[Transcutaneous coronary intervention with the use of extracorporeal membrane oxygenation in patients with acute coronary syndrome]. / Chreskozhnoe koronarnoe vmeshatel'stvo s primeneniem ékstrakorporal'noi membrannoi oksigenatsii u bol'nykh s ostrym koronarnym sindromom.

Analysed herein are the in-hospital and remote (12 months) results of transcutaneous coronary interventions (TCI) carried out in patients with non-ST elevation acute coronary syndrome (nSTE-ACS) and multivessel coronary artery disease with the use of extracorporeal membrane oxygenation (ECMO). From 2013 to 2015, the study included a total of 18 patients with nSTE-ACS and multivessel coronary artery disease who had been denied "open" surgical myocardial revascularization. The mean values (scores) of the scales in the group were as follows: GRACE - 119.7±67.6, SYNTAX Score - 33.5±8.1, Euroscore II - 5.2±21.9. The ejection fraction was averagely moderately low - 49.3±19.4%. During the in-hospital stay of the patients and 12 months after TCI we assessed the major adverse cardiovascular events (MACE): death, myocardial infarction, acute cerebral circulation impairment/transitory ischaemic attack, repeat revascularization of the target vessel - both as separate parameters and in a composite form. Additionally, we analysed perioperative and in-hospital complications, their structure, the volume of replacement therapy with blood components and the length of hospital stay. During the in-hospital period and at 12 months of follow up, the composite number of cases of adverse cardiovascular events amounted to 1 (5.5%) and 3 (16.5%), respectively. One patient died during in-hospital treatment and one more lethal outcome was registered by 12 months of follow up; hence, the mortality rate amounted to 1 (5.5%) and 2 (11%) cases, respectively. Stroke was observed in 1 (5.5%) patient only during the in-hospital period. No repeat revascularisation of the target vessel was performed. By the end of the hospital stay, BARC type 3-5 haemorrhagic complications were observed in 50% of patients. The in-hospital and remote (12 months) results of high-risk TCI with ECMO support in patients with nSTE-ACS and multivessel coronary artery disease, who had been denied surgical revascularization demonstrated an acceptable level of unfavourable outcomes. This approach may be regarded as a method alternative to revascularization and used in an utterly severe cohort of patients.

[Pharmacological neuroprotection for intracerebral hemorrhages in patients with polyvascular disease]. / Farmakologicheskaia neiroprotektsiia pri vnutrimozgovykh krovoizliianiiakh u patsientov s mul'tifokal'nym aterosklerozom.

AIM: To evaluate the efficacy of pharmacological neuroprotection with protein, peptide and metabolic drugs as a part of basic intensive therapy for intracerebral hemorrhages in patients with polyvascular disease (PolyVD). MATERIAL AND METHODS: Twenty-eight male patients with PolyVD referred to surgical treatment of intracerebral hemorrhages, who were on mechanical ventilation and received basic intensive care, were included in a single center prospective observational study. All patients were assigned either to routine daily i/v infusions of 10 ml cytoflavin in 0.9% sodium chloride solution for 10 days (n=12) or 0,2 mg daily of cellex subcutaneously (n=16). Central hemodynamics, intracranial pressure, and continuous indicators of the linear velocity of blood circulation were assessed. All patients underwent SOFA scoring. The markers of brain damage, including protein S-100-ß (ng/l), antioxidant enzyme activity of superoxide dismutase (SOD) U/gr/Hb), glutathione peroxidase (U/gr/Hb) in the systemic circulation and jugular vein on the lesion side were determined. The length of stay in the intensive care unit and the number of nights were calculated. Mortality was assessed in both groups. RESULTS: Intracranial hypertension in both groups tended to subnormal parameters by 3-5 days. Vasospasm was reduced more rapidly (by the 3rd day) in the cytoflavin group compared to the cellex group (174 [152; 189] vs. 205 [182; 219], respectively). The latter demonstrated the less extent of cerebral damage according to S100 protein concentration. A comparative analysis showed that the antioxidant activity was significantly higher in the cytoflavin group. The cellex group demonstrated a pronounced trend towards the regression of neurological deficit on the NIHSS (p=0,025). The number of fatal outcomes and nights spent in the ICU were similar in both groups. The in-hospital stay was insignificantly shorter in the cellex group. CONCLUSION: It is recommended to add both antioxidant and neuropeptide pharmacological neuroprotectors in the routine intensive therapy for treating intracerebral hematomas in patients with PolyVD after surgical management.

[PHARMACOLOGICAL CARDIOPROTECTION DURING REPERFUSION OF ISOLATED HEART].

PURPOSE: To study the contractile function, the degree of damage and regional myocardial metabolism in the isolated rat heart model subjected to cardioplegic stop and reperfusion under the protection of levosimendan. MATERIALS AND METHODS: The study was performed on isolated rat hearts Wistar (group using "Custodiol" vs group using "Custodiol" + "Levosimendan". We assessed the extent of myocardial damage (in terms of markers of myocardial necrosis), the contractile function of the myocardium (coronary flow, heart rate, left ventricular pressure), the dynamics of redox processes during reperfusion with a parallel study of histology of the myocardium. RESULTS: We found a presence of cardioprotective effect of levosimendan in respect of the isolated heart in the reperfusion period of cardioplegic ischemia. The effect related to reducing the emission of reperfusion enzyme markers of myocardial damage, reducing the severity of pathological changes in the myocardium and reducing the intensity of free radical reactions in the myocardium. CONCLUSIONS: Cardioprotection with levosimendan reduces the severity of free radical attack the isolated heart, reduces the severity of damage to cardiomyocytes and preserves the contractile activity of the myocardium during reperfusion due to the effect of postconditioning.

