[Hybrid grafts for aortic arch reconstruction: evolution and state of the art]. / Gibridnye protezy dlia rekonstruktsii dugi aorty: évoliutsiia i sovremennoe sostoianie.

The analysis of the gained experience in treatment of patients with pathology of the arch and descending portion of the aorta is suggestive that the 'frozen elephant trunk' technique is an effective and safe method. In this connection, there is an increasing need for universal hybrid devices characterized by ease of use and durability in various aortic pathologies. Discussed in the article is the state of the art of the technology of treatment of patient with aortic arch pathology by means of hybrid grafts, followed by comparative analysis of currently used vascular hybrid prostheses, and although none of the hybrid grafts available worldwide is either universal or ideal, the grafts for the 'frozen elephant trunk' procedure continue to be improved, which will inevitably lead to wide implementation of this technique.

[Quo vadimus? Fundamental problems of developing hybrid prostheses of thoracic aorta]. / Quo vadimus? Fundamental'nye problemy razrabotki gibridnykh protezov grudnoi aorty.

This article is a review briefly characterizing the state of the art of hybrid surgery of the thoracic aorta using the frozen elephant trunk technique worldwide and in Russia, also discussing unsolved problems of fundamental science, being key issues in creation of new models of hybrid prostheses of the thoracic aorta. The main attention is paid to the problem of radial stiffness of the stent-graft portion of the prosthesis. Performed is a detailed analysis of the factors influencing this characteristic of the sent graft: shape, size and number of cells of the stent element, thickness of the nitinol wire it is made of, method of edge connection, nitinol properties depending on the alloy grade and methods of thermoforming. It is shown that excessive stiffness leads to the development of d-SINE syndrome. This is followed by discussing the problem of optimal stiffness of stent grafts, based on the design of stent graft elements and elastic properties of the wall of the true channel of a dissecting aortic aneurysm. Also proposed is an approach to solving the problem of d-SINE, consisting in creation of conical stent grafts and/or a gradual decrease of radial stiffness of stent elements in the direction of the distal portion. Comprehensively addressed are disadvantages of the graft portion of the prosthesis, in 95% of items made of polyethylene terephthalate fiber: susceptibility to degradation associated with manufacturing defects and intraoperative microdamages, abrasive effect in the zone of contact with stent elements, partial postoperative hydrolysis and an inflammatory reaction to a foreign body, often being clinically pronounced. Also touched upon are certain aspects of creating hermetic coatings of the graft portion, with the use of vancomycin possessing low cytotoxicity as part of an antibacterial component being promising. As a whole, it is demonstrated that advances in creating a novel generation of hybrid prostheses should be associated with new approaches and materials, to be obtained at the junction of medicine and fundamental sciences.

Remote results of Florida Sleeve technique in patients with ascending aortic aneurysms and aortic insufficiency. / Otdalennye rezul'taty metodiki Florida Sleeve u patsientov s anevrizmoi voskhodiashchego otdela i aortal'noi nedostatochnost'iu.

AIM: The aim of our investigation was to assess the remote results of valve-sparing aortic root reimplantation into the graft (Florida Sleeve technique) compared with reimplantation of the aortic valve into the graft (David technique) during surgical correction of ascending aortic aneurysms accompanied by concomitant aortic insufficiency. PATIENTS AND METHODS: Our single-centre, blind, prospective, randomized study carried out from 2011 to 2015 included a total of 64 patients with ascending aortic aneurysms and aortic insufficiency. The patients were randomized into 2 groups: group I - aortic root reimplantation according to the Florida Sleeve technique (FS group) and group II - reimplantation of the aortic valve according to the T. David technique in David I modification (D group). The groups did not statistically differ by the baseline clinical profile. RESULTS: The overall 7-year survival for the FS group and D group amounted to 83% and 85.6%, respectively (p=0.98). Assessing the competing risks of mortality related to cardiovascular or other causes revealed no differences. Freedom from prosthetic repair of the aortic valve in the remote follow-up period amounted to 92.8% and 85.8% for the FS group and D group, respectively (p=0.4). According to the obtained findings, the technique of a valve-sparing operation is not a predictor of either lethality (RR 0.98 (95% CI 0.23-4.15), p=0.98) or prosthetic repair of the aortic valve (RR 2.03 (95% CI 0.40-14.63), p=0.40) in the remote period of follow up. RCONCLUSION: Aortic root reimplantation inside the prosthesis according to the Florida Sleeve technique makes it possible to simplify and accelerate the procedure of aortic root reconstruction in patients with aortic root aneurysms and concomitant aortic insufficiency, demonstrating long-term results comparable with those of the David technique.

