CAROTIDSCORE.RU-The first Russian computer program for risk stratification of postoperative complications of carotid endarterectomy

GOAL

Presentation of the first Russian computer program (www.carotidscore.ru) for risk stratification of postoperative complications of carotid endarterectomy (CEE).

MATERIAL AND METHODS

The present study is based on the analysis of a multicenter Russian database that includes 25,812 patients after CEE operated on from 01/01/2010 to 04/01/2022. The following types of CEE were implemented: 6814 classical CEE with plastic reconstruction of the reconstruction zone with a patch; 18,998 eversion CEE.

RESULTS

In the hospital postoperative period, 0.18% developed a lethal outcome, 0.14%-myocardial infarction, 0.35%-stroke. The combined endpoint was 0.68%. For each factor present in patients, a predictive coefficient was calculated. The prognostic coefficient was a numerical indicator reflecting the strength of the influence of each factor on the development of postoperative complications. Based on this formula, predictive coefficients were calculated for each factor present in patients in our study. The total contribution of these factors was reflected in "%" and denoted the risk of postoperative complications with a minimum value of 0% and a maximum of 100%. On the basis of the obtained calculations, a computer program CarotidSCORE was created. Its graphical interface is based on the QT framework (https://www.qt.io), which has established itself as one of the best solutions for desktop applications. It is possible not only to calculate the probability of developing a complication, but also to save all data about the patient in JSON format (for the patient's personal card and his anamnesis). The CarotidSCORE program contains 47 patient parameters, including clinical-demographic, anamnestic and angiographic characteristics. It allows you to choose one of the four types of CEE, which will provide an accurate stratification of the risk of complications for each of them in person.

CONCLUSION

CarotidSCORE (www.carotidscore.ru) is able to determine the likelihood of postoperative complications in patients undergoing CEE.

[Effect of renal artery stenting on the clinical and geriatric status of elderly patients with vasorenal hypertension.]

The study consists in determining the effect of renal artery stenting in patients with arterial hypertension in combination with renal artery stenosis on the dynamics of clinical and geriatric status in terms of such indicators as the number of drugs taken, cognitive status, determined by the MMSE scale, prevalence of the frequency of falls, psycho-emotional status by the Beck scale, the quality of sleep on the VAS scale, the index of age discrimination according to the E.Palmore ageism questionnaire, the quality of life according to the SF 36 questionnaire. The study involved 72 elderly patients with arterial hypertension in combination with renal artery stenosis. According to the results of the study, as a result of stenting of the renal arteries, there is a decrease in the number of drugs taken, an improvement in the cognitive status on the MMSE scale, a decrease in the frequency of falls, an improvement in the psycho-emotional status on the Beck scale, an improvement in the quality of sleep on the VAS scale, a decrease in the level of age discrimination, an increase in the quality of life according to questionnaire SF-36 on all scales.

Pulmonary Vascular Thrombosis in COVID-19: Clinical and Morphological Parallels

Aim. We aimed to study the histological and thrombotic changes in lung vessels in patients who died with COVID-19, to access the correlation between anticoagulation therapy (ACT) and thrombotic events (TE), treatment results, clinical and laboratory patients' characteristics.

Material and Methods. We retrospectively analyzed treatment results of patients hospitalized with COVID-19 and lung vessel samples of the deceased patients. Dynamic changes and highest levels of D-dimer and fibrinogen were studied in its correlation with the disease severity according to SOFA score, computer tomographic (CT) results, lung, renal and hepatic dysfunction. The association between different doses of ACT and treatment results, laboratory indicators and thrombotic events was accessed. The histological lung vessels examination was performed using Martius Scarlet Blue (MSB)staining.

