[Factors of adverse prediction of application of spinal cord stimulation with chronic pain syndrome in patients with critical lower limb ischemia]. / Faktory neblagopriiatnogo prognoza primeneniia spinal'noi neirostimuliatsii pri khronicheskom bolevom sindrome na fone kriticheskoi ishemii nizhnikh konechnostei.

AIM: To study the clinical dynamics in the long-term period after spinal cord stimulation (SCS) in patients with chronic pain syndrome and critical lower limb ischemia (CLLI) and to identify factors affecting the prognosis of SCS. MATERIAL AND METHODS: The clinical dynamics was analyzed in 48 patients with pain syndrome and CLLI 1 year after SCS. Microcirculatory blood flow (MBF) was studied in the affected foot by laser-doppler flowmetry (LDF) (Perfusion Units (PU)) and transcutaneous oximetry (TcpO2, mmHg.) using an occlusive test before and after SCS. The factors associated with negative clinical dynamics 1 year after SCS were determined. RESULTS: In 74% of cases, SCS contributes to the improvement of clinical status (reduction of pain syndrome, increase in motor activity, healing of ulcers). After SCS, according to LDF and TcpO2, the authors observed an increase in MBF and tissue metabolism - from 1.3 (0.7-2.8) to 6.2 (3.8-8.7) PU and from 14.5 (7.5-22.1) to 41.1 (26.4-57.6) mmHg, respectively with normalization of the MBF reserve during the occlusion test. Negative clinical dynamics after SCS is associated with high comorbidity, TcO2 <10 mmHg and the duration of pain. CONCLUSION: SCS contributes to the improvement of the clinical status of patients with chronic pain syndrome and CLLI. The negative dynamics is associated with high comorbidity, TcrO2 <10 mmHg and the duration of pain.

Balloon pulmonary angioplasty for patients with inoperable chronic thromboembolic pulmonary hypertension.

AIM: To evaluate the effectiveness of balloon pulmonary angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). MATERIALS AND METHODS: Forty patients with inoperable CTEPH were enrolled in this study. The indications were determined by multidisciplinary team. The average age of patients was 53.5 [43; 63] years. In 65% of cases patients had functional class III (according to WHO); the distance in the 6-minute walk test (6MWD) was 327 [280; 400] m; catheterization of the right heart revealed systolic pulmonary artery pressure (SPAP) 82 [64; 100] mm Hg, mean pulmonary artery (mPAP) 48.5 [38; 56] mm Hg, pulmonary vascular resistance (PVR) 784 [525; 1257] dyn·s/cm-5. Each patient underwent 6 BPA. RESULTS: The effectiveness of BPA was assessed 2 months after the last session. According to the data of right heart catheterization SPAP decreased by 27.3%, mPAP by 26%, PVR by 34.5% from baseline. After all series of BPA echocardiography and magnetic resonance imaging demonstrated reverse remodeling of the right heart. Also significant decrease in the level of BNP by 62%, increasing in 6MWD distance by 39% and improvement of the functional class up to I in 60% cases and up to II in 40% cases were noted. CONCLUSION: The results of the present study demonstrated a high efficacy of BPA allowing to normalize hemodynamic and clinical parameters, increasing the physical activity. Balloon pulmonary angioplasty is a new highly effective, safe method for treating patients with inoperable CTEPH.

[Thoracoscopic clipping of patent ductus arteriosus: position of surgery in the era of transcatheter procedures]. / Torakoskopicheskoe klipirovanie otkrytogo arterial'nogo protoka: mesto khirurgii v épokhu transkateternykh tekhnologii.