[Hybrid approach to surgical treatment for a saccular thoracic aortic aneurysm]. / Gibridnyi podkhod pri khirurgicheskom lechenii meshotchatoi anevrizmy grudnoi aorty.

Presented herein is a clinical case report regarding hybrid surgical treatment for a saccular aneurysm of the aortic arch in a female patient. While undergoing a routine medical check-up she had been found to have fluorographic evidence strongly suggesting dilatation of the aortic thoracic portion. Based on the findings of further examination we determined the indications for surgical treatment of the thoracic portion of the aorta. The woman was subjected to reconstruction of the arch and the descending portion of the thoracic aorta according to the frozen elephant trunk technique.

[Florida sleeve operation in a patient with pronounced aortic root calcification]. / Operatsiia po metodike Florida Sleeve u patsienta s vyrazhennym kal'tsinozom kornia aorty.

Aneurysmatic dilatation of the aortic root and ascending portion of the aorta is one of the most complicated pathologies of the cardiovascular system. The 5-year survival rate does not exceed 13%. Especially difficult from the point of view of surgical reconstruction are variants of massive calcification of the aortic root. This article describes a case report concerning the Florida sleeve technique in a patient with diffuse calcification of the aortic root, involving the ostia of the coronary arteries. An important advantage of this type of intervention is technical simplicity consisting in no need for reimplantation of coronary artery ostia, thus decreasing the number of surgical manipulations and sutures on the aortic root, as well as reducing the risk of haemorrhage.

[Exoprosthetic repair of the ascending portion of the aorta: midterm results]. / Ékzoprotezirovanie voskhodiashchego otdela aorty: srednesrochnye rezul'taty.

The authors analyse herein their experience gained in performing the operation of exoprosthetic repair of the ascending portion of the aorta in patients presenting with an ascending aortic aneurysm. This is followed by assessing the results in the remote period. Over the period of follow up from 2012 to 2016 a total of 23 interventions were performed. The average duration of postoperative follow up amounted to 27±9.4 (2-40) months. In the remote period we managed to obtain the data for 20 (90.1%) patients. The patients were interviewed by means of either remote or face-to-face consultations during which we performed assessment of the dimensions of the thoracic portion of the aorta by the findings of MSCT angiography of the aorta. Health-related quality of life was evaluated by means of the Short Form Health Survey Questionnaire SF-36. No statistically significant changes of the aortic sizes were revealed in the remote period as compared with the findings at discharge from hospital. Neither were there repeat interventions related to the operation performed. According to the findings of the SF-36 questionnaire, patients mainly reported improved well-being as compared with that at discharge, including patients having endured coronary artery bypass grafting or prosthetic repair of the aortic valve. Experience shows that using the technique of exoprosthetic repair of the ascending portion of the aorta makes it possible to eliminate dilatation with satisfactory remote results. However, fuller and more reliable assessment of the results requires further studies.

Hybrid surgery in chronic thoracoabdominal aortic dissection. / Gibridnaia khirurgiia pri khronicheskom rassloenii torakoabdominal'nogo otdela aorty.

