[The influence of cardiosurgical intervention type and conditions of artificial blood circulation of perioperative dynamics of cardiac biomarkers].

125 patients after cardiac surgery operated on with the use of artificial blood circulation (ABC) were followed-up. Blood levels of cardiac protein, binding aliphatic acids and troponin 1 and 3 days after the operation were registered. The study showed that aorta clamping more then 90 minutes and hypothermic perfusion regimen influence cardiomyocites negatively. The state of "surgical trauma" and reperfusional myocardium damage was approximately the same during aortic surgery, myocardium revascularization with the use of aortic clamping and cardioplegia, and correction of the acquired heart disease, according to the dynamics of the studied proteins in blood. The minimal blood level of cardiac protein, binding aliphatic acids after coronary by-pass surgery on the working heart witnesses about negative influence of crystalloid hypothermic cardioplegia on coronary microcirculation.

[Mesenteric circulation evaluation during myocardial revascularization with different temperature modes of extracorporeal circulation].

The Mesenteric blood circulation during myocardium revasculization was investigated 40 patients were divided in 2 groups: 1st group - normothermia CPB, 2nd group hypothermia CPB. It was found that reduced mesenteric perfusion occurred in both groups, but it was more pronounced in hypothermia CPB group and was caused by a significant deterioration of the microcirculation.

[The characteristics of hemostasis system disorders in a female patient with syndrome of differentiated dysplasia of connective tissue].

The article discusses the data concerning the homeostasis system in patients with syndrome of differentiated dysplasia of connective tissue, in particular, under the Marfan syndrome. The description of clinical case is provided. The analysis of blood coagulation system in female patient operated on the occasion of dissecting intramural aneurysm of aorta as manifestation of Marfan syndrome is discussed.

[The efficacy and safety of tranexamic acid and epsilon-aminocapronic acid in cardiac surgery under extracorporeal circulation].

Sixty patients who had undergone cardiosurgical operations under extracorporeal circulation (EC) were enrolled in the study. All the patients were divided into 2 groups: (1) 40 patients were injected tranexamic acid (TA) (its loading dose was 15 mg/kg; maintenance infusion 1 mg/kg/h throughout the operation; 500 mg in the primary packing volume for an EC apparatus (EA); (2) 20 patients received epsilon-aminocapronic acid (ACA) (its loading dose was 5 g; 5 g in the primary packing volume for an EA and 10 g for infusion after EC). The effects of TA and ACA on the fibrinolytic system were evaluated from the time of XIIa-kallikrein-dependent fibrinolysis (sec) and the concentration of D-dimer (mg/ml). The hemocoagulation system (activated partial thromboplastin time, thrombin clotting time, prothrombin time with the determination of the international normalized ratio, fibrinogen) was studied. The thromboelastogram (the time R, K, and alpha-angle, MA) was analyzed. The indices were determined at the beginning and end of, and 12 hours after surgery. The analysis of the clinical efficacy and safety of the agents was based on the following perioperative data: the incidence of adverse reactions and complications associated with the administration of the agents, the frequency and amount of transfused donor blood components, the volume of blood loss, and the rate of resternotomies. The laboratory and clinical findings lead to the conclusion that TA (Tranexam, OOO "MIR-PHARM") has a 4-fold antifibrinolytic activity as compared with epsilon-ACA. The more pronounced TA-induced suppression of fibrinolysis affects the clinical course of a perioperative period in this group, which manifests itself as a reduced blood loss volume during and after surgery and a lower frequency of use of donor blood elements. By taking into account these data, TA may be recommended as one of the blood-preserving technology components during cardiosurgical operations under EC.

[Comparative assessment of using various glomerular filtration rate calculations in cardiological patients].

The paper gives the data of comparing the use of various formulas to calculate glomerular filtration rate (GFR) for the evaluation of postoperative renal function in cardiosurgical patients. GFR is shown to evaluate renal filterability with a high degree of reliability. Monitoring of GFR changes may characterize the progression of renal diseases. This indicator is an important predictor of the onset of renal insufficiency and the risk of complications due to chronic renal disease. Calculation of GFR in clinical practice enables the agents excreted owing to glomerular filtration to be dosed to prevent their potential toxicity.

