Cytokine Profile and Concentrations of Metabolic Hormones in the Blood of Overweight Men with Coronary Arteriosclerosis.

Plasma concentrations of cytokines and metabolic hormones and their association with vulnerable atherosclerotic plaques were studied in 36 overweight men (age 40-77 years; BMI 25.0-29.9 kg/m2) with coronary atherosclerosis who underwent coronary endarterectomy. According to histological analysis, the patients were divided into two groups: with stable (17 (47.2%) men) and vulnerable (19 (52.8%) men) plaques in the coronary arteries. The plasma levels of cytokines and metabolic hormones were measured by multiplex analysis: C-peptide, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide-1, glucagon, IL-6, insulin, leptin, monocyte chemoattractant protein-1, and TNFα. In overweight patients with vulnerable plaques, the level of glucagon was lower by 4.17 times, GIP - by 2.47 times, and insulin - by 2.1 times. At the same time, the risk of occurrence of a vulnerable plaque increases by 5.4% with a decrease in GIP concentration by 1 pg/ml irrespectively of age, as well as by 3.1% with an increase in insulin concentration by 10 pg/ml, without achieving statistical significance when included in the age model. Overweight men with coronary atherosclerosis and vulnerable plaques have lower levels of insulin, glucagon, and GIP. The levels of GIP and insulin are inversely associated with the risk of having vulnerable atherosclerotic plaque.

[Impairment of cognitive functions in patients with chronic thromboembolic pulmonary hypertension before and after surgical treatment]. / Kognitivnye narusheniya u patsientov s khronicheskoi tromboembolicheskoi legochnoi gipertenziei do i posle khirurgicheskogo lecheniya.

OBJECTIVE: To study cognitive functions in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and in the long-term after pulmonary thromboendarterectomy and to study factors that negatively affect cognitive status. MATERIAL AND METHODS: One hundred and twenty-four patients with CTEPH were examined before and 6 months after surgery with an assessment of cognitive impairment using the Mini-Mental State Examination (MMSE). Multivariate regression analysis was used to identify factors affecting the MMSE indicators before and in the long-term postoperative periods. RESULTS: Initially, patients with CTEPH had a total MMSE score 23.8±1.1. Six months after surgery, the score was 26.1±1.9 (p<0.001). A history of stroke, disability, stress (loss of spouse), and a high Charleson comorbidity index were independent factors affecting MMSE score before surgery. After surgery, the total MMSE score was influenced by a history of stroke, stress (loss of spouse), residual pulmonary hypertension and atrial fibrillation in the early postoperative period. CONCLUSION: Cognitive impairment in the form of mild dementia was observed in patients with CTEPH before surgery. Six months after the operation, an improvement in cognitive status was revealed, which corresponded to moderate cognitive impairment. At the same time, no complete recovery of cognitive functions was recorded. Patients with CTEPH still experienced the greatest difficulties in the following areas: concentration and counting, memory. A history of stroke, disability, stress (loss of spouse), and a high comorbidity index are associated with a decrease in MMSE scores before surgery. Six months after surgery, MMSE score was affected by a history of stroke, stress (loss of spouse), residual pulmonary hypertension and atrial fibrillation in the early postoperative period.

[Hybrid treatment of Kommerell diverticulum and giant aneurysm of intra-thoracic segment of aberrant left subclavian artery]. / Klinicheskii sluchai gibridnogo lecheniya divertikula Kommerelya i gigantskoi anevrizmy vnutrigrudnogo segmenta aberrantnoi levoi podklyuchichnoi arterii.

Kommerell's diverticulum causes compression of the esophagus, trachea and laryngeal nerve between the aberrant mouth of the left subclavian artery and ascending aorta. This leads to dysphagia or shortness of breath. We describe hybrid treatment of the right aortic arch with Kommerell's diverticulum and giant aneurysm of the aberrant left subclavian artery.

["Guiding lights" for the diagnosis of chronic thromboembolic pulmonary hypertension in the flow of patients with pulmonary embolism].