Results. 313 patients were included in the study (61 patients died). The median age of hospitalized patients was 60 years (IQR 51-66 years). The frequency of the intravitallyconfirmed TE was 4,8%. The strong statistical association was revealed between D-dimer level and 3-4 points SOFA score, patients' mortality, oxygen support requirement, CT3-CT4 pneumonia, glomerular filtration rate and TE. There was no mortality in patients with D-dimer normal references, but in cases with three times elevation reached 13%, 48,5% - in cases with 3-6 times elevation and 64,6% - in cases with more than 6 times elevation. The strong statistical association was registered between fibrinogen and SOFA score, CT 3-4 pneumonia, patients' mortality. D-dimer and fibrinogen levels demonstrated weak correlation. There was no statistical correlation between prophylactic, intermediate and therapeutic ACT and D-dimer and fibrinogen levels, CT results, patients' mortality. MSBstaining was used in 36 deceased patients tissue samples. 1394 lung vessels were analyzed. Lung vessels thrombi persisted in samples of all 36 patients (100%). Vessels with the diameter 3,5-30 mm were thrombosed in 7%, with the diameter 0,034-0,84 mm - in 48%, with the diameter 0,85-3,4 mm - in 45%. The frequency of thrombi persisted 06 hours, 6-12 hours, 12-18hours, 18-24 hours and more than 24 hours was12%, 14%, 62%, 5% and 7% respectively.

Conclusion. Thrombi of different ages from fresh to organized were observed in one third of lung vessels in all deceased patients. Lung vessels thrombosis plays an important role in pathogenesis and thanatogenesis of COVID-19. The D-dimer level correlates with lung, renal dysfunction, patients' mortality and doesn't show any correlation with ACT and can be accepted as a criterion of lung vessel thrombotic progression.

CAROTID ENADRTERECTOMY FOR INTERNAL CAROTID THROMBOSIS IN PATIENTS WITH COVID-19

Analysis of the results of emergency carotid endarterectomy (CEE) against the background of internal carotid artery (ICA) thrombosis in the acute period of acute cerebrovascular accident (ACVA) in patients with COVID-19. During the COVID-19 pandemic (April 1, 2020-May 1, 2021), 43 patients with ICA thrombosis and a positive polymerase chain reaction (PCR) result for SARS-CoV-2 were included in this prospective study. In all cases, CEE was performed in the acutest period of ACVA. These patients were included in group 1. The comparison group was represented by 89 patients who underwent CEE in the acute period of stroke, in the period before the COVID-19 pandemic (April 1, 2019-March 1, 2020). According to laboratory parameters, patients with COVID-19 had severe coagulopathy (with an increase in D-dimer: 3832 ± 627.2 ng/mL, fibrinogen: 12.6 ± 3.1 g/L, prothrombin: 155.7 ± 10, 2%), inflammatory syndrome (increased ferritin: 646.2 ± 56.1 ng/mL, C-reactive protein: 161.3 ± 17.2 mg/L, interleukin-6: 183.3 ± 51.7 pg/mL, leukocytosis: 27.3 ± 1.7 10E9/L). In the hospital postoperative period, the groups were comparable in terms of the incidence of deaths (group 1: 2.3%, n = 1; group 2: 1.1%, n = 1; P= 0.81; OR=2.09; 95 % CI = 0.12-34.3) myocardial infarction (group 1: 2.3%, n = 1; group 2: 0%; P= 0.7; OR = 6.3; 95% CI = 0.25-158.5), CVA (group 1: 2.3%, n = 1; group 2: 2.2%, n = 2; P= 0.55; OR = 1.03; 95% CI = 0,.09-11.7). ICA thrombosis and hemorrhagic transformations were not recorded. However, due to severe coagulopathy with ongoing anticoagulant/antiplatelet therapy, patients with COVID-19 more often developed bleeding in the operation area (group 1: 11.6%, n = 5; group 2: 1.1%, n = 1; P= 0.02; OR = 11.5; 95% CI = 1.3-102.5). In all cases, the flow of hemorrhagic discharge came from the drainage localized in the subcutaneous fat. This made it possible to remove skin sutures in a dressing room, suturing the source of bleeding and applying secondary sutures under local anesthesia. Emergency CEE in the acute period of stroke is an effective and safe method of cerebral revascularization in case of ICA thrombosis in conditions of COVID-19.

