Anemia as a Risk Factor for Organ Dysfunctions in Patients Operated on Heart Valves.

Aim      To study the effects of pre- and postoperative anemia on the risk and the structure of internal organ dysfunction in patients undergoing surgery for acquired heart diseases (AHD).Material and methods  This was a retrospective cohort study including 610 primarily operated patients with AHD. A comparative analysis of the incidence and the structure of internal organ dysfunction was performed, and the likelihood of intraoperative hemotransfusion was determined for patients with preoperative anemia (Hb <130 g/l) and without it. The incidence and the nature of internal organ damage were compared in patients with postoperative Hb < 90 g/l and 90-130 g/l.Results The presence of postoperative anemia detected in 45 % of patients at two days after the surgery 6-fold increased the risk of acute heart failure (odds ratio [OR], 5.75; 95 % confidence interval [CI], 1.23-26.84; р=0.016), 4-fold increased the risk of multiorgan failure (MOF) (OR, 4.2; 95 % CI, 1.16-15.64; р=0.03), and 5-fold increased the likelihood of hemotransfusion (OR, 4.74; 95 % CI, 3.12-7.19; р<0.0001). Severe and moderate anemia (Hb <90 g/l) was observed in 11.2 % of patients, which presence 6-fold increased the risk of brain dysfunction (OR, 5.72; 95 % CI, 2.17-15.06; р=0.001) and MOF (OR, 5.97; 95 % CI, 1.94-18.35; р=0.004) compared to patients with Hb 90-130 g/l.Conclusion      In patients with AHD, postoperative anemia increases the risk of circulatory decompensation at two days after the surgery and of MOF and also increases the likelihood of intraoperative hemotransfusion; postoperative anemia with Hb <90 g/l increases the risk of brain damage and MOF.

[Right ventricular systolic dysfunction as a predictor of adverse outcome in patients with COVID-19].

Aim To analyze survival of patients with COVID-19 based on echocardiographic (EchoCG) criteria for evaluation of the right ventricular (RV) systolic function.Material and methods Data of patients were retrospectively evaluated at the Center for Medical Care of Patients with Coronavirus Infection. Among 142 primarily evaluated patients with documented COVID-19, 110 patients (men/women, 63/47; mean age, 62.3 ± 15.3 years) met inclusion/exclusion criteria. More than 30 EchoCG parameters were analyzed, and baseline data (comorbidities, oxygen saturation, laboratory data, complications, outcomes, etc.) were evaluated. ROC-analysis was used for evaluating the diagnostic significance of different EchoCG parameters for prediction of a specific outcome and its probability. Dependence of the overall survival of patients on different EchoCG parameters was analyzed with the Cox proportional hazards model. For assessing the predictive value of EchoCG parameters for patient stratification by risk of an adverse outcome, a predictive model was developed using the CHAID method.Results The in-hospital death rate of patients included into the study was 15.5 %, and the death rate for this period of in-hospital observation was 12 %. Based on the single-factor analysis of EchoCG parameters, a multifactor model was developed using the method of Cox regression. The model included two predictors for an unfavorable outcome, estimated pulmonary artery systolic pressure (EPASP) and maximal indexed right atrial volume (RAi), and a preventive factor, right ventricular global longitudinal strain (LS RV). Base risks for fatal outcome were determined with an account of the follow-up time. According to the obtained values, an increase in EPASP by 1 mm Hg was associated with increases in the risk of fatal outcome by 8.6 % and in the RA(i) volume by 1 ml/5.8 %. LS RV demonstrated an inverse correlation; a 1% increase in LS RV was associated with a 13.4% decrease in the risk for an unfavorable outcome. According to the ROC analysis, the most significant determinants of the outcome were the tricuspid annular plane systolic excursion (TAPSE) (AUC, 0.84 ± 0.06; cut-off, 18 mm) and EPASP (AUC, 0.86 ± 0.05; cut-off, 42 mm Hg). Evaluating the effects of different EchoCG predictors, that characterized the condition of the right heart, provided a classification tree. Six final decisions were determined in the model, two of which were assigned to the category of reduced risk for fatal outcome and four were assigned to the category of increased risk. Sensitivity of the classification tree model was 94.1 % and specificity was 89.2 %. Overall diagnostic significance was 90.0±2.9 %.Conclusion The presented models for statistical treatment of EchoCG parameters reflect the requirement for a comprehensive analysis of EchoCG parameters based on a combination of standard methods for EchoCG evaluation and current technologies of noninvasive visualization. According to the study results, the new EchoCG marker, LS RV, allows identifying the signs of right ventricular dysfunction (particularly in combination with pulmonary hemodynamic indexes), may enhance the early risk stratification in patients with COVID-19, and help making clinical decisions for patients with different acute cardiorespiratory diseases.

[CORRECTION OF HEMOSTASIS WITH BLOOD PRODUCTS IN THE SURGICAL TREATMENT OF CONGENITAL HEART DISEASE IN INFANTS AND YOUNG CHILDREN].

The article deals with the safety and efficiency of recombinant activated factor VII (Coagil VII, Russia) and prothrombin complex concentrate (protromplex-600, Baxter Austria) in the neonatal and pediatric cardiac surgery. The study included 56 children aged from 7 days to 5.5 years underwent surgery with cardiopulmonary bypass for congenital heart defects repair. Clinical and laboratory evidences suggest that Coagil VII and protromplex-600 effective for bleeding stop. The drugs have no negative impact on hemodynamics. We did not identify allergic reactions and thrombosis associated with the introduction of drugs in the pen operative period.

[LEVOSIMENDAN--THE FIRST 10 YEARS IN CLINICAL PRACTICE].

The article deals with a survey of the main pharmacological effects of levosimendane. Special attention is paid to cardiac and organ protective properties of the medication. The article reviews literature data on the efficacy of levosimendan in various fields of medicine and in the experiment and highlights the problem of heart failure and low cardiac output syndrome treatment in cardiology and cardiac surgery.