AIM: To describe single-center evolution of the procedure and to evaluate the results of thoracoscopic clipping of patent ductus arteriosus (PDA) with diameter over 3,0 mm in term infants weighting over 4,0 kg. MATERIAL AND METHODS: Thoracoscopic clipping of PDA has been performed in 140 patients for the period from March 2012 to March 2018 in Meshalkin National Medical Research Center. Mean age was 4.0 years (range 3 months - 13 years), mean body mass index - 15.4±2.2 kg/m2. INCLUSION CRITERIA: PDA size 3.5-10 mm, Qp/Qs >1,3/1,0, weight 4.0-40 kg. Mean PDA size was 4.6±0.9 mm (range 3.5-8.0 mm), mean pulmonary artery pressure - 34.3±5.8 mm Hg, mean systemic/pulmonary flow Qp/Qs - 1.6±0.3. All patients underwent successful PDA closure through four-port technique under endotracheal general anesthesia and no need for pleural drainage. RESULTS: Mean procedure time was 24.5±15.5 min. In 29 (20,7%) cases we used titanium clips, in 11 (79.3%) - polymer locking ligating clips. There was 1 conversion to mini-thoracotomy. There were no deaths, bleeding or any other life-threatening complications. 94 (67.1%) patients were weaned from ventilator within operating theatre, in other 46 (32.9%) patients mean ventilation time in ICU was 1.3±1.0 hours. In-hospital postoperative complications: pneumothorax - 2 (1.4%) cases, recurrent laryngeal nerve dysfunction - 1 (0.7%), false croup - 1 (0.7%). There were 2 residual leakages in 2 (1.4%) patients in 10 and 6 months after titanium clip deployment. Both of them underwent transcatheter closure using the coil. Considering these cases all following patients underwent PDA closure by polymer locking ligating clips with no cases of residual leakage. CONCLUSION: Thoracoscopic PDA closure by polymer locking ligating clip is safe and effective technique for surgical management of PDA with diameter over 3.0 mm in term infants weighting over 4.0 kg.

Effect of Polyethylene Terephthalate on Functional Properties of Endothelial and Mesenchymal Cells.

We studied the influence of vascular prostheses made of polytetrafluoroethylene and polyethylene terephthalate on the proliferation, migration, and NO production by bone marrow mesenchymal stem cells, human endothelial progenitor cells, and EA.hy926 endothelial cells, colonization of the prosthesis surface by endothelial and mesenchymal cells was also analyzed. Synthetic prostheses have a negative effect on cell proliferation and migration, while surface treatment with proteins (fibronectin or gelatin) promotes colonization of the prostheses with cells.

[Predictors of neurological complications during surgical treatment of the ascending aorta and aortic arch chronic dissection]. / Prediktory nevrologicheskikh oslozhnenii pri khirurgicheskoi korrektsii khronicheskogo rassloeniia voskhodiashchego otdela i dugi aorty.

AIM: To evaluate the prognostic significance of oxygen supply to the brain in the risk of neurological complications in the early post operative period of surgical treatment of the ascending aorta and aortic arch. MATERIAL AND METHODS: The level of oxygenation (rSO2) in the right and left hemispheres was measured in 68 patients with ascending aorta and aortic arch chronic dissection. Before and in the nearest period after surgery, the patients underwent a clinical/instrumental neurological study. RESULTS: The incidence of ischemic stroke in the early post operative period was 5.9%, cognitive impairment was recorded in 22% of patients. Among the parameters of oxygen supply to the brain, the dynamics of rSO2 during circulatory arrest had a significant impact on the post operative neurological status. The risk of cognitive impairment, besides the association with the oxygen status of the brain, increased with the age of patients and comorbid pathology. CONCLUSION: The decrease in rSO2 by ≥30% during surgical treatment of ascending aorta and aortic arch dissection increases the risk of ischemic stroke and cognitive impairment in the early post operative period.

[Robot-assisted atrial septal defect closure in adults: first experience in Russia]. / Robot-assistirovannoe zakrytie defekta mezhpredserdnoi peregorodki u vzroslykh: pervyi opyt v Rossii.

