New Technology for the Use of Inhaled Nitric Oxide to Protect the Heart and Lungs during Operations with Cardiopulmonary Bypass.

The aim of the study was to evaluate the effectiveness of a new technology for the use of inhaled nitric oxide (NO) for the heart and lung protection during operations with cardiopulmonary bypass (СРВ). MATERIALS AND METHODS: The study included 90 patients who underwent heart valve surgery and combined procedures under CPB and pharmacological cardioplegia. Three groups were created: group 1 (control, n=30); group 2 (n=30) - NO inhalation (20 ppm) was conducted traditionally, that is, before and after CPB; group 3 (n=30) - NO inhalation was performed using a new technology - during the entire operation, with pulmonary artery perfusion and lung ventilation performed during CPB. Troponin I (cTn I) level, changes in the pulmonary function parameters, and clinical indicators were studied. RESULTS: Statistically significant lower levels of postoperative cTn I were registered in the patients of groups 2 and 3, at the same time, the levels were significantly lower in group 3 compared to group 2. The patients in group 1 (standardized anesthesia protocol) demonstrated an increase in the alveolar-arterial oxygen difference, an increase in intrapulmonary shunting, a decrease in blood oxygenation, and static lung compliance after СРВ. In both cases, NO inhalation retained the values of lung compliance and pulmonary oxygenating function after CPB, and in the patients of group 3, it also significantly reduced intrapulmonary shunting and alveolar-arterial difference after CPB. NO inhalation allowed a statistically significant decrease in the incidence of pulmonary dysfunction, acute respiratory failure, as well as the time of respiratory support in the ICU. CONCLUSION: The developed technology for the use of inhaled NO in surgery with CPB provides a clinically marked protective effect on the heart and lungs. The effectiveness of the protective action of NO depends on the duration of its administration and is most pronounced when used during the entire operation, including CPB time.

[Open aortic valvuloplasty in surgical treatment of associated heart diseases]. / Otkrytaia aortal'naia val'vuloplastika pri khirurgicheskom lechenii sochetannykh porokov serdtsa.

The article presents indications to surgical correction of aortal stenosis and its variants in patients with rheumatic diseases combined with a lesion of other valves of the heart. The possibility to fulfill valve-saving plastic operations on the stenosed aortal valve was shown in 110 operations. The results obtained proved advantages of plastic operations over prostheses of the stenosed aortas without calcinosis universalis. Such operations allowed the intrahospital lethality to be considerably decreased. In later terms only two patients needed prostheses of the valve. The functional class was improved in the overwhelming majority of the patients.

[The results of the surgical treatment of recurrent mitral stenosis under artificial circulation]. / Rezul'taty khirurgicheskogo lecheniia retsidiva mitral'nogo stenoza v usloviiakh iskusstvennogo krovoobrashcheniia.

A total of 533 operations for recurrent mitral stenosis have been performed since 1987. Two hundred and twenty-six patients were operated on under extracorporeal circulation. Indications for open correction of the abnormality as an alternative to transventricular commissurotomy were defined by echocardiographic studies. In 86 patients, mitral restenosis was accompanied by involvement of other valves: aortic, tricuspid. Mitral prosthesis was required in 216 cases. Valve-preserving operations were made in 10 cases. The hospital mortality was 12.8%, it decreased from 17.5 for the first 126 operations to 7% for the last 100 operations. In isolated restenosis, the hospital mortality rate was 7.8%, it has reduced by 1.8% in the past 2 years. The hospital mortality was 2.4% for 327 transventricular recommissurotomies. There were 20.9% fatal outcomes in restenosis concurrent with other valvular diseases. In mitral-tricuspid stenosis, deaths reduced from 23.8% to 9.5%. The mortality rates decreased from 35.7 to 15.4% in mitral-aortic stenosis and from 33.3% to 18.2% in tricuspid stenosis. High mortality rates in restenosis concurrent with involvement of other valves are mainly related to the baseline status of the patients operated on.

