[Surgical tactics in patients with ischemic heart disease, extensive cicatricial myocardial lesions and circulatory insufficiency]. / Khirurgicheskaia taktika u bol'nykh ishemicheskoi bolezn'iu serdtsa s obshirnymi rubtsovymi porazheniiami miokarda i nedostatochnost'iu krovoobrashcheniia.

The article discusses the results of surgical treatment of patients suffering from ischemic heart disease with extensive cicatricial affections of the myocardium and circulatory insufficiency. Thirteen patients of group I were treated by various reconstructive operations (resection of an aneurysm, formation of an aortocoronary shunt, septoplasty), 10 patients of group 2 underwent orthotopic heart transplantation. Perioperative and long-term (up to 3 years) mortality rates were, respectively, 7.6 and 8% in group I and, respectively, 30% and zero in group 2. The unfavorable prognosis of survival and medicamentous therapy in such patients, the lack of donors, and the acceptable results of reconstructive operations are evidence that they should be undertaken whenever possible. The main criteria of the selection of patients for a reconstructive operation are the values of regional contractility of the left ventricle, the severity of the dystrophic processes in the preserved segments, and the condition of the coronary arteries.

[The role of electrocardiographic examination in the complex evaluation of potential heart donors]. / Rol' élektrokardiograficheskogo issledovaniia v kompleksnoi otsenke potentsial'nykh donorov serdtsa.

From October, 1986 to February, 1990 eighty-five potential donors with death of the brain were examined at the Scientific Research Institute of Transplantology and Artificial Organs, USSR Ministry of Public Health. Thirty of them were used as heart donors in orthotopic transplantation of the heart; 24 (80%) were males and 6 (20%) females. The cause of death of the brain was craniocerebral trauma in 13, brain tumor in 9, hemorrhage into the brain tissue in 7 cases, and gunshot injury to the skull with damage to the brain in one case. In appraisal of the donors; in 8 (26.7%) cases the ECG did not differ from the initial one, in another 8 cases (26.7%) the ECG demonstrated electrolyte disorders in the form of hypokalemia , still in another 8 cases right bundle-branch block was encountered, in 2 (6.65%) the ECG showed transient form of cardiac fibrillation, in still another 2 cases I-II degree atrioventricular block was found, in one (3.3%) right and left bundle-branch block was demonstrated, and in one case the ECG showed diminished nutrition in the region of the posterior left-ventricular wall. All donors had disorders of homeostasis characteristic of patients with death of the brain, while the condition of hemodynamics conformed to these disorders. It is concluded on the basis of the obtained data that electrocardiographic monitoring is expedient and that it plays a role in complex appraisal of a potential heart donor.

[Selection of donors for heart transplantation]. / Selektsiia donora dlia transplantatsii serdtsa.

The article discusses the first clinical experience of the donor maintenance of the program of heart transplantation. Under analysis are etiology and terms of the process of death of the brain in 65 potential donors. The authors propose a scheme of the three-stages assessment of fitness of his heart for transplantation. Specific features of intensive therapy of the donors are considered. Twenty donors were used for clinical transplantations of the heart, in 18 cases (90%) satisfactory recovery of functions of the transplanted heart was noted.

[Heart transplantation. The current problems of patient selection, examination and treatment]. / Transplantatsiia serdtsa. Aktual'nye voprosy otbora, obsledovaniia i lecheniia bol'nykh.

An analysis was made of the work carried out by the Department of Coronary Surgery and Heart Transplantation as regards heart transplantations during 1988. As many as 119 patients, hypothetical heart recipients, received medical advice. The Department refused hospitalization to 42 patients because of the nonconformity to the indications and contraindications to heart transplantation. 77 patients were admitted to the Department. During examinations and treatment, 53 persons were discharged from hospital. 8 patients died before donor's hearts were received. Donor's hearts were transplanted to 10 patients. 3 persons died from severe infectious complications on days 12, 15 and 43 after the operation. Following the operation 7 patients have been surviving from 4 to 17 months. The patients' status remains satisfactory. The functional parameters of the donor's heart are within normal. Taking into consideration the lack of the treatment methods for patients with terminal heart lesions, it is necessary that the number of operations be increased. A great importance in this case is attached to the joint efforts of internists and cardiologists, aimed at the screening and examination of potential heart recipients.

Experimental model of right ventricular failure with heterotopic heart transplantation for assisted circulation.

In 20 acute experiments on 40 mongrel dogs ranging in weight from 15 to 20 kg, a heterotopic heart transplant was implanted into the chest of the recipient with experimentally induced right ventricular failure. A detailed description is presented of the operative technique in acute and chronic experiments. Haemodynamic findings attest to the efficacy of the work of the transplant, the right ventricle of which is able to take over most of the work of the right ventricle of the recipient.