AIM: To analyze immediate results of minimally invasive robot-assisted atrial septal defect (ASD) closure in adults. MATERIAL AND METHODS: For the period from March 2012 to November 2016 sixty patients with contraindications to endovascular procedure have undergone robot-assisted atrial septal defect closure at Meshalkin Siberian Federal Biomedical Research Center. Mean age was 34.5±11.3 years, body mass index - 24.6±4.0 kg/m2. 48 (80%) patients had NYHA class II before surgery. In 37 (61.7%) patients isolated ASD with deficiency or absence of one edge was diagnosed, isolated ASD with primary septum aneurysm - in 16 (26.7%) cases, 7 (11.6%) patients had reticulate ASD. 5 (8.3%) patients had concomitant tricuspid valve insufficiency required surgical repair (suture annuloplasty). All operations were performed under cardiopulmonary bypass with peripheral cannulation. Right-sided anterolateral mini-thoracotomy was used in the first 43 patients. Following 17 patients underwent completely endoscopic procedure. Depending on the shape, size and anatomical features of the defect we performed suturing (14 patients, 23.3%) or repair with xenopericardial patch (46%, 76.6%). RESULTS: Mean CPB and aortic cross-clamping time was 89.1±28.7 and 24.8±9.5 min, respectively. Postoperative variables: mechanical ventilation 3.3±1.5 hours, ICU-stay - 18.2±3.7 hours, postoperative hospital-stay - 13.4±5.7 days. There were no mortality and any life-threatening intra- and postoperative complications. Cases of conversion to thoraco-/sternotomy and postoperative bleeding followed by redo surgery were also absent. 23 patients were followed-up within 1 year, 6 patients - within 2 years, 3 patients - within 3 years. All patients were in NYHA class I-II with 100% freedom from ASD recanalization and redo surgery. According to echocardiography data there were decreased right heart, pulmonary artery pressure and preserved left ventricular function in early postoperative period and 1 year after surgery. CONCLUSION: In view of favorable course of postoperative period, no significant specific complications and encouraging immediate results we can talk about endoscopic robot-assisted ASD closure in adults as a safe and effective alternative to surgical treatment.

[Perspective Directions in Management of Severe Group Two Pulmonary Hypertension].

PURPOSE: To compare immediate results of mitral valve surgery in patients with severe pulmonary hypertension with versus without concomitant pulmonary artery denervation. MATERIALS AND METHODS: From January to December 2015 30 patients were randomly assigned into two groups. Patients of one group underwent mitral valve surgery (comparison group), in the other group mitral valve surgery was accompanied by pulmonary artery ablation (ablation group). Both groups had comparable anthropometric, echocardiographic, and hemodynamics characteristics. RESULTS: There were no hospital mortality and specific ablation-related complications. Left ventricular remodeling and decrease of pulmonary artery pressure were observed in both groups at discharge. On the third day after surgery systolic and mean pulmonary artery pressure assessed by right heart catheterization were 48 and 22 versus 59 and 39 mm Hg in ablation and comparison group, respectively (p.

[Effectiveness of Extended Myectomy in Patients With Hypertrophic Cardiomyopathy With Midventricular Obstruction].

PURPOSE: to assess effectiveness and safety of extended myectomy performed in patients with hypertrophic obstructive cardiomyopathy (HOCM) with midventricular obstruction. MATERIAL AND METHODS: Between 2010 and 2013 185 HOCM patients were operated for left ventricular outflow tract (LVOT) obstruction. Among these patients 32 had midventricular obstruction. Their age was 22-74 (mean 51.9+/-14.2) years. Mean peak gradient across LVOT was 89.1+/-20.4 mm Hg, thickness of interventricular septum was 26.9+/-4.3 mm. Operations were guided by intraoperative transesophageal echocardiography (TEE). RESULTS: There were no early deaths. Gradient at LVOT according to TEE decreased to 15.4+/-5.7 mm Hg. There were no complications specific for extended myectomy (such as ventricular septal defect, left ventricular wall rupture, or aortic regurgitation). In 2 (6.9%) patients permanent pacemaker was implanted because of complete atrio-ventricular block. Mean follow-up was 18.7 (95% confidence interval [CI] 17.2 to 20.3) months. Kaplan-Meier estimate of survival was 100% at 12 and 94.2% (95% CI 65.8-99.1%) at 22 months. CONCLUSION: Extended myectomy can be safely and effectively performed in HOCM patients with midventricular obstruction and should be considered individually in each patient.