[Comparative assessment of criteria for postoperative renal dysfunction in cardiosurgical patients].

The paper presents data on comparison of the detection rate of renal dysfunction after cardiac surgery, by using the criteria developed by Cockroft-Gault, C. M. Mangano, L.-G. Andersson, and G. Zanardo. It is shown that it is expedient to calculate creatinine phosphokinase by the Cochroft-Gault formula that using a patient's individual parameters provides a more objective approach to making the diagnosis of renal dysfunction. The rate of development of renal dysfunctions in patients who have undergone cardiac surgery under extracorporeal circulation (EC) depends on the type of an operation and the duration and temperature of perfusion. By postoperative day 14, renal function became normal in the vast majority of patients. Renal function became chronic in 1% of the patients operated on the heart under EC.

[Conditions of artificial blood circulation and erythrocytic aggregation in cardiosurgical patients].

Normothermic artificial circulation, irrespective of its duration, enhances erythrocyte aggregation in response to noradrenaline stimulation. Short-term hypothermic perfusion reduces adrenergic aggregation of erythrocytes while in long-term hypothermic artificial circulation changes in erythrocyte adrenergic aggregation are not significant. In the course of cardiosurgical operation in conditions of artificial circulation adrenergic erythrocyte aggregation undergoes changes: a maximal rise before perfusion, linear lowering and rise to the preoperative level. If perfusion lasts longer than 90 min adrenergic aggregation of erythrocytes sharply and significantly falls. This aggregation depends little on hematocrit, but if it falls under 15% aggregation becomes significant which may be of importance in blood loss arrest in massive blood loss, hemodilution, dilution of coagulation factors and marked thrombocytopenia. In such conditions erythrocyte aggregates may seal damaged microvessels acting as hemostatic lock.

[Use of a potassium and magnesium asparaginate solution to maintain the balance of potassium and magnesium during cardiosurgical interventions under extracorporeal circulation].

The study included 42 patients with coronary heart disease operated on the coronary arteries. A potassium and magnesium asparaginate (PMA) solution, 450-1000 ml, was injected in 30 patients for 5-7 hours; other crystalloid solutions was used in a control group (n = 12). The concentrations of potassium and magnesium were measured prior to surgery, following initial anesthesia, before and after extracorporeal circulation (EC). The measurements suggested a significant potassium and magnesium intake at surgery under EC. The use of PMA solution showed its advantage in stabilizing the study electrolytes at the main surgical stages. Inclusion of PMA into infusion therapy considerably reduced a need for an additional use of concentrated KCl solution to maintain potassium at the preoperative level. Of particular importance was the use of PMA to maintain magnesium that was held in the upper normal range throughout the operation, as shown by both the median values and an individual analysis. When PLA was not administered, the mean concentration of magnesium was consistent with that in the lower normal electrolyte range and 50% patients developed hypomagnesemia. The comparative analysis of the clinical course after EC in both groups of patients with different levels of magnesium was indicative of the better status of some hemostatic parameters with the level of magnesium being maintained in the upper normal range.

[Impact of protamine sulfate on hemostasis system after operations with artificial circulation].

Effects of different doses and lots of protamine sulfate on hemostasis system after cardiac operations with artificial circulation are analyzed. Overall 982 patients underwent cardiac operations with artificial circulation. Quality and purity of protamine may be the causes of side effects. Negative effect of high doses of protamine on hemostasis system is demonstrated. Thrombocyte dysfunction is the main cause of intensive postoperative bleeding after administration of protamine high doses.

[Haemorheological impairments following aortic surgery and methods of correction thereof].

The article deals with the findings concerning alterations in rheological properties of the blood in patients who endured aortic surgery with and without artificial circulation. Also shown herein is the contribution of the plasmatic and erythrocytic components to the development of haemorheological disorders in the postoperative period. To this was added the assessment of the role plasmapheresis plays in correction of impaired blood rheological properties, depending upon the terms of its carrying out and the type of a surgical intervention performed.