[Therapeutic hypothermia: the potential and prospects].

Hypothermia is a most powerful tool for the protection of various organs especially brain. The review is focused on the mechanisms of protective action (modulation ofmetabolism and local inflammatory reaction, prevention of blood-brain barrier disorders, normalization of nitric oxide synthesis) and technology of therapeutic hypothermia. Main clinical situations in which the most effective and safe application of this technology was achieved are described.

Perioperative Dynamics of TLR2, TLR4, and TREM-1 Expression in Monocyte Subpopulations in the Setting of On-Pump Coronary Artery Bypass Surgery.

Hypercytokinemia plays a key role in the pathogenesis of systemic inflammatory response syndrome (SIRS). Monocytes are the main source of cytokines in the early inflammatory phase. Simultaneous stimulation of toll-like receptors (TLRs) and triggering receptor expressed on myeloid cells (TREM-1) activating receptor on monocytes results in the amplification of the inflammatory signal and multiple increase in proinflammatory cytokine production. The dynamics of those receptors expression on monocyte surface of patients with uncomplicated SIRS course followed coronary artery bypass surgery (CABG) was studied. The increase in TLR2 and TREM-1 expression on the first day after CABG induces proinflammatory and amplification potentials of monocytes in that period. The decrease in TLR2 surface expression on the seventh day compared to the preoperative values can be regarded as a mechanism limiting inflammatory response. The highest level of TLR2, TLR4, and TREM-1 surface expression was observed in CD14(hi)CD16(+) monocyte subpopulation, confirming its proinflammatory profile.

[Transcutaneous coronary intervention accompanied by biventricular circulatory support and combined with extracorporeal membranous oxygenation].

In a multiple-vessel lesion of the coronary bed, pronounced accompanying pathology, low ejection fraction of the left ventricle, obesity, previously performed operation of coronary aortic bypass grafting may be causes of refusal from revascularization by means of coronary bypass grafting. A transcutaneous coronary intervention (TCI) in this patient cohort is also associated with the risk of an unfavourable outcome in case of a technically complicated procedure and a large volume of the myocardium supplied with blood by the target arteries. Haemodynamic support of such high-risk TCI by means of intra-aortic balloon contrapulsation or a left-ventricle assist device is associated with a series of shortcomings which are removed by means of a biventricular bypass used in a combination with extracorporeal membranous oxygenation. This article deals with a case report of successful stenting of the unprotected trunk of the left coronary artery and the right coronary artery in the conditions of a mechanical biventricular bypass.

[Postoperative dynamic changes in matrix metalloproteinase levels in patients with coronary artery bypass graft procedure complications].

The purpose of this study was to evaluate diagnostic and prognostic value of matrix metalloproteinases in postoperative complication development after on-pump coronary artery bypass grafting. 29 coronary artery disease patients who had undergone on-pump coronary artery bypass grafting were examined, 4 of those had complicated systemic inflammatory response and 5 of those had isolated renal failure. Serum matrix metalloproteinase/tissue inhibitor of matrix metalloproteinase concentrations were measured before surgery, at day 1 and day 7 after surgery. Postoperative period was found to be characterized by higher levels of serum matrix metalloproteinases (MMP-9, proMMP-1) and lower levels of matrix metalloproteinase 1 tissue inhibitor. Complicated systemic inflammatory response was associated with higher levels of MMP-9, MMP-3 and proMMP-1, on particular, at day 7.

sTREM-1 as a Prognostic Marker of Postoperative Complications in Cardiac Surgery.

Cell-activating receptor TREM-1 (triggering receptor expressed on myeloid cells 1) regulates congenital immune response and contributes to systemic inflammatory response syndrome (SIRS) development. It is able to multiply cytokine production while stimulated together with the main receptors of the congenital immune system. The purpose of the paper is to study the potential use of soluble TREM-1 (sTREM-1) as a marker of intensive SIRS and a criterion for postoperative complications prediction following on-pump coronary artery bypass surgery (CABG). Results show that early postoperative sTREM-1 concentrations demonstrate their potential prognostic value regarding SIRS-associated complications.

[Permeability of the blood-brain barrier in severe craniocerebral trauma]. / O pronitsaemosti gematoéntsefalicheskogo bar'era pri tiazheloi cherepno-mozgovoi travme.

Permeability of the blood-brain barrier was studied by comparing the molar concentrations of albumin and alpha 2-macroglobulin in the spinal fluid and blood of patients with severe brain injury. If the outcome was good, the selective permeability of the barrier was shown to be fully retained, which meant that its regulatory and protective functions remained normal. If the outcome was poor, the selective permeability changed to a greater extent and the alterations found suggested that the regulatory function of the barrier was preserved with simultaneous loss of its protective properties. More marked changes in the function of blood-brain barrier and in the protein composition of spinal fluid occurred with simultaneously elevated intracranial pressure.