Results of different kinds of carotid endarterectomy in patients with and without type 2 diabetes mellitus

BACKGROUND: Type 2 diabetes mellitus (DM) is one of the important markers for the development of adverse cardiovascular events after carotid endarterectomy (CEE). However, studies on this issue are based on small sample of patients and do not take into account the type of surgery as an additional factor of potentially negative impact on the course of the postoperative period.AIM: Analysis of hospital and long-term results of eversion and classical CEE with plastic surgery of the reconstruction zone with a biological patch in patients with type 2 diabetes and without it.MATERIALS AND METHODS: In this multicenter retrospective study from January 2010 to December 2020. included 5731 patients. Depending on the presence / absence of type 2 diabetes and the type of implemented CEE, 4 groups were formed: group 1 — 12.2% (n = 702) — patients with type 2 diabetes and eversion CEE; Group 2 — 55.0% (n = 3153) patients without type 2 diabetes and eversion CEE; Group 3 — 8.5% (n = 484) patients with type 2 diabetes and classical CEE; Group 4 — 24.3% (n = 1392) patients without type 2 diabetes and classical CEE. The duration of postoperative follow-up was 78.6 ± 39.2 months.RESULTS: At the long-term follow-up stage, patients with type 2 diabetes after the classical surgical technique demonstrated the highest rates of all types of complications: death (p <0.0001), MI (p = 0.011), ischemic stroke (p <0.0001), restenosis / occlusion of the ICA (p <0.0001), combined end point (p <0.0001). At the same time, the group of eversion CEE with impaired carbohydrate metabolism took the second position in terms of the prevalence of adverse events. These circumstances demonstrate that patch implantation is accompanied by an increased risk of developing not only myocardial infarction, but also restenosis of the reconstruction zone, as well as the associated ischemic stroke, which was demonstrated by our results.CONCLUSION: Patients with type 2 diabetes and a history of CEE are at increased risk of ischemic stroke at the hospital stage of observation and all unfavorable cardiovascular conditions (death, myocardial infarction, ischemic stroke, restenosis or ICA occlusion in the reconstruction zone) in the long-term postoperative period.

[Pulmonary artery thrombosis: strategy of anticoagulation]

This review is devoted to the management of primary artery thrombosis (PAT). This disease was always considered only as a part of other venous thromboembolic events, in particular isolated pulmonary embolism (PE). Various studies show that PAT can develop as an independent event without concomitant damage to extra-vessels. PAT is characterized by own typical signs as primary and recurrent event that can determine special strategies of treatment. However, there are no studies devoted to this problem. We can only make some assumptions about PAT anticoagulation (AC) considering data on isolated PE comprising PAT. These data are available in PADIS-PE, ASPIRE, EINSTEIN-PE, Hokusai-VTE studies underlying modern guidelines of various societies. In the absence of studies on PAT AC these guidelines should regulate PAT AC approaches. AC is recommended in all cases of PE except isolated subsegmental PAT in ambulatory patients. Duration of AC depends on risk factors (major or minor). Anticoagulation for PAT following chronic inflammatory diseases is still disputable.

[A multicenter study on the influence of different kinds of carotidal endarterectomy on the course of resistant arterial hypertension]

OBJECTIVE

To analyze the dynamics of systolic blood pressure (SBP) and the results of various types of carotid endarterectomy (CEE) in patients with resistant arterial hypertension (RAH).

MATERIALS AND METHODS

The study included 1577 patients with hemodynamically significant stenosis of the internal carotid artery (ICA) and RAH for more than 3 years. Patients were enrolled from January 2014 to December 2020. Depending on the implemented revascularization strategy, 5 groups were formed: group 1 (n=289 (18.3%)) with classical CEE with plasty of the reconstruction zone with a patch, group 2 (n=472 (29.9%)) with eversional CEE with cut-off of carotid glomus (CG); group 3 (n=109 (6.9%)) with the formation of a new bifurcation; group 4: (n=117 (7.4%)) with autoarterial reconstruction; group 5: (n=590 (37.4%)) with glomus-saving CEE.

