[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.

[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.

[The effect of spinal card stimulation on quality of life in patients with critical lower limb ischemia]. / Vliianie spinal'noi neirostimuliatsii na kachestvo zhizni bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei.

Today, there are insufficient data on the dynamics of quality of life (QoL) in patients with critical lower limb ischemia after spinal cord stimulation. OBJECTIVE: To study the dynamics of QoL in patients with critical lower limb ischemia one year after spinal cord stimulation. MATERIAL AND METHODS: QoL analysis was performed in 43 patients with critical lower limb ischemia using the SF-36 questionnaire before and one year after spinal cord stimulation. RESULTS: At baseline, we detected reduced QoL parameters corresponding to the physical function (≤30 points). The parameters of mental health corresponded to the moderate level (the score ranged between 42 and 59 points). The total score of physical well-being was reduced: 22.8 (20.2-29.3); the mean score of mental well-being was 41 (32.8-49.2) (p<0.001). One year after spinal cord stimulation, the level of all QoL parameters was increased but the total score of physical well-being remained low 33.2 (24-44.1). The mean score of mental well-being corresponded to the moderate level of QoL 56.5 (49-60.4) (p<0.001). Multivariate regression analysis showed that the physical parameters of QoL after spinal cord stimulation are adversely affected by such factors as age, the history of stroke, the ankle-brachial index (ABI), the presence of type 2 diabetes mellitus (DM), and ischemic heart disease (IHD) in combination with stenosis of brachiocephalic arteries (BCA). The mental health is affected by age and the presence of stenosis of brachiocephalic arteries. CONCLUSION: When selecting patients with critical lower limb ischemia for spinal cord stimulation, such factors as the baseline clinical status (comorbidities), age, history of stroke, and the severity of peripheral artery ischemia need to be taken into account to improve treatment effectiveness and QoL.

[The role of integrated assessment of the indicators of external respiration function in cardiac surgical patients]. / Rol' kompleksnoi otsenki pokazatelei funktsii vneshnego dykhaniia u patsientov s kardiokhirurgicheskoi patologiei.

This literature review dedicated to the importance of an integrated assessment of external respiratory function in cardiovascular diseases (CVDs), including an analysis of up-to-date techniques, such as spirometry, body plethysmography, examination of the diffusing capacity of the lung, determination of O2 consumption with evaluation of the effectiveness of pulmonary ventilation. It considers the pathogenetic components of impairments in pulmonary ventilation and gas exchange, which develop in different CVDs, as well as during and after cardiac surgery. The authors analyze the results of international investigations and their own experience, which emphasize the prognostic value of lung function tests and suggest that there is a need for a comprehensive functional assessment of the respiratory system in cardiac surgical patients for their effective preoperative preparation, assessment and reduction of operational risks, and improvement of the prognosis of surgical treatment.

[Lipid peroxidation and cytochrome P-450-dependent metabolism of xenobiotics in patients with coronary heart disease and multiple organ failure].

The aim of the investigation was to study oxidative stress and hepatic monooxygenase function (HMF) in coronary heart disease (CHD) patients with multiple organ dysfunction (MOD) after myocardial revascularization. Twenty-seven CHD patients with signs of MOD and 38 patients with an uncomplicated postoperative period were examined. The intensity of MOD was rated by the SOFA scale; oxidative stress was estimated from the values of malondialdehyde, conjugate trienes, ceruplasmin, and catalase, and HMF was evaluated from antipyrine pharmacokinetic data. On postoperative day 1, the study group showed significant signs of MOD, as well as activated lipid peroxidation (LPO) and a 1.5-fold reduction in HMF. The control group displayed an insignificant HMF suppression under less marked oxidative stress. On days 3-4 after surgery, the total MOD index was noticeably lowered. Both groups exhibited a high LPO rate and enhanced HMF. On days 10-12 postoperatively, the severity of MOD corresponded to the previous period. There was a decrease in LPO activity in both groups. HMF was found to substantially reduce in the study group and to be in line with the baseline values in the control one. Correlation analysis revealed direct and inverse relationships of the indices of MOD with LPO rates and HMF. Therefore, MOD in patients with CHD is attended by increased oxidative stress and leads to a more significant HMF reduction as compared with those with an uncomplicated postoperative period. At the same time, LPO activation is one of the cardinal causes of HMF suppression. Reduced HMF may enhance the sensitivity of CHD patients to drug therapy.

Oxidative stress and monooxygenase liver function in patients with coronary heart disease and multiple organ dysfunction syndrome.

