Search

The objective was to improve the surgical treatment tactics in patients with non-small cell lung cancer (NSCLC) and coronary heart disease (CHD), requiring myocardial revascularization.Methods and materials. Two groups consisting of 24 patients operated on for NSCLC were examined. In one group, operations for NSCLC were performed in the second stage after coronary artery bypass grafting (CABG). Survival rates in both groups and factors influencing them were evaluated.Results. The number of postoperative complications in both groups was comparable: 20.8 % in patients with CABG and 16.6 % in the group operated only for NSCLC. Indicators of relapse-free and overall survival did not differ significantly from each other (p=0.90 and p=0.95). Only the stage of the disease (p=0.009) and the implementation of complex cancer treatment in case of its necessity (p=0.035) had a reliably impact on the long-term results of the operation. The first stage of myocardial revascularization surgery did not affect the results of treatment (p=0.94), as well as the age of patients, the volume of performed surgery, the morphological picture of the tumor.Conclusion. The staging approach to the treatment of patients with NSCLC and critical forms of CHD requiring myocardial revascularization is reliable, convenient and does not affect the long-term results of treatment.

A clinical case of surgical treatment of a patient with atherosclerotic combined lesions of the coronary and carotid areas is presented. A staged surgery was performed. The first stage was carotid endarterectomy sequentially on both sides. The second stage is three-vessel coronary artery bypass grafting. The patient was examined 2 years after the operation. There are no data on restenosis of the reconstruction zone of the carotid system. The return of angina pectoris is not noted.

In 2017, the European Society of Cardiology outlined the importance of the problem of diagnosing myocardial ischemia-reperfusion injury following coronary artery bypass grafting. Myocardial injury can be accompanied by a critical decline in the cardiac index and an increase in cardiac troponin I plasma levels. The prognostic value troponin I elevation after coronary artery bypass grafting is poorly understood. Objective: to determine the prognostic value of troponin I plasma levels in relation to a fall in the cardiac index after coronary artery bypass grafting (CABG). Task: To determine the probability the cardiac index falling below 2.2 for troponin I levels in the first hours, and on days 1, 2, 3, 4 after CABG. Materials and methods. The single-center, non-randomized prospective study, running from 2016 to 2019, included 336 patients admitted for elective surgical treatment of coronary artery disease. The CABG patients were divided into three observation groups: off-pump (n = 175), on-pump (n = 128), and pump-assisted (n = 33). Troponin I levels were measured in the first hours, and on days 1, 2, 3, 4 after surgery using the Pathfast Compact immunoassay analyzer. Cardiac index was measured by invasive method. Results. In patients with a cardiac index higher than 2.2, troponin I level did not exceed 0.5 ng/mL in the off-pump group, 6 ng/mL in the on-pump group, and 3.5 ng/mL in the pump-assisted group. Patients with cardiac index lower than 2.2 have comparable troponin I levels in all groups - 21 ng/mL. Troponin I thresholds on day 1 after surgery, which, when exceeded, was associated with the likelihood of the cardiac index falling below 2.2, was 3.78 ng/mL in the off-pump group, 9.67 ng/mL in the on-pump group and 17.06 ng/mL in the pump-assisted group. Conclusion. After off-pump CABG, clinically significant myocardial injury should be expected at lower troponin I levels (3.78 ng/mL) than after on-pump CABG (9.67 ng/mL) and pump-assisted CABG (14.7 ng/mL).

