes, volumes and ejection fraction of the left atrium persisted. Cardiac autotransplantation is an effective method of a single stage reduction of the left atrium and correction of valvular diseases.

[A comparative assessment of immediate results of correction of mitral insufficiency from the left-auricular and transventruicular accesses in patients with postinfarction aneurysm]

Reconstruction of postinfarction aneurysm of the left ventricle (LV) and plasty of the mitral valve without implantation in combination with coronary shunting or without it were used in 81 patients with ischemic heart disease. Correction of mitral insufficiency was fulfilled in 40 patients by an access via the left atrium, in 41 patients--from the LV in its reconstruction. Lethality in the nearest postoperative period was 3.7%. Mitral insufficiency after operation was absent in 70% of patients with the left atrium access and in 58.5% with the transventricular access, in the rest of the patients the mitral insufficiency was not more than of the II degree. Significant differences between the immediate results depending on the access to the mitral valve were not found.

[Application of the method of continuous suture annuloplasty for mitral valve disease of dysplastic etiology]

Considerable mitral regurgitation of dysplastic etiology was corrected in 63 patients using the method of continuous suture annuloplasty. The operations were fulfilled by the access through median sternotomy, under conditions of extracorporeal circulation, blood isothermal cardioplegy. Immediate results show effectiveness of correction of mitral insufficiency and safety of using the method due to the absence of lethal outcomes, thromboembolic complications and the necessity of another surgical correction in the nearest postoperative period.

[Surgical treatment of chronic thrombo-embolic pulmonary hypertension with floating thrombi in the right heart ventricle]

A 31 years old male patient was admitted to a resuscitation unit with severe dyspnea (MMRC 4 grade). The patient had the dyspnea for 3 months.The diagnosis of chronic thrombo-embolic pulmonary hypertension with floating thrombi in the right heart ventricle was established. On the sixth day of admission after IVC filter insertion, the patient underwent thromboectomy with pulmonary endarterectomy. For an access to segmentary pulmonary arteries during operation SVC and the aorta had been cross-clamped. The duration of deep hypothermic (20 degrees C) circulatory arrest was 54 minutes. The patient was discharged in satisfactory condition on the 17th day. At the check-up at 3 months the dyspnea was absent and heart hemodynamic parameters had been normalized.

[The first experience with heart transplantation in the Federal Center of the Heart, Blood and Endocrinology named after V. A. Almazov]

At the present time heart transplantation is considered to be the operation of choice in treatment of patients with terminal stage of chronic heart failure. Results of the first 5 heart transplantations made in the Federal Center of the heart, blood and endocrinology named after V. A. Almazov are assessed. There were no perioperational lethality and complications at the hospital stage. An analysis of the long-term results has shown effectiveness of heart transplantations in treatment of severe heart pathology.

[Ways to decrease the number of complications of combined operations of carotid endarterectomy and coronary bypass surgery in patients with bilateral lesion of the carotid arteries]

In the period from 2003 to 2009 operations of coronary bypass surgery were made in 2657 cases, 4.25% of the patients being operated on coronary arteries (CA). Mean age (60.6 +/- 4.8) years of 83.2% of the patients had no neurological symptoms. The results of one-stage operations in patients with a unilateral lesion of the coronary arteries are not worse than those after isolated revascularization of the myocardium (lethality 2.8%, infarction 2.8%). The results of one-stage operaions in bilateral lesion of the coronary arteries can be improved using hypothermal perfusion, but the risk of neurological complications remains high.

[Improvement of aortic root replacement technique with aortic valve sparing: immediate and long-term results]

One of the approaches to treatment of the aortic root aneurysms combined with aortic insufficiency is valve-sparing aortic root replacement. An analysis of immediate and long-term results dealt with 19 operations of replacement of the ascending parts of the aorta with sparing the aortic valve by the David I modified technique. The results demonstrated effectiveness and relative safety of this method of correction. At the long-term period 3 patients (16%) showed the II degree aortic regurgitation, in the other patients it was not higher than I degree. The improved David I technique is thought to be optimal in patients with the aortic root aneurysms, aortic insufficiency and unaltered aorta valve cusps.

