[Predictors of Efficacy of Radiofrequency Ablation of Pulmonary Veins Performed During Coronary Bypass Surgery in Patients With Ischemic Heart Disease and Paroxysmal Atrial Fibrillation].

We performed simultaneous coronary artery bypass grafting (CABG) and radiofrequency ablation (RFA) ostia of pulmonary veins in 254 patients (147 men and 107 women) with ischemic heart disease and paroxysmal atrial fibrillation (AF). In-hospital mortality in patients with early recurrence of AF was 8.4%, in patients without recurrence of AF 1.9% (χ2 = 4.65; p = 0.03). The patients were followed-up during 12 months after operation. During follow-up 166 patients (69.5%) had no recurrence of AF without receiving antiarrhythmic drugs (AAP), 33 patients (13.8%) had recurrences of AF, and 40 patients (16.7%) receiving AAD had repeated rare paroxysms of AF. Main predictors of late AF recurrence were age > 65 years, AF duration > 5 years, preoperative atrial effective refractory period < 240 ms, frequency threshold of AF induction < 400 counts/min, anteroposterior left atrial size > 50 mm, glomerular filtration rate < 60 ml/min/1.73 m2. Reverse dynamics of structural, functional and electrophysiological parameters of the heart due to CABG and RFA, use of ß-blockers, angiotensin converting enzyme inhibitors and aldosterone antagonists were associated with the preservation of a stable sinus rhythm. The cardiovascular mortality during 12 months follow-up accounted for 2.1% and 1.2% in groups of patients with and without late recurrences of AF respectively (p > 0.05) to coronary artery bypass grafting surgery and RFA, taking drugs--ß-blockers, angiotensin converting enzyme inhibitors and aldosterone antagonists--were associated with the preservation of a stable sinus rhythm.

[Cardiorenal prognosis in kidney dysfunction patients undergoing cardiac surgery].

AIM: To evaluate the impact of cardiac surgical procedures on cardiac and renal functions within 12 months after surgery in patients with a history of chronic kidney disease (CKD). SUBJECTS AND METHODS: A total of 875 patients (464 men and 411 women) aged 32 to 68 years (62.3±5.2 years), including 396 patients who had undergone heart valve replacement under extracorporeal circulation, 422 who had aortocoronary and/or mammary coronary artery bypass, and 57 who had a combination of these operations, were examined. According to the baseline glomerular filtration rate (GFR), the patients were divided into 2 groups: 1) 508 patients with preserved kidney function (GFR, higher than 90 ml/min/1.73 m2); 2) 367 with CKD (GFR, 89 to 60 ml/min/1.73 m2). Results. In Group 2, early postoperative cardiovascular events were noted significantly more frequently and mortality proved to be higher than in Group 1. By the end of the first year of a follow-up, CKD was diagnosed in 5.4% of the patients in Group 1. In Group 2, CKD regressed in 54.1 % of the patients and, on the contrary, progressed in 9.5%. In Group 2, programmed hemodialysis was performed in 15 (4.4%) patients. Overall mortality was significantly higher in patients with a postoperative glomerular filtration fall in both Groups 1 and 2 (7.5 and 8.4%, respectively). Long-term cardiovascular events were significantly more common in patients with progressive CKD and postoperative kidney dysfunction. CONCLUSION: A slight decrease in glomerular filtration makes the immediate prognosis of cardiac surgery poorer. The late cardiorenal prognosis mainly depends on changes in kidney function; regression of CKD is noted in 50% of the cases.

[THE RISK OF ACUTE RENAL LESIONS AND ITS PROGNOSTIC SIGNIFICANCE IN PATIENTS WITH CHRONIC RENAL DISEASE UNDERGOING CARDIAC SURGICAL INTERVENTION].