Работа посвящена изучению процесса массопереноса вещества в Ð¼Ð¸ÐºÑ€Ð¾ÐºÐ°Ð½Ð°Ð»Ð°Ñ Ð¿ÐµÑ€ÐµÐ¼ÐµÐ½Ð½Ð¾Ð¹ геометрии, Ð¸Ð¼Ð¸Ñ‚Ð¸Ñ€ÑƒÑŽÑ‰Ð¸Ñ ÑƒÑÑ‚Ñ€Ð¾Ð¹ÑÑ‚Ð²Ð¾ «кровеносный сосуд-на-чипе». Для описания процессов массопереноса вещества в микроканале были предложены две математические модели, основанные на Ð´Ð²ÑƒÑ Ñ€Ð°Ð·Ð»Ð¸Ñ‡Ð½Ñ‹Ñ Ð³Ð¸Ð¿Ð¾Ñ‚ÐµÐ·Ð°Ñ : сплошной среды и дискретного потока частиц. Численные расчёты проводились в программной среде COMSOL Multiphysics, оснащенной Ð½ÐµÐ¾Ð±Ñ Ð¾Ð´Ð¸Ð¼Ñ‹Ð¼ модулем микрогидродинамики. Моделирование и экспериментальная проверка моделей выполнены на базе Института аналитического приборостроения РАН, где методом мягкой литографии были  изготовлены микрофлюидные чипы (всего 20 штук), имитирующие кровеносные сосуды. Движение потоков жидкости по микроканалам чипа исследовалось с использованием конфокального микроскопа Leica. В результате, моделирование на основе Ð¾Ð±Ð¾Ð¸Ñ Ð¿Ð¾Ð´Ñ Ð¾Ð´Ð¾Ð² показало, что уменьшение угла анастомоза повышает эффективность шунтирования. Получены расчётные оценки отношения величин потоков на Ð²Ñ‹Ñ Ð¾Ð´Ðµ каналов для Ñ€Ð°Ð·Ð½Ñ‹Ñ ÑƒÐ³Ð»Ð¾Ð² анастомоза. Выполнена экспериментальная проверка Ð¼Ð°Ñ‚ÐµÐ¼Ð°Ñ‚Ð¸Ñ‡ÐµÑÐºÐ¸Ñ Ð¼Ð¾Ð´ÐµÐ»ÐµÐ¹ ламинарности течения жидкости в канале и равномерности Ñ€Ð°ÑÑ Ð¾Ð´Ð¾Ð² в Ð¾Ñ‚Ð²ÐµÑ‚Ð²Ð»ÐµÐ½Ð¸ÑÑ Ð¾Ð´Ð¸Ð½Ð°ÐºÐ¾Ð²Ð¾Ð¹ геометрии. Полученные данные в перспективе можно будет использовать в качестве рекомендаций для ÐºÐ°Ñ€Ð´Ð¸Ð¾Ñ Ð¸Ñ€ÑƒÑ€Ð³Ð¾Ð².Результаты исследования были опубликованы в Ñ‚ÐµÐ·Ð¸ÑÐ°Ñ ÐºÐ¾Ð½Ñ„ÐµÑ€ÐµÐ½Ñ†Ð¸Ð¸ «Неделя науки ИЭИТ 2021», Санкт-Петербург, 15-19 ноября и включены в отчет Лаборатории информационно-Ð¸Ð·Ð¼ÐµÑ€Ð¸Ñ‚ÐµÐ»ÑŒÐ½Ñ‹Ñ Ð±Ð¸Ð¾- и Ñ ÐµÐ¼Ð¾ÑÐµÐ½ÑÐ¾Ñ€Ð½Ñ‹Ñ Ð¼Ð¸ÐºÑ€Ð¾ÑÐ¸ÑÑ‚ÐµÐ¼ Института аналитического приборостроения (Ð²Ñ‹Ñ Ð¾Ð´Ð½Ñ‹Ðµ данные приведены в табл. 1 приложения)., The given work is devoted to the study of the substance mass transfer process in the microchannels of variable geometry, imitating the device "blood-vessel-on-a-chip". In order to describe the processes of mass transfer of substance in the microchannel, two mathematical models based on two different hypotheses were proposed: a continuous medium and a discrete flow of particles. Numerical calculations were performed in the COMSOL Multiphysics software equipped with the necessary microfluidics module. Modeling and experimental verification of the models were undertaken at the Institute of Analytical Instrumentation of the Russian Academy of Sciences, where microfluidic chips that simulate blood vessels (20 units in total) were fabricated by soft lithography. The movement of fluid flows in the chip microchannels was studied with a Leica confocal microscope.As a result, simulations of both approaches showed that decreasing the angle of the anastomosis enhances the efficiency of bypass. Calculated values of the ratio of fluxes at the channel outlet for different angles of the anastomosis were obtained. Experimental verification of mathematical models for fluid flow laminarity in the channel and distribution of flow rates in junctions of the same geometry is performed. The obtained data can be used as recommendations for cardiovascular specialists in future.The results of the research were published in the theses of the conference "IEIT Science Week 2021", St. Petersburg, November 15-19 and included in the report of the Laboratory of Information-Measuring Bio- and Chemosensor Microsystems of the Institute of Analytical Instrumentation (the output data is given in table 1 of the appendix).