BACKGROUND AND OBJECTIVE: The purpose of the study was to evaluate oxidative stress and liver monooxygenase function in patients with coronary heart disease and multiple organ dysfunction syndrome. METHODS: Twenty-seven patients with multiple organ dysfunction and 38 patients with an uneventful postoperative period were studied. Oxidative stress was quantified with malon dialdehyde, coupled trienes, hepatocuprein and catalase activity. Liver monooxygenase function was evaluated with antipyrine pharmacokinetics data. RESULTS: On the first postoperative day patients with multiple organ dysfunction were characterized by high lipid peroxidation (conjugated trienes: +84.7%) and significant decrease in liver monooxygenase function (clearance of antipyrine: -38%), whereas control patients had a mild oxidative stress and a slight depression in liver monooxygenase function. On the third to fourth postoperative day in both groups a considerable intensity of lipid peroxidation and increase in liver metabolism was seen. The major difference was observed on postoperative days 10-12. In both groups oxidative stress intensity decreased (conjugated trienes: +34.7%; +12.9%). In the main group liver monooxygenase function was markedly depressed (clearance of antipyrine: -35.6%), whereas in the control group liver metabolism did not deviate from the baseline. The correlation analysis showed a negative relationship between liver monooxygenase function and oxidative stress parameters. CONCLUSION: Patients with multiple organ dysfunction have considerably more oxidative stress and greater decrease in liver monooxygenase function (one and a half times) than those with an uneventful postoperative period. Lipid peroxidation is one of the main causes of depression of liver monooxygenase function. Slowdown of liver metabolism might change the pharmacokinetic response in patients with coronary heart disease.

[Oxidative stress and hepatic monooxygenase function in patients with coronary heart disease before and after cardiac surgery].

The parameters of lipid peroxidation (LPO) and hepatic monooxygenase function (HMF) were studied in 92 patients with coronary heart disease (CHD). After termination of and within the first 24 hours after myocardial revascularization, the levels of malonic dialdehyde and conjugate trienes were found to show 45.6 and 62.1% increases, respectively. The half-life of antipyrine (AP T(1/2)) increased by 23.5%. Studies on postoperative days 3-4 and 10-12 revealed a reduction in LPO rates and normalized HMF. After off-pump surgery, LPO and HMF significantly unchanged. On the contrary, open heart surgery resulted in a noticeable activation of LPO and an almost 1.5-fold decrease in HMF. The increase in oxidative stress and the deceleration of hepatic microsomal oxidation were ascertained to be directly related to the duration of extracorporeal circulation and the time of myocardial ischemia. After surgery, the rate of LPO and the reduction of HMF were more considerable in patients with multiple organ dysfunctions, as compared with the uncomplicated postoperative period. Within the first 24 hours following surgery, AP T(1/2) increased by 83.4%, but on postoperative days 10 to 14, it remained to be decreased by almost 1.5 times as compared with the baseline. Thus, LPO activation is one of the leading mechanisms of decelerated hepatic xenobiotic biotransformation after myocardial revascularization. Diminished lower HMF enhances the sensitivity of CHD patients to drug therapy and requires a differential approach to its use.

[Prediction of the outcomes of renal replacement therapy for acute renal failure after cardiosurgical interventions].

The aim of the study was to evaluate the influence of different predictors on the outcomes of acute renal failure (ARF) in cardiosurgical patients. A hundred and five cases of ARF in January 1995 to August 2004 were retrospectively analyzed. Sixty-one patients received continuous renal replacement therapy (CRRT) and 44 patients had intermittent RRT (IRRT). Eighteen preoperative, perioperative, and postoperative risk factors were assessed. The overall hospital mortality was found to be 42%: 48.4% in the CRRT group and 33.3% in the IRRT group. A statistical analysis revealed 8 significant predictors of fatal outcomes: (1) the severity according to the APACHE II scale (25 +/- 1 scores); (2) the number of organ dysfunctions (3.6 +/- 0.2); (3) large-dose inotropic support; (4) artificial ventilation; (5) oliguria; (6) severe concomitant hepatic failure; (7) moderate-to-severe concomitant posthypoxic encephalopathy. CRRT improved survival in AFR associated with severe cardiorespiratory failure, oliguria, and cerebral dysfunctions. The paper discusses criteria for choosing the modes of renal replacement therapy.

[Effectiveness of plasmapheresis and its modifications in the treatment of cardiosurgical patients]. / Effektivnost' plazmafereza i ego modifikatsii v lechenii kardiokhirurgicheskikh bol'nykh.