On December 13, 2021, an expert council was held to determine the position of experts of different specialties regarding the reasons for the low level of diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in real clinical practice in a pandemic of a new coronavirus infection and possible ways to improve detection in patients with pulmonary embolism (PE) ) in history. The reasons for the low level of diagnosis of CTEPH are the insufficient level of knowledge of specialists, especially primary care physicians; lack of clear regulatory documents and expert centers for the management of this category of patients. Primary diagnosis of CTEPH in a pandemic can be strengthened through the widespread use of telemedicine for consultations of primary care physicians with specialists from expert centers; to maximize the role of echocardiography and computed tomography (CT) as differential diagnostic tools for dyspnea, in particular in patients with COVID-19. To increase the detection rate of CTEPH, diagnostic vigilance is required in patients with risk factors and episodes of venous thromboembolism. To improve the screening of CTEPH, it is necessary to create an algorithm for monitoring patients who have had PE; provide educational activities, including through the media; create materials for patients with accessible information. The regulatory documents should designate the circle of responsible specialists who will be engaged in long-term monitoring of patients with PE. Educational programs are needed for primary care physicians, cardiologists, and other physicians who come into the field of view of patients with CTEPH; introduction of a program to create expert centers for monitoring and managing patients with the possibility of performing ventilation-perfusion lung scintigraphy, cardiopulmonary stress test, CT, right heart catheterization. It seems important to build cooperation with the Ministry of Health of Russia in order to create special protocols, procedures for managing patients with PE and CTEPH.

[Features of psychoemotional status in patients with chronic thromboembolic pulmonary hypertension after cardiac surgery during the COVID-19 pandemic]. / Osobennosti psikhoemotsional'nogo statusa u patsientov s khronicheskoi tromboembolicheskoi legochnoi gipertenziei posle kardiokhirurgicheskogo vmeshatel'stva v period pandemii COVID-19.

OBJECTIVE: To study the features of the psychoemotional status in patients with chronic thromboembolic pulmonary hypertension in the long term after pulmonary thromboendarterectomy (PTE) during the COVID-19 pandemic and to identify factors affecting the development of clinically pronounced anxiety and depressive disorders. MATERIAL AND METHODS: Psychoemotional status was analyzed in 151 patients in the long term after PTE using the Generalized Anxiety Disorder (GAD) Assessment (GAD-7) and the Beck Depression Inventory. The number of patients who underwent COVID-19 was recorded and the functional status scale of the patient who underwent COVID-19 (PCFS) was evaluated. Logistic regression analysis was used to identify predictors of clinically pronounced depression and GAD in the long-term period after surgery during the COVID-19 pandemic. RESULTS: Clinically significant GAD and depression in the long-term period after PTE during the COVID-19 pandemic were observed in 11 and 17.8% of patients, respectively. Clinically pronounced depression is associated with older age, chronic cerebral circulatory insufficiency and pronounced post COVID-19 disorders of functional status according to PCFS. The development of GAD symptoms is influenced by cardiopulmonary insufficiency in the hospital period after PTE. The combination of anxiety and depression symptoms is correlated with older age. CONCLUSION: In patients in the long term after PTE during the COVID-19 pandemic, the symptoms of GAD and depression were detected in 11 and 17.8% of cases, respectively. The complicated course of cardiac surgery has shown a negative impact on the development of GAD in the long term after surgery. The factors influencing the development of clinically pronounced depression were older age, chronic cerebral circulatory insufficiency and pronounced post COVID-19 disorders of functional status.

Ab ovo: Factors Affecting the Radial Stiffness of Thoracic Aorta Stent-Grafts.