[Analysis of direct results of mitral valve annuloplasty]

In the present-day cardiosurgery there is no doubt that in case of possible plastic operation on the mitral valve the latter must be preserved. In the current literature there are no investigations which could convincingly prove advantages of any single group of techniques of constriction of the fibrous ring when performing mitral reconstructions. The aim of the work was to compare the direct results of reconstructive operations on the mitral valve with the using of three different means of constriction of the fibrous ring. It was found that all the three types of plasty of the mitral valve fibrous ring gave good direct results. Nevertheless an analysis of long-term results is necessary for the assessment of effectiveness of mitral reconstructions in the long-term postoperative period.

[Cardiac autotransplantation in a patient with congestive heart failure]

Congestive heart failure with intact or moderately lowered left ventricular pump function is caused in some patients by mitral regurgitation. Consequences are dilation of the left atrium, pulmonary hypertension, tricuspid regurgitation, thromboembolic complications, rhythm disturbances, elevated risk of sudden death. Efficacy of drug treatment, electroimpulse therapy is little and surgery is the method of choice. One of alternatives is cardiac autotransplantation. A successful experience of application of this technique is presented. Cardiac autotransplantation was carried out in a female patient with moderately lowered left ventricular contractile function, extreme degree of mitral and tricuspid regurgitation, atriomegaly, atrial fibrillation and pronounced signs of congestive heart failure.

[Autotransplantation of the heart as the method of treatment of congestive heart failure]

Congestive heart failure with preserved or moderately lowered left ventricular pump function in some patients is caused by mitral regurgitation. Its consequences are left atrial dilation, pulmonary hypertension, tricuspid regurgitation, thromboembolic complications, disturbances of rhythm with elevated risk of sudden death. As efficacy of drug treatment and electroimpulse therapy is small surgery is the method of choice and one of alternatives - autotransplantation of the heart. Here we present a successful experience of application of this technique in a patient with moderately lowered left ventricular function, extreme degree of mitral and tricuspid regurgitation, atriomegaly, atrial fibrillation, and pronounced manifestations of congestive heart failure.

[Functional state of endothelium and oxidant activity of leucocytes in patients with ischemic heart disease after coronary bypass surgery]

Relationship between disorders of endothelial function, proinflammatory activity of leucocytes and effects of therapy with simvastatin or its combination with ezetimibe was studied in 72 patients with ischemic heart disease subjected to coronary artery bypass grafting (CABG). Vascular endothelial function was assessed by ultrasound detection of brachial artery response to its compression, oxidant activity of leucocytes - by chemiluminescent microscopy, severity of coronary artery atherosclerosis - by invasive coronary angiography. Twenty two healthy individuals comprised control group. Endothelial function, activity of leucocytes, and lipid levels were evaluated before and in 12 months after CABG. Patients with multivessel involvement revealed more complex disorders of endothelial function and higher levels of leucocytes activity compared to patients with single-vessel disease. CABG resulted in disappearance of anginal attacks and negative stress echo test during 1-year observation in 80.6% of patients. Patients with recurrent angina after CABG had more severe endothelial and leucocytes disorders. Combined lipid lowering therapy (simvastatin plus ezetimibe) compared to simvastatin alone demonstrated higher efficacy in terms of achievement of target lipid levels, improvement of endothelial function and leucocytes disorders.

[Prosthesis of mitral valve in mesenchimal dysplasia: anatomo-morphological aspects and technical specificities]

Pathomorphological aspects of acquired mitral defects of the heart caused by manifestations of mesenchimal dysplasia were studied in 100 patients. Special attention is given to important features of surgical strategy when performing mitral valve prosthesis in such patients unlike similar procedures for mitral defects of another etiology.

[Hemodynamic features during coronary bypass surgery on the working heart]

Changes in hemodynamics and blood oxygen transport function were studied during coronary bypass surgery (CBS) on the working heart under anesthesia with propofol and fentanyl. In patients operated on the working heart, the course of the basic stage of an operation was characterized by a moderate reduction in cardiac index and stroke volume due to the cardiac changes and immobilization, which resulted in cardiac compression and venous return deterioration. These impairments did not lead to worse oxygen-transportfunction and they were completely eliminated in the rehabilitative period. Analyzing the results of studies of troponin-T and creatinine kinase-MB showed that the procedure of coronary bypass surgery without using EKK had a less damaging effect on the myocardium. Analyzing the course of an early postoperative period indicated that the use of perfusionless technology substantially reduced needs for inotropic support, the time of artificial ventilation, and the length of stay at an intensive care unit.