The efficiency of plasmapheresis in the treatment of infectious complications and multiple organ dysfunctions was evaluated in 66 patients after heart surgery. Early plasmapheresis attenuated the cytokine-related systemic inflammatory response and organ damage. The optimal use of plasmapheresis modifications (membrane plasma filtration, plasma carboperfusion, cryoapheresis) improved the clinical outcomes.

Changes in myocardial metabolism and ultrastructure of myocardial microvessels during pharmacological and cold cardioplegia under hypothermic conditions without perfusion.

A combination of pharmacological and cold cardioplegia in with hypothermia without perfusion in open-heart surgery guarantee the reversible character of shifts in energy and free radical balance in the myocardium. However, this procedure can impair coronary micricirculation due to structural and functional changes in microvessel endothelium. Our results demonstrate that new cytoprotective approaches are extremely needed for cardiac protection during surgery.

Effect of calcium antagonists on ultrastructure of myocardial microvessels during open heart surgery under conditions of pharmacological and cold cardioplegia.

Ultrastructure of myocardial microvessels was examined during surgical correction of congenital heart disease (ventricular septal defect) under conditions of cold and pharmacological low-potassium cardioplegia without perfusion. Addition of calcium antagonist verapamil to cardioplegic solution prevented postischemic damage to vascular and perivascular structures occurring during reperfusion and body temperature rise.

Effectiveness of forced air warming after pediatric cardiac surgery employing hypothermic circulatory arrest without cardiopulmonary bypass.

STUDY OBJECTIVE: To evaluate the effectiveness of forced-air warming compared to radiant warming in pediatric cardiac surgical patients recovering from moderate hypothermia after perfusionless deep hypothermic circulatory arrest. DESIGN: Prospective unblinded study. SETIING: Teaching hospitals. PATIENTS: 24 pediatric cardiac surgical patients. INTERVENTION: Noncyanotic patients undergoing repair of atrial or ventricular septal defects were cooled by topical application of ice and rewarmed initially in the operating room by warm saline lavage of the pleural cavities. On arrival at the intensive care unit (ICU), patients were warmed by forced air (n = 13) or radiant heat (n = 11). The time, heart rate, and blood pressure at each 0.5 degrees C increase in rectal temperature were measured until normothermia (36.5 degrees C) to determine the instantaneous rewarming rate. MEASUREMENTS AND MAIN RESULTS: Baseline characteristics were not different in the two groups. The mean (+/- SD) age was 5.6 +/- 3.4 years, weight was 20 +/- 8 kg, esophageal temperature for circulatory arrest was 25.7 +/- 1.3 degrees C, and duration of circulatory arrest was 25 +/- 11 minutes. The mean core temperature on arrival at the ICU was 29.9 +/- 1.3 degrees C and ranged from 26.1 to 31.5 degrees C. The mean rewarming rate for each 0.5 degrees C was greater (p < 0.05) for forced-air (2.43 +/- 1.14 degrees C/hr) than radiant heat (2.16 +/- 1.02 degrees C/hr). At core temperatures <33 degrees C, the rewarming rate for forced-air was 2.04 +/- 0.84 degrees C/hr and radiant heat was 1.68 +/- 0.84 degrees C/hr (p < 0.05). At core temperatures > or = 33 degrees C, the rewarming rate for forced air was 2.76 +/- 1.20 degrees C/hr and radiant heat was 2.46 +/- 1.08 degrees C/min (p = 0.07). Significant determinants of the rewarming rate in a multivariate regression model were age (p < 0.001), temperature (p < 0.05), time after arrival to the intensive care unit (p < 0.05), pulse pressure (p < 0. 05) and warming device (p < 0.001). The duration of ventilatory support and ICU length of stay was not different in the two groups. CONCLUSIONS: Both forced-air and radiant heat were effective for rewarming moderately hypothermic pediatric patients. When core temperature was less than 33 degrees C, the instantaneous rewarming rate by forced air was 21% faster than by radiant heat.

Experimental studies on the endothelium ultrastructure of heart capillaries under moderate (28-30 degrees) and deep (22-24 degrees) hypothermia without perfusion.