The aim of the investigation was to study the factors influencing the radial stiffness of the thoracic aorta stent-grafts with the stent elements made of nitinol tubes by laser cutting and thermal shape setting. Materials and Methods: The work used stent elements made by different technologies by two different manufacturers from a nitinol tube with a wall thickness of 0.5 mm (E1) and 0.4 mm (E2), with a final diameter of 20 mm. Height of cells E1 - 15 mm, E2 - 12.5 mm. The stents were manually attached to a tubular woven non-crimped base (PTGO Sever, Russia) with a 6/0 suture, resulting in either single or continuous stitches. In the RLU124 radial force tester (Blockwise Engineering LLC, USA), each of the four stent-grafts, as well as their individual stent elements, were compressed by 10 mm from the initial diameter. The dependence of the radial forces on deformation under loading and unloading was graphically presented. The temperature and enthalpy of phase transitions of nitinols into the austenite (Af) and martensitic (Mf) phases were studied using differential scanning calorimetry (DSC-3; Mettler Toledo, USA). All indicators were compared with the characteristics of two commercial models - Cronus (China) and E-vita Open Plus (Germany). Results: Four prototypes of SibHybrid stent-grafts were tested; those differed in their stent elements, distances between them, and the type of sutures (single or continuous). The stent elements of the models studied differed in the values of Af, Mf, and the enthalpy of phase transitions of nitinols. The hardest stent was the E2 prototype. The fixation of stent elements to the woven fabric in the graft increased the radial force by 4.0-5.5 times. During compression by 50 and 20% of the original diameter, the SibHybrid models developed radial force 4.5-6.0 times greater compared with the E-vita Оpen Plus model. The radial force values of SibHybrid models were almost the same as for the Cronus and models at 20% compression. Using continuous twining round suturing increased the radial force by about 10 N; accordingly, SibHybrid E2 had the highest radial force because it was fixed by a continuous suture. The density of the stent elements fixed on the fabric did not affect the radial force of the stent-graft as a whole. Conclusion: In the manufacture of stent elements from nitinol tubes, the main factor determining the radial stiffness is the technology of nitinol shape setting. With the standard technology of thermal shape setting, radial force can be changed by varying the height of the structure cell element and the cross-sectional area of the cell bars, as well as the suturing technique.

Surface characterization and biological assessment of corrosion-resistant a-C:H:SiOx PACVD coating for Ti-6Al-4V alloy.

The paper focuses on the SiOx-doped amorphous hydrocarbon (a-C:H:SiOx) coating on the titanium (Ti-6Al-4V) alloy substrate obtained by plasma-assisted chemical vapor deposition (PACVD) in a mixture of argon gas and polyphenylmethylsiloxane vapor using a bipolar substrate bias. It is shown that the a-C:H:SiOx coating deposition results in the formation of a negative surface potential important for application of this coating for medical implants. The a-C:H:SiOx coatings improve the corrosion resistance of Ti alloy to 0.5 M NaCl solution and phosphate-buffered saline. In particular, the corrosion current density of the a-C:H:SiOx-coated sample in a 0.5 M NaCl solution at 22 °C decreases from 1∙10-8 to 1.7∙10-10 A/cm2, that reduces the corrosion rate from 9∙10-5 to 15∙10-7 mm/year. The a-C:H:SiOx coating facilitates the surface endothelization of an implant located in the thoracic aorta of a mini pig, and reduces the risk of thrombosis and implant failure. This effect can be explained by the ability of the a-C:H:SiOx coating ability to reduce in vitro a 24-hour secretion of pro-inflammatory interleukins (IL-6, IL-12(p70), IL-15, and IL-17) and cytokines (IFN-g and TNF-a) by blood mononuclear cells (MNCs) and elevates the concentration of anti-inflammatory interleukin IL-1Ra. In vitro analysis shows no cytotoxicity of the a-C:H:SiOx coating for the human blood MNCs, suggesting a promising PACVD on Ti alloys for cardiovascular implants, including pumps for mechanical heart support systems.

[Predictors of neurological complications after cardiac surgical interventions in oldery patients.]

To identify predictors of neurological complications in the hospital period after coronary artery bypass grafting (CABG), 92 patients with coronary heart disease aged 70 years and over were analyzed. Intraoperative monitoring of cerebral oxygenation (rSO2, %) was carried out. At the stage of induction anesthesia, the average level of rSO2 for left and right hemispheres was 64-65% without significant changes during the operation. A decrease in rSO2 during cardiopulmonary bypass (CPB) was associated with increased risk of neurological complications. The risk of neurological complications increase 7-fold and 9-fold with a decrease in rSO2 by 20% or more during CPB relative to baseline for left and right hemispheres, respectively. A history of two or more myocardial infarctions increases 3-fold the risk of neurological complications after CABG.

[Hybrid procedures for aortic arch disease]. / Obzor gibridnykh vmeshatel'stv pri zabolevaniiakh dugi aorty.

Different surgical approaches for aortic arch disease were reviewed in the article. We have also compared various vascular prostheses for aortic replacement.