[Functional reserves of peripheral perfusion in patients with chronic lower limb ischaemia and the risk for restenosis development].

The authors studied the functional state of the peripheral microcirculatory blood flow (MCBF) by means of laser Doppler flowmetry and the level of partial pressure of oxygen (TcPO(2)) in a total of 82 patients presenting with stage IIB-IV chronic lower limb ischaemia (CLLI) prior to percutaneous transluminal balloon angioplasty (PTBA) with stenting of lower limb arteries and in the remote terms following revascularization (after 12 months). The study was aimed at assessing the functional reserves of peripheral perfusion in CLLI patients and the risk for the development of restenoses in the remote period after revascularization. Group One comprised 47 patients with the compensated functional state of the peripheral MCBF by the results of the orthostatic test (changing from the lying to standing position) and Group Two was composed of 35 patients with the decompensated state of MCBF. Decompensated disorders of functional reserves of the peripheral MCBF in CLLI patients, i.e., 1) no reaction of microcirculation to the orthostatic test and 2) a substantial decrease in the oxygen pressure in peripheral tissues (TcPO(2) less than 20 mm Hg) increase the chances of restenoses development in the remote period after revascularization 1.9- and 2.4-fold, respectively. Impairments of carbohydrate and lipid metabolism in CLLI patients promote a more than two-fold increase in the risk for the development of restenoses in the postoperative period. It is necessary to determine the functional reserve of the peripheral microcirculation in patients with CLLI at the preoperative stage in order to assess the prognosis of efficacy of revascularization and determine further goal-directed correction of the MCBF.

Outcomes of the Ross procedure in patients with an accompanying ascending aortic aneurysm.

Analysed in the article are the results of the Ross procedure in patients presenting with dilatation of the ascending portion of the aorta. A combination of aortic valve defects with dilatation of the ascending aorta of more than 45 mm supposes simultaneous prosthetic repair of the aortic valve and ascending aorta. The most common surgical procedure remains the Bentall-DeBono operation whose main disadvantage is associated with implantation of a mechanical prosthesis and the necessity of lifelong anticoagulant therapy. An alternative method is the Ross procedure demonstrating low risk of thromboembolic complications and freedom from anticoagulant therapy. Over the period from 2002 to April 2015, specialists of the Novosibirsk Scientific Research Institute of Circulatory Pathology named after Academician E.N. Meshalkin carried out a total of 162 Ross procedures in patients presenting with accompanying dilatation of the ascending aorta (more than 45 mm). The mean diameter of the aorta at the level of Valsalva sinuses amounted to 45.6±8.6 mm, with that of the ascending aortic portion equalling 53.4±7.8 mm. The technique of total replacement of the aortic root was used in all cases. When the aneurysm extended to distal portions of the ascending aorta, additionally performed were the following procedures: in 24 patients--reduction aortoplasty, in 6 patients--replacement of the resected aorta with an insert from xenopericardium, and in 2 patients with a vascular graft. The average duration of follow up amounted to 40.1±21.6 months. Ten patients were subjected to repeat operations for autograft dysfunction. There were no reoperations on the ascending portion of the aorta. The regression analysis revealed that predictors of the development of autograft dysfunction were the baseline dilatation of the fibrous ring (FR) of the aortic valve of more than 27 mm (p=0.04) and uncorrected arterial hypertension in the postoperative period (p=0.03). In the group of patients with the FR less than 27 mm there were no cases of allograft dysfunction. The results of the study suggest that the Ross procedure is a safe and effective method in patients with accompanying dilatation of the ascending aorta. Risk factors for autograft dysfunction are dilatation of the FR of the aortic valve exceeding 27 mm and arterial hypertension in the postoperative period.