Ultrastructural changes in endothelial cells (EC) of myocardial capillaries were studied in 24 dogs which underwent hypothermia without perfusion. Biopsy specimens for electron microscopy were taken from the left ventricle of each dog in the control group, during anesthesia (prior to active cooling), and at the end of moderate (28-30 degrees ) and deep (22-24 degrees ) artificial body cooling. The following morphological types of the EC were identified both in the control group and in all test groups: those with moderately dense cytoplasm, light, dark, and irreversibly damaged cells. Dark cells showed increased numbers of plasmalemmal vesicles and appeared to be more transport-specialized as opposed to other types. In all stages of the experiment the amount of dark cells continuously increased (to 23.80, 34.62, and 47.17%, respectively). On cooling to 28-30 degrees, subcellular manifestation of reduced synthetic activity of organelles (nucleus, Golgi complex, and rough endoplasmic reticulum) was observed in all types of the EC. These changes persisted, or even increased, at the end of deep hypothermia. The transport activity of the EC changed differently in three experimental groups in all cell types. Micropinocytotic activity increased under spontaneous mild hypothermia (34-35 degrees ) during anesthesia and tended to decrease with subsequent artificial lowering of the temperature to 22-24 degrees. These ultrastructural changes seem to make up an integral part of the process of capillary endothelium adaptation to body surface cooling, and they might contribute to the development of tolerance to subsequent ischemic exposure during cardiac arrest.

[A procedure for compensating for the blood loss in heart operations under hypothermia without perfusion]. / Taktika vozmeshcheniia krovopoteri pri operatsiiakh na serdtse v usloviiakh besperfuzionnoi gipotermii.

It was established that compensation of blood loss in patients during hypothermal occlusion facilitates more rapid restoration of cardiac activity and adequate hemodynamics, which allowed to reduce administration of alpha-adrenomimetic drugs during the postocclusive periods. Simultaneously the period of the recovery of electric activity of the brain becomes shorter, the postoperative respiration rate is slower. Cardiac insufficiency and neurological complications are rarer.

[A method of pharmacologic support in experimental operation on the dry heart]. / Metod farmakologicherskogo obespecheniia operatsii na sukhom serdtse v éksperimente.

The method of prolonged (up to 35 min) reversible circulatory arrest at anesthetized dogs consists of body external cooling, main vascular occlusion with cardioplegia, cardiac function recovery and animal body warming. Special reference was made to anesthetic security of the experiment. The method provides the study of hypothermic protective mechanisms, the improvement of surgical techniques up to organ transplantation, as well as the observation of long-term results.

Hypothermic protection (26-25 degrees C) without perfusion cooling for surgery of congenital cardiac defects using prolonged occlusion.

Open heart surgery was performed without perfusion under deep hypothermia in 343 patients with congenital heart defects aged from 1 year 3 months to 44 years. Cooling to a temperature of 26-25 degrees C in the oesophagus was achieved by covering the body with crushed ice. The patients were maintained under superficial ether narcosis and they were given morphine (0.5 mg/kg) and tubocurarine (0.5-1.0 mg/kg). The duration of circulatory arrest was 30 minutes in 190 and longer in 153 patients--60-77 minutes in 10 patients. It took an average of 7.6 minutes for resumption of normal cardiac activity after circulatory arrest prolonged beyond 60 minutes. Of the 343 patients operated on 32 (9.3%) died. Analysis of the mortality pattern showed that patients with acute cardiac insufficiency contributed most to the total number of deaths (19 patients, 5.5%); those with pulmonary oedema ranked second (4 patients, 1.2%) and those with brain oedema third (3 patients, 0.9%). Neurological complications were observed in 13 patients (3.8%). Their frequency was significantly related to the duration of circulatory arrest. Circulatory inadequacy in patients with poor myocardial function who had undergone extensive repair appeared to be a contributory factor. The results obtained without perfusion under deep (26-25 degrees C) hypothermic protection suggest that 75 minutes is a safe time, in terms of brain damage, for circulatory arrest. Under these conditions complex cardiac defects can be repaired.

[Neurologic functions of patients after open-heart surgery under perfusion-less deep (26-25 degrees C) hypothermic protection]. / Sostoianie nevrologicheskikh funktsii u bol'nykh posle operatsii na otkrytom serdtse v usloviiakh besperfuzionnoi uglublennoi (26--25 gradusov C) gipotermicheskoi zashchity.

Neurological investigation was performed in 47 children and adults in which no brain functions damage was detected after their cardiac defects repaired under perfusion-less deep (26 to 25 degrees C) hypothermia. Apart of these, 35 patients were studied in which cerebral complications immediately followed the surgery. EEG was recorded in selected patients. The relationship between the neurological complications incidence and duration of major vessels occlusion in surgery was analyzed. Perfusion-less deep hypothermia was efficient means of brain protection against hypoxic damage.