[Disturbance of endothelium-dependent vasodilation and morphological changes of the radial artery in patients with coronary heart disease]

AIM

To elucidate whether endothelium-dependent vasodilation (EDVD) is a method of early diagnosis of endothelial dysfunction or is a sign of established morphological changes in the vascular wall.

MATERIAL AND METHODS

Endothelialfunction was studied in 44 males with essential hypertension (EH) (mean age 46.9 +/- 0.9 years), in 52 patients with coronary heart disease (CHD) (mean age 50.0 +/- 0.9 years) after mammary-coronary and aortocoronary bypass operation with use of radial artery (RA), and in 28 healthy males (mean age 44.2 +/- 1.2 years). Intraoperative RA biopsy results for patients with ischemic heart disease after coronary artery bypass grafting with RA as an arterial graft were analysed.

RESULTS

Patients with CHD showed thicker complex intima-media (TIM) of the common carotid arteries compared to control and hypertensive patients free of CHD clinical symptoms. This is associated with lowering of EDVD in RA and, therefore, suggests systemic occurrence of endothelial dysfunction. The histological study of RA has found hyperplasia of the internal vascular intima of 1.1 +/- 0.2 degree in 97% of CHD patients. Combination of CHD with hypertension showed thicker intima, higher index of intima thickness and RA narrowing percentage vs such parameters in CHD free of hypertension.

CONCLUSION

Impaired EDVD in the test with reactive hyperemia is due to morphological changes in the radial artery, its intima. The degree of changes in endothelial vascular reactions in RA is closely related to severity of systemic atherosclerosis. In CHD, RA has a marked intimal hyperplasia which leads to vasospasticity and may result in development of stenosis in its use as a graft for myocardial revascularization. One of the basic factors influencing the degree of intimal hyperplasia of the radial artery is severity of arterial hypertension.

[Clinical value of morphological analysis of radial and internal mammary arteries in patients with ischemic heart disease]

Morphological study of intraoperative biopsies of radial and internal mammary arteries taken from patients with ischemic heart disease during coronary bypass surgery revealed structural alterations of intima and media mostly in radial artery. These alterations depended on severity of arterial hypertension, presence of diabetes and extent of atherosclerosis. Hyperplasia of intima could be a basis for radial artery spasm and cause of graft stenoses and occlusions. Therefore protocols of pre and post operative care should take into consideration individual risk factors and morphological and functional features of an artery used for grafting.

[A comparative assessment of the myocardium protection by methods of blood and crystalloid cardioplegia in patients with high risk of coronary bypass grafting operation]

A comparative assessment of specific features of the intraoperative and early postoperative periods was made using antegrade blood and crystalloid cardioplegia during coronary artery bypass grafting operation in 100 patients with ischemic heart disease with a fraction of expulsion of the left ventricle of the heart < 0.5. Using the blood cardioplegia has allowed the need in inotropic support to be lowered at the isolated coronary artery bypass from 29.7% to 11.8%, and at a combination with the resection of the left ventricular aneurysm from 66.7% to 36.4% respectively in the control and main groups. The results obtained suggest that the proposed technique of blood cardioplagia has essential advantages over crystalloid cardioplegia in the coronary shunting of patients with a severe and complicated course of ischemic heart disease.

[Immediate results of using the radial artery in direct revascularization of the myocardium]

The authors discuss results of more than 300 operations of the aorto-coronary bypass using the radial artery as a shunt. An analysis of the initial state of the patients, the intraoperative, early postoperative and intrahospital periods was made. Special attention was given to specific features of the isolating and using the radial artery grafts. Specific complications resulting from the application of them were analyzed and recommendations are given for prophylactics of such complications. The experiences with using the radial arteries allow to recommend it in revascularization of the myocardium. It is one of the ways of improving immediate and long-term results of operations on patients with ischemic heart disease.