COVID-19 management in heart transplanted recipients: registry of Almazov National Medical Research Centre.

Aim      This study presents the experience of managing patients with COVID-19 after cardiac transplantation (CT).Material and methods  Infectious complications (IC) following CT are a leading cause for morbidity and mortality. A prolonged incubation period, atypical IC symptoms, and originally altered results of laboratory and instrumental diagnosis are characteristic of recipients due to immunosuppression. In 2020, the coronavirus infection (COVID-19) rapidly spread worldwide, and timely diagnosis and searching for effective treatments for this disease became a major challenge. From January 2010 through July 2020, 148 patients received orthotopic heart transplants at the V.A. Almazov National Medical Research Center; 34 of these patients died by the present time and were excluded from this analysis. 114 patients were included into the retrospective evaluation of results. These patients had been a part of the group followed up at the Center for more than a month.Results From March through July 2020, 12 (10.5 %) of 114 CT recipients were infected with the virus SARS-CoV-2. In 75 % (n=9) of the sick patients, the COVID-19 infection developed after more than one year after CT. From the first day of clinical symptoms, mycophenolic acid/everolimus were temporarily suspended. The outpatient treatment was started on the first day and included an antiviral therapy (oseltamivir), mucolytics (bromhexine), vitamin C, and anticoagulants. If the disease onset was associated with pyretic fever the empiric antibacterial levofloxacin treatment was administered due to a high risk of mixed infection. Hospitalized patients with moderately severe COVID-19 (n=3) were treated with oxygen inhalation through nasal cannula and prone position with a positive effect.Conclusion      Remote counseling of patients after CT and consistency of the outpatient treatment with recommendations of managing transplant physicians provided timely diagnosis of IC, early administration of treatment, and the absence of COVID-19 complications. Reducing the regimen of immunosuppressive therapy (antiproliferative agents) for up to 14 days facilitated infection control and was not associated with acute rejection crisis and/or impairment of the transplant function.

[Arterial hypertension after heart transplantation].

Aim To evaluate incidence of arterial hypertension (AH) in the posttransplantation period and to identify risk factors for this complication.Materials and methods From January, 2010 through December, 2017, 96 heart transplantations (HT) (70 men and 26 women aged 46.5±13.9 years) were performed. During the first month following HT, 8 recipients died and were excluded from the analysis. The retrospective evaluation of results included 88 patients followed up for more than one year.Results For the entire post-HT period (maximum 92 months), AH was observed in 75 of 88 (85%) recipients. Post-HT AH was correlated with male gender (r=0.24; p=0.031), history of smoking before HT (r=0.45; p<0.001), history of ischemic heart disease (IHD) (r=0.28; p=0.01), older age (r=0.35; p=0.001), higher body weight index (r=0.37; p=0.0005), creatinine level (r=0.37; p=0.001), and low-density lipoprotein cholesterol level (r=0.27; p=0.04). Interrelations with other AH risk factors were not found. Most patients developed AH within the first two years after HT. During the first year, AH was diagnosed in 60% (53 of 88) of patients (relapse, 85% (n=29); newly diagnosed, 45% (n=24), p=0.0003). At two years, AH was detected in 79% (46 of 58) of patients (relapse, 53% (n=18); newly diagnosed, 53% (n=28), p=0.9). All recipients received an adequate antihypertensive therapy. 40-63% of patients required a single-drug therapy at different points of follow-up; from 29 to 45% of patients required a two-drug therapy, and 5-15% of patients required three or more drugs. During all 5 years of treatment, most patients used angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) (70-87%) and slow calcium channel blockers (SCCB) (48-53%). The presence of AH following HT was associated with development of all cardiovascular events (CVE; r=0.31; p=0.012) whereas persistent AH, which required a combination antihypertensive treatment, was associated with a high mortality (r=0.61; p=0.015).Conclusion AH is a frequent complication of HT (85%), which is newly diagnosed in most patients during the first two years. AH incidence was higher for male recipients with a history of IHD, hypertension, and smoking. Approximately half of patients required only a single-drug antihypertensive therapy. After HT, the most frequently prescribed drugs included ACE inhibitors or ARBs and SCCBs (70-87% and 48-53%, respectively, depending on the time elapsed after HT). Persistent AH requiring a treatment with two or more antihypertensive drugs was associated with development of all CVEs and a higher long-term mortality.

[Experience of general surgical procedures in patients after heart transplantation].