Aim. Identification of factors affecting coronary bypass graft patency in patients with type 2 diabetes (T2D) during one year after coronary bypass grafting.Materials and methods. Coronary artery bypass grafting for stable effort angina was ordered in 23 men with T2D. The patients had transthoracic echocardiogram before surgery. All patients were verified for lupus anticoagulant (LA) in blood on the 14th day after surgery. A year later, the patients underwent coronary shuntography to assess bypass patency.Results. LA was detected in 15 of 23 patients (65%). One year after surgery, occlusions of coronary shunts were revealed in 10 of 23 patients. In patients with coronary shunt occlusions, end-diastolic and end-systolic dimensions, end-diastolic and end-systolic volumes, end-systolic and end-diastolic indices (EDD, ESD, EDV, ESV, ESI, EDI, respectively), as well as the LA ratio significantly exceeded those in patients without occlusions (Mann—Whitney p values 0.004, 0.012, 0.012, 0.006, 0.006, 0.004, 0.017, respectively). A method is proposed for predicting coronary shunt occlusions based on assessment of end-diastolic volume of left ventricle and the LA ratio.Conclusion. Echocardiographic values for left ventricle (EDD, ESD, EDV, ESV, ESI, EDI) and the LA ratio are predictors of coronary graft occlusions in patients with type 2 diabetes.

Aim.To assess the cytokine profile and the level of endothelial dysfunction in patients with coronary artery disease (CAD) and different outcomes of coronary artery bypass grafting (CABG).Materials and methods.The study included 95 people, with 22 of them being practically healthy (without CAD). The CAD patients (73) were retrospectively divided into 2 subgroups according to the presence of complications within the first month after the CABG. The first subgroup consisted of 25 patients suffering from complications after CABG, with 48 people making up the second subgroup (no complications after CABG). CABG was performed on a beating heart; bypass grafts were attached during revascularisation. The serum levels of IL-4 and IFN-γ were determined through the enzyme-linked immunosorbent assay (ELISA) using appropriate test systems manufactured by BCM Diagnostics and a Zenyth 340 microplate photometer (Biochrom Ltd). In order to determine the content of endothelin-1 in blood serum, ELISA test systems manufactured by Biomedica were used. The statistical analysis of study results was performed employing the descriptive statistics module of Statistica 12.0 (StatSoft, USA). The mean (M), its error (m), median (Me) and the interquartile range [Q25; Q75] were calculated. In cases when p ≤ 0.05, the results were considered statistically significant.Results.It was revealed that, in the preoperative period, CAD patients from both subgroups exhibited increased levels of endothelin-1 (p = 0.0001) and IFN-γ (p = 0.0001), whereas an increase in IL-4 production was noted only in the first subgroup (p = 0.0001), as compared to the control group. The follow-up revealed that CAD patients with complications after CABG exhibited stable high levels of IL-4 (p > 0.05) and IFN-γ (p > 0.05) during the entire observation period, as compared to the initial values. The content of endothelin-1 in both subgroups increased significantly on the 4th day of observation (p > 0.05) and returned to its initial high values after 1 month.Conclusion.Immune response in CAD patients suffering from complications after CABG develops mainly along the pro-inflammatory pathway and is accompanied by endothelial dysfunction.