RESULTS

In the postoperative period, no significant differences were obtained in the frequency of deaths (0.34% for group 1; 0.63% for group 2; 0% for groups 3, 4 and 5), myocardial infarction (0.34%, 0.84%, 1.83, 0.85%, 0.33%, respectively); ischemic stroke (0.34%, 1.27%, 0.91%, 0.85%, 0.17%, respectively), hemorrhagic transformation (0%, 0.84%, 0.91%, 0.85%, 0%, respectively). However, according to the frequency of the combined endpoint (death + myocardial infarction + ischemic stroke + hemorrhagic transformation), the lowest rates were observed in the group of classical carotid endarterectomy with plasty of the reconstruction zone with a patch and glomus-sparing CEE (1.03%, 3.6%, 3.67%, 2.56%, 0.5%, respectively). This is due to the absence of cases of labile AH and hypertensive crises among patients of groups 1 and 5, which was ensured by the preservation of carotid glomus (CG). As a result, the number of patients with 2 and 3 degrees of hypertension in these groups decreased statistically significantly. The vast majority of patients after these operations achieved a stable target SBP. In groups 2, 3, and 4, there was a statistically significant increase in the number of patients with 2 and 3 degrees of AH, which is associated with excision of the CG.

CONCLUSION

Classical CEE and glomus-sparing CEE techniques make it possible to achieve a stable target SBP level in patients with RAH as a result of CG preservation. Removal or traumatization of the latter during eversional CEE, the formation of a new bifurcation, autoarterial reconstruction is accompanied by the development of labile hypertension, an increase in the degree of hypertension and a high risk of hemorrhagic transformation in the brain. Thus, the most effective and safe types of CEE in the presence of RAH are classical CEE with plasty of the reconstruction zone with a patch and glomus-sparing CEE.

[Extended lesion of the internal carotid artery: carotid autotransplantation, creation of a neobifurcation or prosthetic repair?]

AIM

The aim of our investigation was to analyse the results of autotransplantation, creation of a neobifurcation or prosthetic repair of the internal carotid artery during the in-hospital and long-term follow-up periods.

PATIENTS AND METHODS

The study included a total of 241 patients presenting with and treated for extended atherosclerotic lesions of the internal carotid artery from 2016 to 2019. The patients were divided into three groups depending on the surgical modality employed: group 1 - autotransplantation of the internal carotid artery (27.8%, n=67), group 2 - creation of a neobifurcation (55.2%, n=133), and group 3 - prosthetic repair of the internal carotid artery (17.0%, n=41). The duration of the postoperative follow-up period amounted to 24.8±11.9 months. The outcome measures selected were as follows: all-cause mortality, myocardial infarction, ischaemic stroke, haemodynamically significant restenosis, and a composite endpoint (death + myocardial infarction + ischaemic stroke + haemodynamically significant restenosis).

RESULTS

During the in-hospital postoperative period we registered 1 (2.4%) ischaemic stroke in the group of prosthetic repair, with no significant inter-group difference revealed (p=0.08). In the remote period of follow-up, no statistical differences were revealed for the following outcome measures: all-cause mortality (group 1: 7.5%, n=5; group 2: 10.5%, n=14; group 3: 14.6%, n=6; p=0.49); cardiovascular-related death (group 1: 4.5%, n=3; group 2: 6.7%, n=9; group 3: 12.2%, n=5; p=0.31); myocardial infarction (group 1: 1.5%, n=1; group 2: 3%, n=4; group 3: 4.9%, n=2; p=0.59). However, the patients in the group of prosthetic repair of the internal carotid artery were found to have the highest incidence rates of ischaemic stroke (group 1: 3%, n=2; group 2: 3%, n=4; group 3: 14.6%, n=6; p1-2=0.1; p1-3=0.02; p2-3=0.008), haemodynamically significant restenosis (group 1: 0%, n=0; group 2: 0%, n=0; group 3: 14.6 %, n=6; p1-2>0.99; p1-3=0.000; p2-3=0.000), and higher values of the composite endpoint (group 1: 12 %, n=8; group 2: 16.5%, n=22, group 3: 48.8%, n=20; p1-2>0.99; p1-3=0.000; p2-3=0.000).