[Microsurgery of coronary arteries using an operating microscope]. / Mikrokhirurgiia koronarnykh arterii s ispol'zovaniem operatsionnogo mikroskopa.

The world experience of coronary artery bypass surgery using an operating microscope is reviewed in the article. Important role of operating microscope and microsurgical techniques for coronary anastomoses formation is shown. High optical magnification provided by operating microscope directly affects the quality of surgical technique and accuracy of coronary anastomoses suturing that affects postoperative graft patency. Thus, the use of operating microscope can affect the results of coronary artery bypass surgery, as shown in several reports.

[Changes of Content of Matrix Metalloproteinases and Their Tissue Expression in Various Types of Atherosclerotic Plaques].

AIM: to investigate diagnostically significant for atherosclerotic plaques (ASP) of various types parameters of activity of matrix metalloproteinases (MMP-3, MMP-7, MMP-9) in homogenates, as well as tissue expression of MMP-2, MMP-9 and collagen type IV. MATERIALS AND METHODS: We included in this study 54 men with coronary atherosclerosis without acute coronary syndrome who underwent coronary artery bypass surgery with endarterectomy. In the obtained samples we determined levels of MMP-3, MMP-7, and MMP-9 (by enzyme immunoassay), as well as tissue expression of antibodies to MMP-2, MMP-9 and collagen type IV. RESULTS: In unstable plaques we observed increased activity of MMP-7 and MMP-9, significant increase of tissue expression of MMP-2 and MMP-9, and decreased expression of type IV collagen. Of three types of unstable ASP the highest tissue expression of MMP-9 was found in plaques of lipid type compared with plaques of necrotic and inflammatory-erosive types. Expression of type IV collagen predominated in plaques of necrotic type. CONCLUSION: The data obtained allows us to speak about tissue expression of collagen as the marker of fibrous cap stability; the presence of metalloproteinases in necrotic detritus, collagen fibers, and cellular elements can characterize an ASP as unstable or being in the transitional structural state. The immunohistochemical method helps to detect structural elements that characterize instability in various types of ASP.

[Lung Diffusion Capacity and Efficiency of Pulmonary Gas Exchange in Chronic Thromboembolic Pulmonary Hypertension].

AIM: to study lung diffusion capacity and efficiency of pulmonary ventilation in patients with chronic thromboembolic pulmonary hypertension (CTEPH) depending on the severity of pulmonary hypertension. MATERIALS AND METHODS: The study included 139 patients with CTEPH. The parameters of body plethysmography, lung diffusion capacity, efficiency of pulmonary ventilation and their interrelation with results of angiopulmonography were assessed. RESULTS: Patients were divided according to systolic pulmonary artery pressure (SPAP): group 1 - < 50, group 2 - 50-80, group 3 - > 80 mm Hg. The lung diffusion capacity and the efficiency of pulmonary ventilation in patients with CTEPH were reduced against the background of normal spirometric parameters, most pronouncedly in group 3. Regression analysis revealed an inverse relationship between severity of pulmonary hypertension and lung diffusion capacity (regression coefficient -13.7 [-19.1; -8.3], p 80 mm Hg. The results of the study demonstrate the close relationship between pulmonary hypertension and respiratory ventilation-diffusion disorders in patients with CTEPH.

[Predictors of neurological complications during surgical treatment of the ascending aorta and aortic arch chronic dissection]. / Prediktory nevrologicheskikh oslozhnenii pri khirurgicheskoi korrektsii khronicheskogo rassloeniia voskhodiashchego otdela i dugi aorty.

AIM: To evaluate the prognostic significance of oxygen supply to the brain in the risk of neurological complications in the early post operative period of surgical treatment of the ascending aorta and aortic arch. MATERIAL AND METHODS: The level of oxygenation (rSO2) in the right and left hemispheres was measured in 68 patients with ascending aorta and aortic arch chronic dissection. Before and in the nearest period after surgery, the patients underwent a clinical/instrumental neurological study. RESULTS: The incidence of ischemic stroke in the early post operative period was 5.9%, cognitive impairment was recorded in 22% of patients. Among the parameters of oxygen supply to the brain, the dynamics of rSO2 during circulatory arrest had a significant impact on the post operative neurological status. The risk of cognitive impairment, besides the association with the oxygen status of the brain, increased with the age of patients and comorbid pathology. CONCLUSION: The decrease in rSO2 by ≥30% during surgical treatment of ascending aorta and aortic arch dissection increases the risk of ischemic stroke and cognitive impairment in the early post operative period.