The OBJECTIVEof the study was to assess the immediate results of the use of two internal thoracic arteries during coronary bypass surgery.MATERIAL AND METHODS. 200 patients with coronary artery disease underwent coronary artery bypass grafting in Samara cardiology dispensary from 2016 to 2018. Patients were divided into 2 groups. Group 1 (100 people) used both internal thoracic arteries (ITA) and the radial artery as conduits; group 2 (100 people) used the left ITA and the great saphenous vein as conduits. The duration of the operation, complications in the early postoperative period, and hospital mortality were evaluated.RESULTS. Groups (1 – 73 % of men, average age (59±12) years, average number of conduits – (3.1±0.4), 2 – 62 % of men, average age (67±7) years, average number of conduits – (3.3±0.6)) were significantly different only in age. The average duration of the operation in the group 1 was (174±25) min, in 2 – (165±18) min (p0.05). The number of complications in the early postoperative period did not have a statistically significant difference between the groups.CONCLUSION. Bilateral internal thoracic arteries coronary artery bypass grafting in CHD patients did not lead to a significant increase in the duration of the operation, an increase in mortality and infectious complications from the sternum, compared with single internal thoracic arteries grafting.

Background: In multi-vessel atherosclerotic coronary artery disease, coronary artery bypass grafting remains the method of choice and allows for the best possible revascularization and maximal continuity of the results. Conduit functioning to a large extent depends on the coronary artery (CA) diameter and on the severity of atheromatous involvement and anatomic abnormalities of its walls. However, there is no consensus on what minimal diameter and extent of CA lesions could provide robust long-term results of bypass surgery. Consequently, surgical strategy for bypass grafting in diffuse coronary involvement and small vessel diameters has not been clearly defned.Aim: To perform a comparative analysis of the bypass grafts functioning depending on CA anatomy and methods of revascularization.Materials and methods: The study included 98 patients, who, irrespective of their clinical condition, had a control coronary angiography (CAG) with shuntography (SHG) between 6 months to 5 years after they had undergone direct myocardial revascularization by coronary artery bypass grafting. In total, 215 anastomoses were assessed. The bypassed CAs were divided into two groups according to their diameters and into two subgroups depending on the severity of the coronary vasculature involvement. When bypassing an artery with diffuse involvement, angioplastic anastomoses were done in 52.5% of the cases. Long-term graft functioning was assessed by shuntography.Results: Conduit functioning after bypassing of CA >1.5 mm in diameter and with local CA narrowing did not depend on the graft type and was 95.1% for the internal thoracic artery (ITA) grafts and 90.1% for the great saphenous vein (GSV) grafts. With diffuse lesions, these values decreased to 68.4% for ITA and 69.1% for GSV (р < 0.05). Long-term revascularization results for coronary arteries with a diameter of ≤ 1.5 mm were signifcantly lower for all types of conduits: with local stenosis, 78.6% ITA and 68.4% GSV grafts were patent, whereas in diffuse coronary bed involvement, 50 and 33.3%, respectively (р < 0.05). After placement of an angioplastic anastomosis to the CA with diffuse lesions, 79.3% of the ITA and 69.2% of the GSV grafts were functioning, whereas after the use of the standard technique, such were 55.6 and 40%, respectively (р < 0.05).Conclusion: Bypass grafting of CA with local lesions and > 1.5 mm in diameter, the graft type has not signifcant impact on its long-term functioning. In diffuse CA involvement, angioplastic anastomoses should be used.

The issue of the optimal timing of coronary artery bypass grafting (CABG) in acute coronary syndrome (ACS) remains controversial. It is known that on the one hand there will be a delay in revascularization, leading to recurrent myocardial infarction with irreversible cardiac dysfunction. On the other hand, there is an increased incidence of perioperative complications associated with surgery.This article provides a detailed analysis of the evidence base and current guidelines on the validity and timing of coronary artery bypass grafting in various types of ACS. The emphasis is made on the contradictions regarding the earlier implementation of the active strategy in non-ST segment elevation ACS. We describe problem of insufficient evidence base on optimal timing of CABG, comparison of outcomes of percutaneous coronary intervention (PCI) performed in the first 24 hours and open surgery for high-risk non-ST segment elevation ACS, as well as a number of organizational and clinical issues to ensure the surgery availability.