CONCLUSION

Prosthetic repair of the internal carotid artery for an extended atherosclerotic lesion is a less preferable method compared with autotransplantation and creation of a neobifurcation, as evidenced by the highest incidence rates of ischaemic stroke, haemodynamically significant restenosis, and higher values of the composite endpoint in the remote period of follow up.

[Stenting of the first segment of the spinal artery in the acutest period of ischemic stroke in the vertebrobasilar territory]

OBJECTIVE

To analyze hospital and long-term results of stenting of the V1 segment of the vertebral artery (VA) in the first hours after acute cerebral hemopoiesis/transient ischemic attack (stroke/TIA) in the vertebrobasilar territory (VT).

MATERIAL AND METHODS

The current retrospective study from 2012 to 2019 included 169 patients with hemodynamically significant stenosis of the V1 segment of the VA, who underwent emergency stenting in the first hours after the onset of stroke. The mean time between the development of stroke and correction was 368.5±129.8 minutes. The average time between admission to the medical institution and submission to the X-ray operating room was 89.2±10.7 minutes. VA stenting was performed through the transfemoral approach. In 118 cases (69.8%) a drug eluting stent was implanted, in 51 (30.2%) a bare metal stent was implanted. 90% of VA segment V1 stenosis was diagnosed in 48 patients before the onset of stroke. Of these, 33 received conservative therapy for vertebrobasilar insufficiency (VBI) for 2.5±1.0 months in anticipation of regression of the disease. The remaining 15 did not have VBI symptoms and did not need active drug treatment. Ultimately, within this sample, the time interval between the visualization of stenosis and the onset of stroke was 3.0±1.0 months. In 17 patients, stroke/TIA in VT became recurrent. The period between two neurological events was 1.5±0.5 months. Nine patients did not wait for the planned intervention due to the development of an adverse neurological event before the appointed date of hospitalization. The other 8 did not appear for the interventional correction on time due to subjective reasons and were again admitted to the medical facility on an urgent basis.

RESULTS

During the hospital follow-up period, no adverse cardiovascular events were recorded. When assessing the dynamics in the neurological status, there was a significant regression of the deficit by the time of discharge from the hospital. In the long-term follow-up period (38.2±20.4 months), a fatal outcome was recorded in 2.4% of cases (n=4). Non-fatal myocardial infaction was diagnosed in 5 patients (2.9%). Restenosis of the stent in the VA was visualized in 56 patients (33.1%). In 17 cases, it became symptomatic (10.0%). All patients underwent repeated stenting with a successful result of the procedure.

CONCLUSION

Emergency stenting of hemodynamically significant stenosis of the V1 segment of the VA in the acute period of stroke in VT is a safe and effective method of revascularization characterized by the absence of adverse cardiovascular events at the hospital stage of observation.

Evolution of carotid endarterectomy: A literature review

<p>This review investigates the various methods used for carotid endarterectomy (CEE). These methods are presented, and allow us to analyse effective revascularisation with extended damage to the internal carotid artery. The data of studies comparing the results of eversion and classical carotid endarterectomy with plasty of the reconstruction zone with a patch made of diepoxy-treated pericardium are presented. Special attention is paid to emergency carotid endarterectomy and carotid endarterectomy in the acute period of ischemic stroke. The important and main aspects of the glomus-saving species of CEE are also demonstrated. The main complications behind operations, and causes of restenosis in long-term follow-up periods are also duly noted. Similarly, suggestions to eliminate these issues are also proposed. This review comprehensively covers the state of the art of carotid endarterectomy and dissects current techniques and methods in the area.</p><p>Received 16 July 2020. Revised 24 August 2020. Accepted 25 August 2020.</p><p><strong>Conflict of interest:</strong> Authors declare no conflicts of interest.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Author contributions</strong><br />Conception and study design: G.G. Khubulava<br />Drafting the article: A.N. Kazantsev<br />Critical revision of the article: A.A. Erofeev, V.N. Kravchuk, K.P. Chernykh<br />Final approval of the version to be published: G.G. Khubulava, A.N. Kazantsev, A.A. Erofeev, V.N. Kravchuk, K.P. Chernykh</p>