The authors describe and analyse their experience gained in performing prosthetic repair of the thoracoabdominal portion of the aorta, combined with open aortic stenting using the Djumbodis uncovered metal stent. Over the period from 2013 to 2015 we performed a total of 16 hybrid interventions. All patients were found to have type B aortic dissection, with their false and true lumens patent. All patients underwent reconstruction of the thoracoabdominal aorta combined with open implantation of the Djumbodis uncovered metal stent into the area of lower thoracic and visceral arteries. The patients underwent either isolated prosthetic repair of the thoracic aortic portion - type A correction, or prosthetic repair of the thoracic and infrarenal portions - type B correction. In the postoperative period we performed MSCT angiography of the thoracic and abdominal aortic portions in order to control patency of the true and false lumens, patency of visceral arteries, to assess the diameter of the aorta, presence or absence of thrombosis. All five patients subjected to type B correction (100% of the total number of this type operation) were found to develop thrombosis of the false lumen, and eight patients undergoing type A correction (72.7% of the total number of operations of this type) were diagnosed with false channel thrombosis. There was 1 (6.3%) lethal case registered at the hospital stage in the group of patients with type A correction. There were no cases of neurological deficit, malperfusion of visceral organs or lower-limb ischaemia. Our experience shows that using hybrid technologies in surgery of the thoracoabdominal portion of the aorta is (appears to be) optimal from the point of view of decreasing intraoperative trauma, reducing the complications rate and without detriment to the radicality.

[Four-year follow up of the results of the first in Russia use of a hybrid prosthesis for surgical management of type I aortic dissection]. / Chetyrekhletnee nabliudenie rezul'tatov pervogo v Rossii primeneniia gibridnogo proteza pri khirurgicheskom lechenii rassloeniia aorty I tipa.

Presented in the articles is a case report of successfully using hybrid prosthesis "E-vita Open plus" (Jotec) in surgical treatment of a female patient presenting with type I chronic aortic dissection according to the DeBakey classification. Careful consideration is given to an uncomplicated course of the early and remote postoperative periods in the first-in-Russia patient to undergo surgery with the use of a new-type prosthesis. The control examinations carried out 6, 12, 28 and 39 months after the operation were unequivocally indicative of complete thrombosis of the false canal of the aorta at the level of the prosthesis and lack of signs of aortic diameter growth below the zone of the surgical intervention. An example of successful treatment of DeBakey type I aortic dissection may be regarded as an important stage in the development of more effective methods of surgery for the severe pathology concerned.

[Open stenting of thoracic aorta in combination with the borst operation].

Described herein in is a clinical case report concerning combined method of surgical treatment for chronic DeBakey type I aortic dissection: prosthetic repair of the ascending aorta and aortic arch according to Borst's technique in combination with open stenting of the descending aorta with the "Djumbodis" uncoated metal stent. This technique makes it possible to achieve expanding of the vascular prosthesis in the descending portion, thus increasing the probability of thrombosis of the false channel at this level and, consequently, to decrease the probability of further dilatation of the thoracic aorta, which is one of the main purposes in aortic reconstruction. Besides, the use of this technique does not exclude a second stage of surgical treatment, both within the framework of the classical surgical technology and with the use of endovascular methods.

[Remote results of reimplantation of the aortic valve in patients with ascending aortic aneurysm accompanied by aortic insufficiency].

