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Treatment results of 96 patients with ischemic heart disease, operated on with the use of artificial blood circulation and polycomponent anesthesia, were analyzed. The modified protocol of infusion therapy and functional tests (passive limb elevation and volume load test) were used to assess the dynamic vascular reaction among patients of the main group (n=54). Patients from the control group (n=42) received only standard infusion therapy. The use of functional test permits more individual calculation of the necessary volume to correct vascular reactions on the initial anesthesia. The simultaneous monitoring of tissue and brain oxygenation permits adequate assessment and correction of short vascular reactions during the cardiac surgery. During short vascular reactions the tissue perfusion in the absence of cardiac insufficiency changes in an inverse proportion to arterial blood pressure.

The interrelationship of the cardiac index (CI) and carbon dioxide concentration measured at the end of respiration (CO2ER) was studied in 258 patients, aged from 5 to 71 years, during operations on the open heart. Statistical analysis of the stage of revision of the left ventricular posterior wall showed that CO2ER decreases from 29.9 +/- 0.7 mm Hg to 24.9 +/- 1.4 mm Hg in parallel with reduction of CI from 2.81 +/- 0.19 l/min/m2 to 1.62 +/- 0.13 l/min/m2. At the end of this manipulation the CI and CO2ER were restored to the initial level. Marked parallel dynamics of CO and CO2ER was revealed in continuous appraisal of the cardiac output (CO), determined by the method of catheter flow measurement, at the stage of parallel circulation and blood pumping from the extracorporeal circulation apparatus before CO2ER stabilization. The correlation coefficient of these parameters varied in this stage in various patients from +0.73 to +0.96. Analysis of the mass of data (n = 161) collected in 14 patients showed that the CI--CO2ER relation was exponential in character and could be expressed by the equation CI (l/min/m2) = e (-0.99 + 0.065 x CO2ER); standard determination error +/- 0.42 l/min/m2. Analysis of the "CO2ER-venous pressure" relation in these 14 patients showed it to be similar to the "cardiac index-venous pressure" relation. The coefficients of correlation between CVD and CO2ER at this stage ranged in various patients from +0.74 to +0.96 and those between VP and CI from +0.58 to +0.97. Transition of the relations to the plateau occurred at equal CVP values.

The authors analyse experience in the first eight operations for orthotopic transplantation of the heart. Six patients were discharged from the clinic with good immediate results. Comparison of their own data with summarized results gained in other countries allowed the authors to define some specific problems which are of practical interest for clinics embarking on the clinical realization of the problem of heart transplantation.