[Radiofrequency Pulmonary Artery Ablation for Treatment of Residual Pulmonary Hypertension After Pulmonary Endarterectomy].

OBJECTIVE: to assess the safety and efficiency of radiofrequency pulmonary artery ablation for treatment of residual pulmonary hypertension after pulmonary endarterectomy. MATERIAL AND METHODS: Radiofrequency pulmonary artery denervation (PADN) was performed in 16 patients (10 men, mean age 39 years [26; 51]). Indication for PADN was mean pulmonary artery pressure (PAP) >25 mm Hg with absence of proximal pulmonary artery lesion according to computer tomography. PADN procedure was performed with nonfluoroscopic 3D navigation system. RESULTS: After PADN mean PAP decreased from 37.3 mm Hg [29; 38] to 24.6 mm Hg [17; 30] (p=0.01); pulmonary vascular resistance decreased from 672 dyn·s·c -5 [387; 566] to 386 dyn·s·c -5 [155; 449] (р=0.02); cardiac output increased from 3.4 l / min [3.2; 3.4] to 3.5 l / min [3.2; 4.0] (p=0.4); 6­minute walk test distance increased from 427 meters [352; 510] to 447 meters [370; 525] (p=0.16), respectively. CONCLUSION: Initial results allow to assume that radiofrequency pulmonary artery denervation combined with optimal medical therapy may take its rightful place in the treatment of this category of patients.

[Lung Ventilation Efficiency and Quality of Life After Orthotopic Heart Transplantation].

Aim of the study was assessment of efficiency of lung ventilation and its relationship with quality of life in patients undergoing orthotopic heart transplantation (OHT). MATERIALS AND METHODS: The study involved 40 patients with terminal chronic heart failure (CHF) included in the waiting list for heart transplantation. Before surgery and after OHT all patients underwent cardiopulmonary exercise testing, evaluation of clinical status and quality of life (QL) according to the 36-Item Short Form Survey (SF-36). RESULTS: During the follow-up period (5 years) after OHT there were a significant increase in physical capacity, two-fold increase of peak oxygen consumption (VO2), normalization of VE/VCO2 slope level, improvement of the efficiency of the VO2 recovery within first minute and reduction of the VO2 recovery time. OHT was associated with significant improvement of physical and mental health components of QL. Among exercise test parameters significantly associated with improved physical health component of QL were increments in exercise capacity, peak VO2, rate of VO2 recovery within first minute. There was no relationship between cardiopulmonary parameters of exercise test and mental health component of QL. CONCLUSION: In patients with terminal CHF OHR led to significant increase of the lung ventilation efficiency and QL. Factors contributing to QL improvement after OHT were augmentation of left ventricular ejection fraction and reduction of CHF NYHA class. Among cardiopulmonary exercise test parameters, a high predictive value relative to improvement of subjective assessment of physical health component of QL showed exercise capacity, peak VO2, and efficiency of VO2 recovery within first minute.

Radiofrequency Pulmonary Artery Ablation for Treatment of Residual Pulmonary Hypertension After Pulmonary Endarterectomy.

OBJECTIVE: to assess the safety and efficiency of radiofrequency pulmonary artery ablation for treatment of residual pulmonary hypertension after pulmonary endarterectomy. MATERIAL AND METHODS: Radiofrequency pulmonary artery denervation (PADN) was performed in 16 patients (10 men, mean age 39 years [26; 51]). Indication for PADN was mean pulmonary artery pressure (PAP) >25 mm Hg with absence of proximal pulmonary artery lesion according to computer tomography. PADN procedure was performed with nonfluoroscopic 3D navigation system. RESULTS: After PADN mean PAP decreased from 37.3 mm Hg [29; 38] to 24.6 mm Hg [17; 30] (p=0.01); pulmonary vascular resistance decreased from 672 dyn∙s∙c-5 [387; 566] to 386 dyn∙s∙c-5 [155; 449] (р=0.02); cardiac output increased from 3.4 l/min [3.2; 3.4] to 3.5 l/ min [3.2; 4.0] (p=0.4); 6-minute walk test distance increased from 427 meters [352; 510] to 447 meters [370; 525] (p=0.16), respectively. CONCLUSION: Initial results allow to assume that radiofrequency pulmonary artery denervation combined with optimal medical therapy may take its rightful place in the treatment of this category of patients.