PURPOSE: To study the frequency of general surgical diseases development snd their features in patients after heart transplantation (HTx). METHODS: From January 2010 to December 2018 it was performed 112 HTx (mean age - 46.7±14.0 years old; 82 - male, 30 - female). During 30 days after HTx 9 patients died. After discharge all recipients (n=98) were included in dispensary observation list. We retrospectively analyzed patients (n=35) who underwent general surgery manipulations in more than 30 days after HTx. All surgical interventions have been done under the reduction of immunosuppression therapy. RESULTS: During 9 years of post-heart transplant follow-up 45 surgical interventions were performed, 7% (n=3) of them due to infectious complications, 31% (n=14) - oncology and others (62%, n=28). Most of manipulations were planned (39 from 45, 87%), the following general surgery interven- tions prevailed: laparoscopic cholecystectomy (n=13) and those to remove inguinal and umbilical hernia (n=12). During the 1st year the frequency of diseases required surgical treatment was 26% (n=11), infectious causes took place in 5 patients, non-infectious - in 6. Subsequently the incidence of infectious complications decreased that could be associated with the minimization of immunosuppressive therapy. Oncology was more frequent long-term after HTx - more than 3 years: among them the development of colon polyps prevailed and all recipients underwent polypectomy. There was no impact of age, gender, causes of chronic heart failure, obesity, immunosuppressive regimen (including the induction) on the frequency of general surgery diseases development (p>0.05). CONCLUSION: Based on our experience, we proposed an algorithm of examination, the features of surgical tactics and preparation for it in heart transplanted recipients are described. The important role of post-heart transplant follow-up in the timely detection of diseases requiring general surgical care is given.

[THE TEST OF GENERATION OF THROMBIN IN DYNAMICS IN PATIENTS AFTER TRANSCUTANEOUS CORONARY INTERVENTION].

The article presents results of observation of generation of thrombin in patients with ischemic heart disease in different terms after transcutaneous coronary intervention. The sampling included 37 patients with stable ischemic heart disease. The control group included 30 healthy individuals. To study system of hemostasis of this category of patients the test of generation of thrombin and its modification with added thrombomodulin were applied for evaluating anti-coagulant activity of system of protein C. The comparison of indicators of test of generation of thrombin in patients with ischemic heart disease before operation and in individuals of control group revealed no reliable differences (p > 0.05). The observation of patients with stable ischemic heart disease in various time-frame after mechanical re-vascularization of myocardium established significant increasing of generation of thrombin and decreasing of anticoagulant activity of system of protein C at 1-3 day after operation (p < 0.05). The positive correlation was established between endogenous thrombin potential and annexin 5, an early marker of dysfunction of endothelium in mentioned time-frame after operation (p = 0.0008; r = 0.57). The significant increasing of content of anti-inflammatory markers of C-reactive protein and fibrinogen was observed at 1-3 day after transcutaneous coronary intervention (p < 0.05). In that way, the study data give evidence to hyper-coagulation in patients with stable ischemic heart disease in early time-frame after operation despite normal values of activated partial thromboplastin time, prothrombin time, D-dimer and applied standard disaggregant therapy.

[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.

[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.

[Characteristics of hemodynamics and metabolism and structural polymorphisms of angiotensin converting enzyme and angiotensin II type I receptors genes in women of childbearing]. / Osobennosti gemodinamiki, metabolizma i strukturnyi polimorfizm genov angiotenzinprevrashchaiushchego fermenta i retseptorov 1-go tipa angiotenzina II u zhenshchin detorodnogo vozrasta pri arterial'noi gipertenzii 1-i stepeni.

Parameters of systemic and intracardiac hemodynamics, characteristics of metabolism, and structural polymorphisms of angiotensin converting enzyme (ACE) and angiotensin II type 1 receptor (ATR(1)) genes were studied in women of childbearing age and men of the same age both with first degree hypertension. Women had lower mean 24-hour blood pressure (BP), greater BP variability, preponderance of "dipper" variant of 24-hour systolic and diastolic BP profile, higher prevalence of left ventricular hypertrophy, lower blood levels of cholesterol, triglycerides, urea and potassium. Among women A allele of ATR(1) gene was significantly more frequent than C allele. Comparison of ATR(1) gene polymorphisms in women and men showed that frequencies of AA genotype and A allele were higher in women. Presence of DD genotype of ACE gene in women was related to parameters of both hemodynamics and metabolism, whereas that of II genotype of ACE gene as well as AA and AC genotypes of ATR(1) gene were linked with parameters of hemodynamics.

[Clinical manifestation of hypertension in citizens of siege Leningrad (1941-1944). Retrospective analysis of archive materials]. / Osobennosti klinicheskikh proiavlenii arterial'noi gipertonii u zhitelei blokadnogo Leningrada (retrospektivnyi analiz arkhivnykh materialov).

AIM: To characterize peculiarities of arterial hypertension course in citizens of sieged Leningrad. MATERIALS AND METHODS: 2000 case records of hypertensive patients treated in 6 hospitals of sieged Leningrad have been analysed. RESULTS: Arterial hypertension (AH) was verified as the basic disease in 69 cases. Of them, only 47 patients were eligible for analysis. Mean age of the patients was 45 years. AH duration before hospitalization was less than 1 year in 35% of the cases. Hypertensive crises, hypertensive angiopathy, cerebral atherosclerosis, cardiac hypertrophy were documented in 25, 15, 15 and 64% of the cases, respectively. In hospital, no specific antihypertensive therapy was given. At the discharge, systolic blood pressure decreased significantly, diastolic blood pressure decreased insignificantly. CONCLUSION: Clinical data evidence for rapid affection of target organs in hypertensive subjects exposed to unfavourable conditions of the war time.