Valve-sparing operations on the aorta has recently been gaining ever increasing popularity due to more detailed study of physiology of the aortic root, as well as promising mid- and long-term results. The world practice uses various techniques making it possible to remove both ascending aortic aneurysm and aortic valve insufficiency. The authors herein describe and analyse their experience in performing reimplantation of the aortic valve in patients with ascending aortic aneurysm and concomitant aortic insufficiency. Specialists of the clinic of the Novosibirsk Scientific Research Institute for Circulatory Pathology during the period from 2003 to 2013 performed a total of 77 operations of reimplantation of the aortic valve in patients with ascending aortic aneurysm and pronounced aortic valve insufficiency. The majority of patients were men (57 males and 20 females), mean age 53.1±12.2 years (range 21-72). 80% of cases had NYHA functional class II-III circulatory insufficiency (degree 2.3±0.7). Preoperative examination revealed in the majority of patients (97.4%) moderate-to-severe aortic valve insufficiency and ascending aortic aneurysm. All patients underwent reimplantation of the aortic valve. The duration of artificial circulation amounted to 202.4±33 minutes, with the average time of aortic occlusion being 164±28 min. Accompanying procedures (annuloplasty of the mitral valve and/or coronary aortic bypass grafting) were performed in 12 (15.6%) cases. Additional plasty of valvular cusps was carried out in 9 (11.7%) patients, with rethoracotomy required in 5 (6.4%) cases due to haemorrhage. The average period of follow up amounted to 53.3±8.5 (3-115) months. During this time total survival amounted to 91%, with freedom from aortic valve prosthetic repair equalling 93%. The obtained findings suggest that aortic valve reimplantation into the prosthesis is a safe intervention and associated with a comparatively low level of operative lethality. Moderate aortic insufficiency at discharge is a predicting factor for repeat surgical intervention, i.e. prosthetic repair of the aortic valve. No association between the preoperative degree of aortic insufficiency, root diameter and durability of the reimplanted valve was revealed.

[Hybrid approach in surgery of proximal-type aortic dissection]. / Gibridnyi podkhod v khirurgii rassloenii aorty proksimal'nogo tipa.

From May 2011 to November 2012, specialists of the Novosibirsk Scientific Research Institute for Circulatory Pathology named after Academician E.N. Meshalkin carried out a total of eleven hybrid operations of prosthetic repair of the aortic ascending portion with stenting of the aortic arch and descending aortic portion using uncovered bare metal stent with open meshes «DJUMBODIS¼. In order to assess the false-lumen status at the level of the installed stent, all patients were subjected to contrast-enhanced MSCT before discharge from hospital and 3-11 months after surgical treatment. The obtained findings revealed thrombosis of the false channel of the dissected aorta in 5 (62.5%) out of 8 patients 3-11 (mean 10.3±4.4) months after the intervention. A hybrid approach to surgery of DeBakey type I aortic dissection is safe for patients and does not considerably complicate surgical intervention as compared with the traditional technique. Using the hybrid approach creates prerequisites for thrombosis of the aortic false lumen, which in its turn slows down dilatation of the thoracoabdominal portion.

[Remote results of surgical reconstruction of the aortic arch in patients with proximal aortic dissection].

INTRODUCTION: It is generally known that Stanford type A aortic dissection has up to now been a serious problem of cardiothoracic surgery. The current state of the art of aortic surgery, anaesthesiological support, and perfusion strategy make it possible to achieve acceptable results in the early postoperative period in various-difficulty aortic arch reconstruction. Taking into consideration that the pathological process to some extent involves the brachiocephalic arteries, of special interest are remote results of various in aggressiveness and radicality types of reconstruction of the aortic arch in its proximal dissection from the point of view of the development of delayed impairments of cerebral circulation. MATERIAL AND METHODS: Over the period from 1999 to 2011, specialists of the Novosibirsk Scientific Research Institute for Circulatory Pathology named after Academician E.N. Meshalkin under the Ministry of Public Health and Social Development operated on a total of 124 patients presenting with DeBakey type I aortic dissection. All factors supposedly influencing the development of cerebral ischaemia were subdivided into the qualitative and quantitative ones. The qualitative factors included gender, aetiology, type of dissection, type of aortic arch reconstruction, type of cerebral perfusion, type of intervention on the aortic root, previous operations on the heart, and the presence of accompanying CAD, arterial hypertension, chronic obstructive pulmonary diseases, and renal pathology. The quantitative factors were as follows: age, height, body weight, duration of assisted circulation (AC), duration of aortic occlusion (AO), duration of circulatory arrest (CA). We examined a total of 80 patients within the terms of 11-124 months (mean 48,3±26,0 months) after surgical treatment. We studied interrelationship between the factors and the development of cerebral circulation impairments in the remote postoperative period. CONCLUSION: In the remote postoperative period virtually all cases of focal impairments of cerebral circulation were associated with accompanying atherosclerosis, i. e. the already compromised brachiocephalic vascular bed. Amongst the qualitative parameters the most significant variables were: aetiology, accompanying diseases, and the type of cerebral perfusion.