Обоснование. На сегодняшний день ИБС занимает первое место в структуре смертности в РФ. Несмотря на стремительное развитие методов лечения ИБС золотым стандартом по-прежнему остается коронарное шунтирование (КШ). В настоящее время для оценки функционального состояния коронарных шунтов и определения в них скорости кровотока все чаще используется интраоперационная флоуметрия, что значительно повышает общее качество проведенного оперативного вмешательства [1–3]. Цель: оценить эффективность применения интраоперационной ультразвуковой флоуметрии и выявить различия характеристик кровотока по коронарным шунтам у пациентов высокого хирургического риска, перенесших операцию в условиях ИК и на работающем сердце. Методы: в проспективное исследование, проводимое в период с 2017 по 2019 г., включено 189 пациентов высокого хирургического риска, которым было выполнено КШ как в условиях ИК, так и на работающем сердце. Интраоперационная ультразвуковая флоуметрия была проведена всем пациентам обеих групп. Для оценки функционального состояния наложенных шунтов использовались такие показатели как средняя объемная скорость кровотока, индекс пульсации и диастолический поток. Результаты. При сравнении флоуметрических показателей между группами статистически значимых различий выявлено не было (р>0,05). Однако, у пациентов, которым было выполнено КШ в условиях ИК (1 группа), отмечалось более длительное время длительное время ИВЛ и необходимость пролонгированной ИВЛ (27,5±93,7 час. и 17 случаев против 10,2±40 час. и 6 случаев в группе с КШ на работающем сердце (2 группа)). У большинства пациентов 2 группы гемодинамика оставалась стабильной, кардиотоническая поддержка в течение 24 часов и более потребовалась 48 (37,5%) больным, тогда как в 1 группе 78 (61,3%) больных нуждались в кардиотонической поддержке в раннем послеоперационном периоде (p = 0,0001). Среднее время пребывания в ОРИТ составило 39,9±97,3 и 19,3±36,2 час. для 1 и 2 группы, соответственно (p=0,0006). Кроме того, средняя кровопотеря у пациентов 1 группы превышала значения кровопотери 2 группы (420±220 мл и 315±245 мл, соответственно). Смертельный исход в 1 группе составил 1,5% (2 пациента), причиной которого стал ишемический инсульт, во 2 группе – 1% (1 пациент), причина — полиорганная недостаточность на фоне острого инфаркта миокарда. Заключение. Несмотря на статистически незначимое различие полученных флоуметрических данных в группах, сама возможность интраоперационной оценки коронарного кровотока с помощью ультразвуковой флоуметрии значительно снижает риски развития послеоперационных осложнений, связанных с техникой выполнения анастомоза., Backgraund. Today ischemic heart disease (CHD) ranks first in the structure of mortality in the Russian Federation. Despite the rapid development of methods for treating coronary artery disease, coronary artery bypass grafting (CABG) remains the gold standard. Currently, intraoperative flowmetry is increasingly used to assess the functional state of coronary bypass grafts and to determine the blood flow velocity in them, which significantly improves the overall quality of the performed surgical intervention [1–3]. Aims: to evaluate the effectiveness of the use of intraoperative ultrasound flowmetry and to reveal the differences in the characteristics of blood flow in coronary bypass grafts in patients with high surgical risk who underwent surgery in conditions of cardiopulmonary bypass and on a beating heart. Materials and methods: In a prospective study conducted in the period from 2017 to 2019, 189 patients of high surgical risk who underwent CABG both under the conditions of cardiopulmonary bypass and on a beating heart were included. Intraoperative ultrasound flowmetry was performed in all patients in both groups. To assess the functional state of the imposed shunts, such indicators as mean volumetric blood flow velocity, pulsation index and diastolic flow were used. Results. When comparing the flowmetric parameters between the groups, no statistically significant differences were found (p>0,05). However, in patients who underwent CABG under the conditions of cardiopulmonary bypass (group 1), there was a longer duration of mechanical ventilation and the need for prolonged mechanical ventilation (27,5±93,7 hours and 17 cases versus 10,2±40 hours and 6 cases in the group with CABG on the beating heart (group 2)). In the majority of patients in group 2, hemodynamics remained stable, cardiotonic support for 24 hours or more was required for 48 (37,5%) patients, while in group 1, 78 (61,3%) patients required cardiotonic support in the early postoperative period (p = 0,0001). The mean time spent in the ICU was 39,9±97,3 and 19,3±36,2 h for groups 1 and 2, respectively (p = 0,0006). In addition, the average blood loss in patients of group 1 exceeded the values of blood loss in group 2 (420±220 ml and 315±245 ml, respectively). The fatal outcome in group 1 was 1,5% (2 patients), caused by ischemic stroke, in group 2 — 1% (1 patient), the cause was multiple organ failure against the background of acute myocardial infarction. Conclusions. Despite the statistically insignificant difference in the obtained flowmetric data in the groups, the very possibility of intraoperative assessment of coronary blood flow using ultrasound flowmetry significantly reduces the risks of postoperative complications associated with the anastomotic technique., Вестник Национального медико-хирургического Центра им. Н.И. Пирогова, Выпуск 4 2021, Pages 19-22