[Risk of Cerebral Complications of Surgical Treatment of Patients With Chronic Pulmonary Embolism].

Aim of the study was to assess risk of cerebral complications at the background of various methods of brain protection during surgery in patients with chronic pulmonary embolism (PE). We examined 61 patients aged 39-54 years operated because of chronic PE. Monitoring of cerebral oxygenation (rSO2, %) was performed at various stages of surgery. Neurological status was assessed in the immediate postoperative period. We conclude that antegrade cerebral perfusion was the most effective method of cerebral protection which was associated with reduction of risk of neurological complications in the early postoperative period. Application of full cardiac arrest at the background of craniocerebral hypothermia was associated with the most significant reduction of rSO2 and increased risk of impairment of neurological status in the early postoperative period.

Therapy of Chronic Cardiosclerosis in WAG Rats Using Cultures of Cardiovascular Cells Enriched with Cardiac Stem Cell.

We developed a protocol for preparing cardiac cell culture from rat heart enriched with regional stem cells based on clonogenic properties and proliferation in culture in a medium with low serum content. Experiments on WAG rats with experimental ischemic myocardial damage showed that implantation of autologous regional stem cells into the left ventricle reduced the volume of cicatricial tissue, promoted angiogenesis in the damaged zone, and prevented the risk of heart failure development.

[Immediate Results of Mitral Valve Surgery in Asymptomatic Patients With Severe Mitral Regurgitation Due to Degenerative Mitral VaIve Disease].

Degenerative mitral valve disease nowadays is the most common cause of mitral insufficiency in developed countries and is associated with high morbidity and mortality. In the last decades repairing the mitral valve has become the operation of choice for treatment of the mitral valve prolapse, enabling to improve the geometry and function of the left ventricle and long-term survival. Nevertheless, the problem of choice of method of management of severe mitral regurgitation in asymptomatic patients with degenerative mitral valve disease remains unsolved. In this article we present immediate results of a prospective comparative study of mitral valve surgery in asymptomatic and symptomatic patients in dependence on NYHA class of heart failure.

[Efficiency of Pulmonary Ventilation in Remote Period After Surgery in Patients With Chronic Pulmonary Thromboembolism].

AIM: to assess efficiency of pulmonary ventilation in remote period after surgical treatment of chronic pulmonary thromboembolism (CPTE). MATERIAL AND METHODS: We examined 29 patients with CPTE with median age 49 (38-60) years. Pulmonary ventilation was studied by body plethysmography and its efficiency was evaluated by oxygen utilization coefficient (OUC). RESULTS: Comparison of OUCs before and in the remote period after surgery showed that after surgical treatment efficiency of pulmonary ventilation increased by 26% at the account of reduced hyperventilation but remained below normal. Patients' age and duration of the disease had a direct impact on the baseline bronchial conductivity as well as on recovery of the respiratory system reserve in the remote period after surgery.

[Immediate Results of Mitral Valve Surgery in Asymptomatic Patients With Severe Mitral Regurgitation Due to Degenerative Mitral Valve Disease].

Degenerative mitral valve disease nowadays is the most common cause of mitral insufficiency in developed countries and is associated with high morbidity and mortality. In the last decades repairing the mitral valve has become the operation of choice for treatment of the mitral valve prolapse, enabling to improve the geometry and function of the left ventricle and long-term survival. Nevertheless, the problem of choice of method of management of severe mitral regurgitation in asymptomatic patients with degenerative mitral valve disease remains unsolved. In this article we present immediate results of a prospective comparative study of mitral valve surgery in asymptomatic and symptomatic patients in dependence on NYHA class of heart failure.

[Efficiency of Pulmonary Ventilation in Remote Period After Surgery in Patients With Hronic Pulmonary Thromboembolism].