AIM: to determine the frequency and risk factors of acute renal lesions (ARL) and their prognostic significance in patients with chronic renal disease (CRD) undergoing surgical intervention. MATERIALS AND METHODS: The study included 1122 patients (586 men and 536 women) aged 32-68 (mean 62.3 ± 5.2) years who underwent correction of valvular defects, aortocoronary bypass surgery or their combination). Initial glomerular filtration rate was higher than 90 ml/min/l.73 m2 in 656 patients (group 1) and 89-60 ml/min/l/73 m2 in 470 ones (group 2). ARL were diagnosed based on the serum creatinine level using RIFLE criteria. RESULTS: In the early postoperative period, ARL were diagnosed in 23.9% of the patients in group I and 38.7% of those in group 2 (p < 0.001). Intra-hospital lethality in group 1 was 4.9% (14.1% in patients with ARL) and 12.1% in group 2 (18.1% iin patients with ARL). In group 2, 47.9% of the patients with ARL experienced regress of renal dysfunction during 12 months compared with 56.9% ones without ARL. The progress of CRD was documented in 11% of group 2 patients with ARL and in (4.5% without AR (p = 0.013). 5.7% of the patients in group 1 developed CRD after ARL. 4.9% of the patients in group 2 needed programmed hemodialysis. CONCLUSION: The development of ARL in patients with CRD is associated with unfvouravle cardiovascular prognosis following cardiosurgery.

[Predictive Value of Renal Dysfunction for Early and Long-Term Outcomes of Coronary Artery Bypass Grafting].

AIM: to assess value of renal dysfunction for immediate and long-term prognosis after coronary artery bypass grafting (CABG). MATERIAL AND METHODS: We examined 657 patients (419 men and 238 women) aged 54-68 (60.6 ± 5.3) years before and after coronary artery bypass grafting (CABG). Patients with baseline glomerular filtration rate (GFR) > 90 and with GFR 89-45 ml/1.73 (n = 246) comprised groups 1 and 2, respectively. Acute kidney injury (AKI) was diagnosed using the AKI Network criteria. RESULTS: In early postoperative period AKI (perioperative AKI) was diagnosed in 97 (23.6%) and 102 (41.55) patients of group 1 and 2, respectively (χ² = 22.4; p < 0.001). Rate of early cardio-vascular complications and hospital mortality were significantly higher in patients with compared with those without perioperative AKI. During 12 months of follow-up 6.8% of patients in group 1 developed chronic kidney disease (CKD). In group 2 we noted progression of CKD in 14.7 and 5.4% (p > 0.05) and its regression in 45.1 and 61.4% (p = 0.004) of patients with and without perioperative AKI, respectively. Programmed hemodialysis was carried out in 12 patients of group 2, including 10 with perioperative AKI (p = 0.003). CONCLUSION: Presence of CKD and development of perioperative AKI was associated with unfavorable cardiorenal prognosis after CABG.

[Dynamics of parameters of systemic inflammation and hemocoagulation in early postoperative period in patients with heart valve prostheses].

In 42 patients with rheumatic heart defects before implantation of mechanical valves and on days 5 and 20 after surgery we measured parameters of hemostasis, levels of proinflammatory cytokines (interleukin 6 [IL-6], tumor necrosis factor- [TNF-] and C-reactive protein [CRP]) as well as activity of enzymes (alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatine phosphokinase and its MB fraction). On day 5 after surgery we revealed substantial elevation of IL-6, TNF-, and CRP levels, increase of activity of the studied enzymes, contents of fibrinogen and soluble fibrin monomer complexes (SFMC), and to the contrary lowering of antithrombin III level and decrease of number of platelets. On day 20 IL-6 and TNF- levels remained significantly elevated compared to preoperative values. Concentrations of enzymes and parameters of hemostasis returned to baseline values while content of SFMC remained significantly decreased. In early postoperative period levels of IL-6 and TNF- significantly correlated with that of SFMC and platelet count what reflected interrelation ship of processes of inflammation and coagulation. Severity of systemic inflammatory reaction in patients with implanted prosthetic valves influenced optimal doses of warfarin.

[The medical rehabilitation of patients with an artificial pacemaker]. / Nekotorye aspekty lechebnoi reabilitatsii bol'nykh s iskusstvennym voditelem ritma serdtsa.

AIM: To study prognostic significance of individual rehabilitation of patients with pace-maker with account for leading cardiac syndromes. MATERIALS AND METHODS: 375 patients with artificial pace-maker were treated in a cardiological hospital for cardiac failure, blood hypertension, angina pectoris, cardiac arrhythmias. RESULTS: Congestive heart failure, blood hypertension, secondary cardiac arrhythmia, angina of effort were diagnosed in 57.4, 44.4, 33.0. 30.6% of the studied patients with artificial pace-maker. The patients died primarily of cardiac diseases, cancer and complications of cardiac pacing (71.3, 14.9 and 6.7% of cases, respectively). CONCLUSION: Aftercare of patients with pace-maker should be performed in groups of follow-up (5 groups) according to specially designed programs of diagnostic, therapeutic and prophylactic measures.