[Effect of an antioxidant on vascular wall cell apoptosis markers after reconstructive operations]. / Vliianie antioksidanta na markery apoptoza kletok sosudistoi stenki posle rekonstruktivnykh operatsii.

AIM: This study was aimed at determining Bcl-2 and Bax proteins expression before and after reconstructive-repairing operations in patients with atherosclerosis obliterans of lower extremities and at assessing the effect of an antioxidant (vitamin E at a dose of 100 mg once daily for 1 month after surgery) on the dynamics of changes of Bcl-2 and Bax proteins in the postoperative period. PATIENTS AND METHODS: The study included a total of 60 patients with stage III-IV lower limb atherosclerosis obliterans. All patients underwent reconstructive-repairing operations on the arteries of the aortofemoral segment. After surgery the patients were divided into two groups. Group A included 30 patients who during 1 month received additionally to basic therapy vitamin E at a daily dose of 100 mg. Group B was composed of 30 patients receiving basic therapy alone according to the National guidelines of managing patients with peripheral artery disease. All patients before, on POD 1, and 1 month after surgery were subjected to venous blood test aimed at determining Bcl-2 and Bax apoptosis proteins expression by means of enzyme-linked immunosorbent assay. RESULTS: In patients of groups A and B, the baseline level of Bcl-2 protein (4.75 and 4.2 ng/ml, respectively) was comparable with that in apparently healthy volunteers (5.3 ng/ml). The baseline levels of Bax protein in patients of the operated groups (26.9 and 26.0 ng/ml, respectively) were increased compared with the values in healthy volunteers (16.5 ng/ml). On POD 1 there was increased expression of Bax protein in Group A and B patients to 39.4 and 30.2 ng/ml, respectively. One month after surgery, Group B patients demonstrated a decrease in the Bcl-2 values below the baseline level - 1.1 ng/ml (p=0.003), with the Bax level continuing to increase - 36 ng/ml (p=0.004). In turn, Group A patients after 1 month were found to have increased levels of the Bcl-2 protein - 5.75 ng/ml, with the Bax level returning to the baseline values - 27.4 ng/ml. CONCLUSION: In stage III and IV lower limb obliterating atherosclerosis, the level of the Bax proapoptoric protein was higher than that in healthy volunteers. On POD 1, there occurred increased expression of the pro-apoptotic protein Bax and activation of apoptosis markers. On the background of using vitamin E at a dose of 100 mg once daily for 1 month, there was a decrease in level of the Bax propapoptotic protein (p=0.003) and an increase in level of the anti-apoptotic Bcl-2 protein level (p=0.0007).

Oxygen provision of the brain at various stages of operation in patients with chronic pulmonary artery thromboembolism.

The authors studied cerebral oxygen supply by means of cerebral oximetry in patients presenting with chronic pulmonary artery thromboembolism (PATE) at various stages of operation. The study was aimed at assessing cerebral oxygen supply while carrying out surgical treatment in patients with chronic PATE on the background of various methods of perfusion. Thromboendarterectomy (TEA) from the pulmonary artery with the use of circulatory arrest and craniocerebral hypothermia is accompanied by more pronounced impairment of oxygen supply of the brain with a decrease in the cerebral oxygenation indices by more than 30% from the baseline values. These alterations promote increased risk for the development of neurological complications in the early postoperative period. Using the technique of antegrade cerebral perfusion ensures a minimum decrease of cerebral oxygenation during TEA and contributes to a reduction of the risk for the development of neurological complications.

[Experience with intra-aortic balloon pumping preventively used in patients with a low left ventricular ejection fraction, operated on under extracorporeal circulation].

One hundred and fifty-six patients with coronary heart disease and a low (less than 30%) left ventricular ejection fraction (EF), operated on under extracorporeal circulation and preventive intra-aortic balloon pumping (IABP) were examined. The latter was found to promote the maintenance of stable hemodynamic parameters during and after surgery. Postoperative acute heart failure developed in 101 (64.7%) patients. Mortality was 9.6% (15 patients), in 9 cases death occurred after acute heart failure. There were no intra- and postoperative cases of lower extremity ischemia. Thus, preventive IABP is a safe and effective procedure in patients with low myocardial contractility (EF less than 30%), operated on under extracorporeal circulation.