[Plastic correction of aortic stenosis in two- and three heart valve diseases]. / Plasticheskaia korrektsiia aortal'nogo stenoza pri dvukh- i trekhklapannykh porokakh serdtsa.

Plastic correction of aortic stenosis with simultaneous intervention on the mitral and, in some cases, on the tricuspid valve was performed on 50 patients whose ages ranged from 25 to 53 years (average age 43.2 years); 15 were in NYHA functional class III and 35 in class IV. There were 38 females and 12 males. Correction of the aortic stenosis was achieved by open valvulotomy and additional plane resection of the cusps, suture plastic was conducted whenever necessary. In 6 cases calcinates were removed form the cusps simultaneously. Mitral valve prosthetics was undertaken in 42 patients, and open mitral commissurotomy in 8 patients. In 17 patients aortic and mitral stenoses were attended by defect of the tricuspid valve which called for plastic correction. Among the 50 patients who underwent operation 8 (16.0%) died. there were no fatal outcomes among patients related to the NYHA functional class III. In 41 cases the result of aortic stenosis correction was satisfactory, which was confirmed by clinical and echocardiographic data. After the operation, opening of the aortic valve cusps during echocardiography in the M-regimen increased, on average, from 12 +/- 2.0 to 18 +/- 2.6 mm. According to doppler-echocardiogram, the gradient on the aortic valve reduced, on average, from 45 +/- 5.0 to 26.5 +/- 4.0 mm. Only in one female patient aortic incompetence started progressing after the operation and called for prosthetics 6 months later.

[Surgical correction of mitral valve stenosis and its recurrence]. / Khirurgicheskaia korrektsiia mitral'nogo stenoza i ego retsidiva.

The article analyses the results of surgical treatment of 1,394 patients with mitral stenosis who were operated on in the period between January 1, 1986 and April 1, 1989. Hospital mortality was 2.0%. Distinct indications for transventricular commissurotomy and mitral valve prosthetics were determined. The choice of the method for mitral stenosis correction was based on the character of the morphological changes in the cusps and subcuspal structures, which were determined during echocardiographic examination. With proper indications transventricular commissurotomy presents a small risk. Hospital mortality was 0.8% in mitral stenosis (among 1,039 patients who underwent operation 8 died) and 2.5% in recurrent stenosis (among 197 patients 5 died). Lethal outcomes were not encountered in stage 11, the mortality rate was 0.6% in stage III and 2.2% in stage IV. Mitral valve prosthetics was performed in 158 patients with 15 (9.5%) lethal outcomes. Hospital mortality was 4.5% in stage III and 10.3% in stage IV of the disease. In the group of patients with mitral stenosis hospital mortality was 7.5% (93 patients underwent operation). Hospital mortality after operations for recurrent mitral stenosis (65) was 12.3%. The initial severity of the patients' condition is still the main factor which influences unfavorably of the immediate results of mitral valve prosthetics.

[Surgical treatment of mitral valve insufficiency]. / Khirurgicheskoe lechenie nedostatochnosti mitral'nogo klapana.

The paper reports on 127 operations on the open heart for mitral incompetence, including 112 prostheses and 15 annuloplasties on the support ring. After operation 28 (22.0%) patients died. Among the operated on patients with stage II-A circulatory insufficiency mortality was 9.3%, in those with stage II-B it was 28.5%. Mortality with mitral valve prosthesis was 24.1%, with annuloplasties 6.7%. The use of hypothermia and pharmaceutical agents for myocardium protection permitted the mortality decrease to 12.1%. The ten-year survival among patients subjected to prosthesis for mitral incompetence was 54.6%, the mortality in patients with stage II-A circulatory insufficiency was 75.4%, and in those with stage II-B it was 40%. The operations for mitral incompetence must be undertaken before the degenerative changes in the myocardium and other organs develop. In mitral competence prosthesis is indicated only in cases where the valve sparing operation is impossible.