[Planning and organization of allo-grafting performed on the soldier's face]

Planning and organisation of allo-grafting performed on the soldier's face. According to the experience of military conflicts facial trauma with the Ioss of person's social function occurs in 4,5-5% of patients with such injury. In most cases, these injuries can be fixed with the help of reconstructive plastic surgery using their own tissue. However, some of the wounded to various reasons the use of autologous tissue is not possible or does not allow adequately restoring the appearance and function of the person. In such cases the only way is a donor allograft. There are just over 3 dozens of such successful operations, which indicates of their uniqueness and complexity. In May 2015 at the S.M.Kirov Military Medical Academy for the first time in our country made a successful transplantation of a difficult graft to a conscript, who was injured during the duty. The article presents the basic directions of the planning and organization of this unique operation.

[Treatment of elderly patients with combination of coronary artery disease and aortic valve pathology]

Increasingly, there are patients with concomitant coronary artery disease and aortic valve, especially in elderly patients, who often have severe comorbidities and high surgical risk, which is undoubtedly a certain effect on the choice of method and tactics of treatment. Today, there are several approaches to the treatment of patients in this category, and all of them have certain advantages and disadvantages.

[DIRECT REVASCULIZATION OF THE MYOCARDIUM FROM LEFT-SIDE MINITHORACOTOMY - MODERN PERFORMANCE OF THE OPERATION NAMED AFTER V.I. KOLESOV]

The article provides the results of minimally invasive direct revasculization of myocardium at the period from 2012 to 2014. Given method was used in 49 interventions. There weren't any lethal cases or myocardial infarctions. A mean hospital stay consisted of 8,6±2,7. Computer thomographic coronary bypass angiography was carried out after operation in terms of 6-48 months. The occlusion of mammary coronary shunt was revealed in 3 patients with minimally invasive revasculization of the myocardium in terms up to 48 months. There were noted a decrease' of hospital stay, bleeding during surgery and in early postoperative period, duration of artificial pulmonary ventilation, length of stay in intensive care unit for this group of patients.

[HYBRID REVASCULIZATION AS METHOD OF SURGICAL TREATMENT OF ISCHEMIC CORONARY DISEASE IN NUMEROUS LESIONS OF CORONARY BED]

Hybrid revasculization of myocardium combined the advantages of mammary-coronary bypass surgery and coronary arteries stenting. It presented itself as a perspective direction in treatment of ischemic coronary disease. The article provides the results of comparison of usage of hybrid revasculization of myocardium and aortocoronary bypass in 71 patients with multivessel coronary artery disease. The data obtained indicated, that hybrid approach allowed complete revasculization of the myocardium (as in case of aortocoronary bypass), fast recovery of the patient, shortening a hospital stay due to decrease of intra- and postoperative complications.

[Endovascular treatment of bifurcation lesions of the coronary arteries in elderly patients: a literature review N-2]

Intervention in bifurcation coronary arteries disease is complicated kind of endovascular treatment of coronary heart disease, especially in patients of elderly and senile age. Recently, in the practice of the operating surgeon there is a large choice of bifurcation coronary artery stents. This report contains the views, features and shortcomings of the presented bifurcation structures. Despite the fact that in the Russian Federation bifurcation stents are rarely implanted, their use can greatly simplify and accelerate interventional procedures, along with the decrease of peri- and postoperative complications.

[Endovascular treatment of bifurcation lesions of the coronary arteries in patients of elderly age: a review of the literature No 1]

Stenting of coronary artery bifurcation lesions is one of the most difficult types of interventional procedures for coronary heart disease. The frequency of coronary artery bifurcation lesion occurs up to 20%. The article reflects a wide variety of types of classifications of coronary bifurcations compared with the basic classification for A. Medina. Having considered the arts of bifurcations stenting, from a provisional Tstenting to complex procedures culote and crush stenting, we advocate the use of bifurcation structures, especially in elderly and senile.