[Immediate results of surgical reconstruction of the aortic arch in patients with proximal aortic dissection].

AIM: Despite obvious progress of surgical technologies in correction of proximal aortic pathology, improvement of methods of protection of the brain, one of the main problems of this direction remains the development of postoperative cerebral ischaemia of various degree of manifestation: strokes, transitory ischaemic attacks, or hypoxic encephalopathy. Of special interest is studying the group of patients presenting with aortic dissection, since this pathology may be accompanied by a wide variety of combinations of occlusive and stenotic lesions of the branches of the ascending portion of the aorta and aortic arch (coronary and brachiocephalic basins) by the detached intima. MATERIAL AND METHODS: Over the period from 1999 to 2011, we operated on a total of 124 patients presenting with DeBakey type I aortic dissection. Of these, 194 were men (75.8%) and 30 (24.2%) women. The mean age amounted to 48.7±11.0 years. Etiologically prevailing were systemic atherosclerosis (91 patients, 73.4% of cases) and Marfan's syndrome in 14 (11.3%) cases. In all patients operative intervention included reconstruction of the aortic arch according to one of the following techniques: prosthetic repair according to the type of an aggressive oblique anastomosis ("hemiarch repair") - 78 (62.9%) patients, prosthetic repair of the aortic arch using the multiple-branch prosthesis Plexus Vascutek - 37 (29.8%) patients, and nine patients underwent prosthetic repair of the aortic arch with a vascular graft with reimplantation of the brachiocephalic arteries with a single islet. The average duration of artificial circulation amounted to 230.1±70.0 minutes, the mean time of aortic occlusion was 167.2±44.2 minutes and that of circulatory arrest equalled 51.9±16.2 minutes. The brain during hypothermic circulatory arrest was protected according to the following techniques: 16 (12.9%) patients - isolated hypothermia with no cerebral perfusion, 76 (61.3 %) patients retrograde cerebral perfusion (RCP) through the superior vena cava, 23 (18.6%) patients - antegrade cerebral perfusion (ACP) and in 8 (6.5%) patients a combination of RCP + antegrade cerebral perfusion. CONCLUSION: The early postoperative period showed a clear-cut interrelationship between the aetiology of aortic dissection and the onset of impairment of cerebral circulation. Increased incidence of strokes is promoted by more complicated and hence longer in time types of reconstruction of the aortic arch (islet technique, multiple-branch prosthesis). Antegrade cerebral perfusion had no statistically significant advantages over retrograde perfusion or perfusion-free hypothermic protection of the brain. Neither did the type of aortic dissection exert influence on cerebral circulation impairment (CCI). The presence of accompanying diseases did not determine the probability of the development of CCI in the early postoperative period. The analysis of the obtained findings revealed statistically significant relationship between the patient's age and severity of CCI.

[A comparative evaluation of the antianginal action of commercially and noncommercially produced validol in neurocirculatory dystonia and stenocardia]. / Sravnitel'naia otsenka antianginal'nogo deistviia validola promyshlennogo i nepromyshlennogo izgotovleniia pri neirotsirkuliatornoi distonii i stenokardii.

As many as 20 patients with neurocirculatory dystonia (NCD) and 10 IHD patients presenting with stable exertional angina were evaluated for an effectiveness of antianginal action of validol tablets commercially- and noncommercially produced, the above tablets being of the changed composition in the latter case. Validol of both changed and unchanged composition had a similar transient antianginal effect which was higher in NCD than it was in angina pectoris. Economical as well as clinical effects of validol of the changed make up warrant it to be commercially produced.

