[The support of immune safety of hemotransfusions under implementation of cardiosurgery operations].

The index and structure of allosensibilization of patients according transfusion dangerous antigens of erythrocytes were identified. The purpose of action was to evaluate risk of development of post-transfusion hemolytic complications under application of hemotransfusions during operative interventions on heart and vessels. The immune anti-erythrocytes antibodies were detected in 81 cases (1.7%) and their main percentage formed antibodies of Rhesus system (67.7%). The antibodies to antigens of other systems like anti-K (10%), anti-S (2.5%), anti-Jka (1.2%), anti-Fya (1.2%), anti-Lea (3.7%) were more rarely detected. The estimated index of sensitization in patients made up to 1.7% that testifies higher degree of alloimmunization of examined patients and potential risk of development of post-transfusion complications of hemolytic type under hemotrasfusions. The received data was used as a background to develop and to implement algorithm of immune hematologic examination of patients of cardiosurgery profile. This approach permits minimizing risk of alloimmunization of recipients, to forecast and to prevent development of complications under transfusion of erythrocyte-containing components of donor blood that significantly enhances quality of transfusion therapy.

[Left anterior descending bypass grafting from the anterolateral minitorakotomy].

Current efficient methods of open revascularization in patients with multivessel coronary artery lesions are associated with a certain amount of general and local complications depending on traumatic interventions, bypass, manipulation on the ascending aorta. Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) allows to avoid certain perioperative risk factors and appears to be a promising myocardial revascularization model in isolated lesion of left anterior descending (LAD) and multivessel lesions, applying combines percutaneous intervention (PCI).

[Role of coronary angiography in decreasing cardiac complications rate during vascular operations].

In order to assess the prevalence of coronary artery lesions in patients running various clinical risks of cardiovascular complications prior to surgical interventions on cardiac vascular basins, we performed a retrospective analysis of 392 case histories (340 men and 52 women, mean age 61.0±8.5 years). All patients in the preoperative period underwent coronary angiography (CAG). For the analytical purposes, the patients were subdivided into four groups. Group One (n=44) comprised patients without clinical risk factors, Group Two (n=184) was composed of those diagnosed as having one clinical risk factor. Group Three (n=122) comprised those with two clinical risk factors, and finally Group Four (n=42) was composed of those presenting with three and more clinical risk factors. CAG revealed that 91% of patients had coronary artery lesions. Haemodynamically significant lesions of three coronary arteries and/or stenosis of the left coronary artery trunk were observed in 15.6% of patients with no clinical risk factors of cardiac complications, in 19.0% of patients with one such factor, in 28.5% of those with two risk factors, and in 42.2% of patients with three and more risk factors. Preventive myocardial revascularization was performed in 22.7% of cases, more often in Group Three and Group Four patients. The number of postoperative complications in the groups did not differ significantly. The total hospital mortality rate was low (0.8%), with all 3 lethal outcomes observed amongst the patients with one clinical risk factor (1.6%). Hence, clinical preoperative stratification of the risk by means of the Lee index prior to vascular operations fails to reveal a considerable part of patients with prognostically unfavourable lesions of coronary arteries, and thus it should seemingly be used in this patient cohort with caution.

[Predictors of stent thrombosis in patients with ST-elevation acute coronary syndrome subjected to primary coronary artery intervention].

Basing on complex evaluation of clinical, angiographic, and laboratory data we revealed predictors of stent thrombosis in patients with ST-elevation acute coronary syndrome (ACS) subjected to percutaneous coronary interventions (PCI). Among studied sample of patients (n=124) we distinguished a group of patients with proven stent thrombosis at various stages of follow-up (n=22, group 1) and a group of patients with favorable outcome (n=102, group 2). Unifactorial analysis revealed unfavorable prognostic influence (p=0.025) of hemodynamically significant stenosis of proximal segment of anterior distending artery, disturbances of rhythm and conduction (p=0.0002), as well as degree of heart failure (HF) according to Killip on day 1 of development of symptoms of ACS, and also of high selectin P level on day 10 (p=0.031). With the aim of assessment of prognostic significance of revealed factors we conducted stepwise discriminant analysis according to results of which most significant parameter affecting development of stent thrombosis in patients with ST-elevation ACS appeared to be high Killip class of HF (p<0.0003), to a lesser degree - elevated level of sP-selectin on day 10 of observation (p=0.005). Parameter for which prognostic significance was not revealed as a result of multifactorial analysis was lesion in proximal segment of anterior descending artery (p=0.496). Probability of correct classification of the model was 88.7% at p<0.0001.

[Predictors of coronary adverse events in patients with acute coronary syndrome with ST segment elevation treated with percutaneous coronary interventions with stenting].

OBJECTIVE: The aim of this 12 months observational study was to investigate risk factors of major adverse coronary events, such as death or Q wave myocardial infarction due to stent thrombosis or in stent restenosis. MATERIAL AND METHODS: One hundred fifty four patients with ST segment elevation acute coronary syndrome were treated with percutaneous coronary intervention (PCI) and with implantation of metal stent. TIMI and CADILLAC scores were used for evaluation of initial risk. Blood levels of cytokines and sP selectin were measured on day 1 before PCI and on day 10 of hospitalization. RESULTS: We proved that CADILLAC score was applicable for evaluation of prognosis in patients with acute coronary syndrome and ST segment elevation treated with coronary stenting. High levels of tumor necrosis factor during first 24 hours of acute coronary syndrome and interleikin 8 on day 10 after PCI were found to be risk factors of major adverse coronary events during subsequent 12 months. High sP selectin level on day 10 predicted stent thrombosis during long term follow up.

[Quantitative analysis of hemodynamic disorders in coronary occlusion based on the roentgeno-cinematographic data]. / Kolichestvennyi analiz narushenii gemodinamiki pri koronarnykh obstruktsiiakh po dannym rentgenokinematografii.

The contrasting time of the coronary arteries in 4 types of atherosclerotic lesions was determined by means of quantitative analysis of the coronarograms. The contrasting time was found to be dependent both on the degree of the stenosis and on the condition of the distal segment of the coronary artery. The condition of the drainage tracts had a more marked effect on the contrasting time. The coronary arteries contrasting time is considered as an index of peripheral resistance in the studied segment.

[Experience in the perfecting of direct myocardial revascularization inpatients with ischemic heart disease]. / Opyt osvoeniia operatsii priamoi revaskuliarizatsii miokarda u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The first 100 operations for aortocoronary and mammary-coronary shunting in patients with ischemic heart disease are analysed. The operations were carried out on patients aged from 36 to 59 years who had no severe concomitant diseases. Angina pectoris of effort was encountered in 47%, angina of effort and of rest in 33%, and unstable angina in 20% of patients. The operations were performed under conditions of extracorporeal circulation. In 100 patients 184 arteries were shunted (1.8 shunt per one patient). A mammary-coronary shunt was established in 13 patients; the left internal thoracic artery was used in all of them for shunting the anterior interventricular branch. Improvement was recorded in 88.5% of patients after the operation. Thirteen (13.0%) patients died. It is concluded that patients should be chosen with great care for aortocoronary shunting with due regard for the risk factors.