[Efficiency of Operation Trombendarterektomy From Pulmonary Artery Branches Depending on the Degree of Pulmonary Hypertension and Duration of Disease].

AIM: to assess effect of thromboendarterectomy from pulmonary artery branches on clinical functional state of patients with chronic thromboembolic pulmonary hypertension (CTEPH) in dependence on degree of pulmonary hypertension and disease duration. MATERIAL: Patients (n=152) were divided into 3 groups: (1) with systolic pulmonary artery pressure (SPAP) less or equal 50 mm Hg (n=20), (2) with SPAP>50- less or equal 80mm Hg (n=46), (3) with SPAP >80mm Hg (n=86). METHODS: Examination included registration of dynamics of general clinical state and character of complaints, six-minute walk test, transthoracic echocardiography with measurement of SPAP and right ventricular ejection fraction, pulmonary perfusion scintigraphy with calculation of index of perfusion deficit. RESULTS AND CONCLUSION: Pulmonary thromboendarterectomy from pulmonary artery branches was associated with stable improvement of clinical functional state of patients with CTEPH and regression of symptoms irrespective of preoperative level of pulmonary hypertension.

[Clinical and Economic Analysis Riotsiguata in Patients With Unresectable or Residual Chronic Thromboembolic Pulmonary Hypertension].

OBJECTIVE: to undertake economic evaluation of riociguat in comparison with standard practice of treating patients with inoperable or residual chronic thromboembolic pulmonary hypertension (CTEPH) in Russian healthcare. METHODS: Standard practice was revealed by means of peer interview. It comprised bosentan monotherapy with addition of sildenafil in case of disease progression. Difference in efficacy between riociguat and bosentan was established through the indirect comparison based on the results of randomized controlled trials. Difference in costs of CTEPH treatment with riociguat and standard practice eas estimated in the Markov model that simulated changes in disease functional class (FC). Direct medical costs were considered and included drugs prescriptions, in-patient and out-patient medical care. Probabilistic sensitivity analysis was conducted. RESULTS: The results of indirect comparison suggest statistically significant higher probability of favorable outcomes in case of treatment with riociguat: improvement by more or equal 1 FC (difference in proportions =14.8% with 95% confidence interval from 0.1 to 29.5; p=0.048) and increase of distance in 6-minute walking distance (mean difference =42.9 m with 95% confidence interval from 10.5 to 75.3; p=0.009). In base-case scenario difference in costs between riociguat and standard practice was 60 646.15 RUB per 1 patient per year in favor of the former. Riociguat costs were lower in 94.4% of sensitivity analysis cycles. In 72.5% of sensitivity analysis cycles costs difference in favor of riociguat was at least half of that in in base-case. In 47.3% of sensitivity analysis costs difference in favor of riociguat was equal or higher to that in base-case. CONCLUSION: The results of modeling suggest that in Russian healthcare treatment of CTEPH with riociguat is characterized by higher efficacy at lower costs.

[EFFICACY OF DIFFERENT FORMS OF LOCAL HEMOSTATIC MATERIALS BASED ON OXIDIZE CELLULOSE IN THE EXPERIMENT].

The bleeding of intraoperative period is one of the actual problem in surgery. There aren't any universal hemostatic means in spite of large variety of modern hemostatic methods. An experimental research studied the results of hemostatic activity of different forms of materials on the basis of oxidize cellulose (a gauze, a powder) as compared with their foreign analog (a hemostatic gauze "SurgiceI"). Median of hemostasis time consisted of (120 ± 59.9) and (73 ± 46.8) s, in case of application of gauze and powder preparations, respectively. The rate of group using the hemostatic gauze "Surgicel" was (142 ± 77.4) s. The authors made a conclusion on the basis of given research, that the hemostatic material based on oxidize cellulose (the powder form) showed a more expressed hemostatic activity and reliably twice reduced the time of hemostasis as compared with their analog forms of gauze (p < 0.05).