[Serotonin receptors blocker ketanserin in the combined therapy of patients with chronic obstructive bronchitis]. / Primenenie blokatora serotoninovykh retseptorov ketanserina v kompleksnom lechenii bol'nykh khronicheskim obstruktibnym bronkhitom.

The addition of ketanserin (a blocker of serotonin S2-receptors) to treatment of bronchial obstruction is shown to lower plasma and platelet concentrations of serotonin, leukotriene B4 level in the lavage fluid, to shift prostacyclin-thromboxane balance to the side of prostacyclin. In 40 patients with chronic obstructive bronchitis treated, the above changes were associated with persistent clinical response, a decrease of bronchial obstruction, being the most profound in a group of patients with chronic catarrhal bronchitis.

[Effect of ketotifen on the eicosanoid system, immunoreactivity and bronchial patency in patients with obstructive pulmonary diseases]. / Vliianie ketotifena na sistemu éikozanoidov, immunologicheskuiu reaktivnost' i bronkhial'nuiu prokhodimost' u bol'nykh s obstruktivnymi zabolevaniiami legkikh.

A study was made of the effect of ketotifen on the concentration of leukotriene B4, prostacyclin and thromboxane A2 in the liquid of bronchoalveolar lavage and on external respiration and cellular immunity during 4 weeks of the treatment of patients with infection-dependent bronchial asthma and chronic obstructive bronchitis. Inclusion of ketotifen into the treatment of patients with bronchial obstruction exerts a stimulating action on the suppressor component of T-cell immunity, leads to a decrease of the content of leukotriene B4 and thromboxane A2 in the lavage liquid, which is accompanied by positive shifts in the clinical course of the broncho-obstructive syndrome. Ketotifen turned out most effective in patients with an initially low content of the subpopulation of T suppressors and with high concentrations of leukotriene B4 and thromboxane A2 in the liquid of bronchoalveolar lavage.

[Various rhythmologic precursors of terminal arrhythmia in patients with myocardial infarct]. / Nekotorye ritmologicheskie predvestniki terminal'nykh aritmii u bol'nykh infarktom miokarda.

The presence of near one hour ultradian cardiac rhythm was revealed on the ECG of 24 patients with acute myocardial infarction during 24-hour Holter monitoring. A classification of the phases of near one hour rhythm was developed according to the first coefficient value of autocorrelation of cardiac rhythm function. Special attention was attracted to the critical phase indicating high probability of the development of terminal arrhythmia and the threatening phase preceding it. Peculiarities of the variational structure of cardiac rhythm in the threatening phase and physical prerequisites of its origination are discussed.

[Dynamics of the joint pains at night in rheumatoid arthritis and arthroses treated with Rengasil and piroxicam]. / Dinamika nochnykh sustavnykh bolei pri revmatoidnom artrite i artrozakh, lechennykh rengazilom i piroksikamom.

The effect of a novel nonsteroidal antiinflammatory drug Rengasil on pain at rest in rheumatoid arthritis and arthroses was studied in comparison with piroxicam and placebo. Intensity of nocturnal pains was estimated according to the "visual analogous scale". The relationship between the time of occurrence of a complete analgesic effect and severity of the pain syndrome before the beginning of monotherapy was established.

[Use of the hypotensive drug guanfacine in the treatment of patients with hypertension]. / Primenenie guanfatsina - gipotenzivnogo preparata dlia lecheniia bol'nykh gipertonicheskoi bolezn'iu.

The hypotensive effect of guanfacin was evaluated in 39 essentially hypertensive patients aged 18 to 64 years and treated for 2 months. Their central, and peripheral hemodynamics, intracardiac kinetics and some humoral factors responsible for vascular tonicity control were also examined. The drug can be effective in patients with second- and third-stage essential hypertension, with a good hypotensive effect being obvious within 3-5 days of treatment (3 mg daily was the highest dose). In the course of treatment, general left-ventricular pump function returned to normal in 20 patients exhibiting a good hypotensive effect. Within 2 months of treatment, originally high plasma renin activity returned to normal, and the activity of angiotensin-converting enzyme declined.