[Application of a device for determination of the transplant length during operation of the aorta-coronary bypass]

Determination of the necessary length of the bypass is one of the principal stages of operation of the aorta-coronary bypass. The greatest difficulty of the determination of the bypass length is the first-priority applying of proximal anastomoses. It requires the surgeon to have great experience, the operation to be longer. It also makes it necessary to prepare a conduit of deliberately excessive length. A device is proposed for the determination of the necessary bypass length during operation of aorta-coronary bypass consisting of a crocodile grip with a fixed to it polymer tube.

[Specific features of the technique of performing coronary bypass operations on the beating heart]

The article presents a technique of performing coronary bypass operations on the beating heart used by the authors in 847 patients which is based on high thoracic epidural anesthesia, primary formation of proximal anastomoses of the aorto-coronary bypasses and specified succession of the formation of distal, stabilization of the local part of the heart in the field of placing distal anastomosis and access to the lateral and posterior surface of the heart with vacuum stabilizers, using blower-humidifier and intracoronary shunts.

[The dynamics of functional state of the cardio-vascular system during 2 years after aorto-coronary shunting]

The investigation included 45 patients with coronary heart disease operated for aorto-(mammaro)-coronary artery bypass grafting. It was found that surgical treatment resulted in the improvement of subjective symptoms of angina and increased contractile reserve of the myocardium during the first days after surgery. Significantly increased subjective and objective exercise tolerance, improvement of local myocardial contractility, diastolic function and symptoms of myocardial remodeling were registered only within 6 months after surgery. Assessment of the dynamics of the myocardial contractile reserve can be used as an objective criterion of the earliest positive result of surgical treatment of coronary artery disease.

[Experience of left ventricular assist device "Incor" as "bridge to recovery" implantation in patients with end stage congestive heart failure]

Left ventricular assist device "Incor" ("Berlinhear", Germany) implantation experience in patient with ischemic cardiomiopathy and severe congestive heart failure is presented. Left ventricular assist device implantation was followed by coronary artery bypass grafting simultaneously. Total assist time was 211 days. Complications developed during assisting time are shown. After Left ventricular assist device explantation three chamber pacemaker was implanted as cardiac resynchronization therapy. Left ventricular end diastolic size decreased (from 78 to 70 mm), ejection fraction increased (from 19 to 35%) during assist time.

[Features of surgical treatment of ischemic heart disease in women]

The features of preoperative status, course of the perioperative period and immediate results of coronary shunting were compared and analyzed in 523 patients, 56 of them were women. In female patients there were more often factors negatively influencing the course of the postoperative period. No additional intraoperative risk factors were found. The direct results of coronary shunting proved to be similar in men and women. No significant difference in the frequency of the development of early postoperative complications and hospital lethality, considerable correlation between the gender and frequency of postoperative complications were established by the methods of correlative analysis.

[Surgical treatment of patients with post-infarction aneurysm of the left ventricle and diffuse lesion of the anterior interventricular artery]

Diffuse lesions of the anterior interventricular artery (AIVA) at different levels were diagnosed in 27 out of 417 patients operated for post-infarction aneurysm of the left ventricle (PIALV). During the preoperative period coronography, ventriculography, ultrasonic examination of the heart were made in all the patients, one-photon emission computed tomography with 123I-iodopent was used for radioisotope investigation of perfusion and metabolism of the myocardium. The presence of PIALV, diffuse atherosclerotic lesion of AIVA and viable myocardium in its basin was taken as an indication for autovenous plasty of the artery with the following shunt of the left intrathoracic artery and resection of PIALV.

[Topographo-anatomic interrelationships between the branches of the lumbar arteries and the spinal ganglia, nerves and roots]

By using a complex of investigation methods variants of branchingout of the spinal cord and spinal ganglia blood supply sources and their anatomo-topographic interrelations were discerned in 140 preparations of lumbar spinal ganglia obtained from human cadavers of both sexes and different age. With the help of anastomoses these sources form a specific arterial circle around the ganglion. The radicular arteries are noted to be non-equivalent. The annular architectonics of the blood vessels is considered as a morphological manifestation of a functionally reliable blood supply to the border area between the central and peripheral divisions of the nervous system.