AIM: to assess efficiency of pulmonary ventilation in remote period after surgical treatment of chronic pulmonary thromboembolism (CPTE). MATERIAL AND METHODS: We examined 29 patients with CPTE with median age 49 (38-60) years. Pulmonary ventilation was studied by body plethysmography and its efficiency was evaluated by oxygen utilization coefficient (OUC). RESULTS: Comparison of OUCs before and in the remote period after surgery showed that after surgical treatment efficiency of pulmonary ventilation increased by 26% at the account of reduced hyperventilation but remained below normal. Patients age and duration of the disease had a direct impact on the baseline bronchial conductivity as well as on recovery of the respiratory system reserve in the remote period after surgery.

Effect of morphofunctional properties of mobilized progenitor cells of patients with chronic heart failure on the efficiency of autologous intramyocardial cell transplantation.

We studied the phenotype and cytokine production in peripheral blood mononuclear cells mobilized from the bone marrow after administration of granulocyte colony-stimulating factor (G-CSF) and the relationship of these parameters with clinical efficacy of autologous intramyocardial injection of donor cells in patients with chronic heart failure. We found that mononuclear cells contain endothelial progenitor cells and are capable of producing pleiotropic cytokines exhibiting angiogenic and cardioprotective properties. High concentration of cells with of CD34+ and CD34+/CD133+ phenotype in the cell transplant and enhanced production of IL-10, TNF-α, and granulocyte-macrophage-CSF by blood mononuclear cells mobilized from the bone marrow can contribute to improvement of myocardial perfusion and increase in left ventricular ejection fraction after intramyocardial transplantation and can serve as predictors of high efficiency of cell therapy. Peripheral blood is an available source of progenitor cells, while mononuclear cells after administration of granulocyte-CSF can produce a reparative effect on ischemic myocardium.

Phenotype of peripheral blood cells mobilized by granulocyte colony-stimulating factor in patients with chronic heart failure.

Administration of granulocyte CSF preparation to patients with chronic heart failure produced a hemostimulating effect and increased the content of leukocytes and neutrophils in the peripheral blood. Granulocyte CSF induced mobilization of bone marrow progenitor cells into the peripheral blood. The content of hemopoietic CD34(+)progenitor cells, which attained 0.42% (0.25-0.64) by the end of mobilization, inversely correlated with the number of myocardial infarctions. Administration of granulocyte CSF not only led to mobilization of bone marrow hemopoietic cells, but also increased the pool of endothelial progenitor cells in the peripheral blood: the content of CD34(+)/CD133(+)and CD34(+)/KDR(+)attained 0.02% (0.013-0.075) and 0.1% (0.05-0.20), respectively. Peripheral blood is an available source of progenitor cells, while mononuclear cells after administration of granulocyte CSF can produce a reparative effect on ischemic myocardium.

Left ventricular dimension and shape after postinfarction aneurysm repair.

OBJECTIVE: We evaluated left ventricular dimensions and shape in the patients with postinfarction LV aneurysm before and after different techniques of ventricular reconstruction. METHODS: From January 1997 to December 2003, 158 patients underwent LV aneurysm repair. There were 152 men and 6 women, with a mean age 50+/-8.4 years. Ventricular reconstruction was performed by using linear plasty of the Cooley technique in 35 patients, septal plasty of the Stoney technique-in 57 patients, and endoventriculoplasty of the Dor technique-in 66 patients. Left ventricular volumes and dimensions, global and contractile left ventricular function, diastolic sphericity were analyzed before and after operation over a period of 10 days to 5 years. RESULTS: The EchoCG studies showed a significant postoperative improvement of the LV contracting function regardless of LV plasty technique used. The index of sphericity changed from 0.71+/-0.08 to 0.72+/-0.06 after linear plasty, from 0.71+/-0.05 to 0.73+/-0.07 after septal plasty, from 0.74+/-0.06 to 0.56+/-0.05 after endoventriculoplasty. The hospital mortality rate was 6.3%. There is no significant difference in hospital mortality rates between the different techniques of LV aneurysm repair. CONCLUSIONS: Our results show the effectiveness of different techniques of LV aneurysm repair, when the differentional approach to choice an adequate method of ventricular reconstruction was applied.