Целью исследования явилось определение предикторов риска развития острого повреждения почек (ОПП) и разработка карты прогноза ОПП у пациентов с ишемической болезнью сердца при шунтирующих операциях на работающем сердце. Признаки ОПП в послеоперационном периоде наблюдались у 42,4% больных. Среди множества факторов с применением шагов метода обратного исключения Вальда выбраны 17 наиболее значимых признаков риска развития ОПП, с использованием которых построены прогностические модели (1) и (2). Также установлено возрастание вероятности развития ОПП при сопутствующем метаболическом синдроме., The aim of the study was to identify the risk predictors of developing acute kidney injury (AKI) and to create an AKI prognosis chart for patients with coronary artery disease (CAD) undergoing off-pump coronary artery bypass grafting. The signs of AKI after the surgery were observed in 42.4% of patients. Out of the numerous factors, 17 most significant signs of the risk of developing AKI were selected using the Wald test. Using the identified signs, we built models (1) and (2) for predicting the probability of developing AKI with the sensitivity of 81% and specificity of 91%. We also revealed increased probability of developing AKI in patients with concomitant metabolic syndrome., Якутский медицинский журнал, Выпуск 2 (70) 2020

Most in-hospital strokes occur after cardiac or vascular surgeries, during invasive therapeutic and diagnostic procedures on the heart and blood vessels. The incidence of stroke after coronary artery bypass grafting is about 2%; that after valve surgery and percutaneous cardiac intervention is 1 to 10% and 0.03 to 0.4%, respectively. Objective: to analyze the risk factors, pathogenetic, clinical, and laboratory characteristics of stroke after cardiac surgery and invasive interventions. Patients and methods. The investigation enrolled in-hospital stroke patients who had undergone invasive cardiac or open-heart surgery in Sverdlovsk Regional Hospital One in 2011 to 2015. A comparison group consisted of 196 patients with community-acquired stroke. Results. Stroke after cardiac surgical or endovascular interventions developed in 88 patients (44.9% of all the in-hospital stroke cases registered in the above period). The incidence of stroke after open-heart surgery was 0.97% (63 cases), depending on the type of surgery. Stroke following open-heart surgery was recorded after combined correction (1.4%), two-valve replacement surgery (1.98%), aortic and mammary coronary artery bypass grafting under extracorporeal circulation (1%), and beating heart bypass surgery (0.25%). The severity of stroke and the degree of disability did not differ in patients after invasive cardiac and open-heart surgeries. Conclusion. Patients who have undergone cardiac surgery and are at high risk for in-hospital stroke should be followed up and should receive preventive treatment for stroke in the early postoperative period.

The study presents the results of quality assessment of antiischemic myocardial protection by low- volume method of cardioplegia by «Custodiol» solution during operations with cardiopulmonary by- pass. The study involved 57 patients who underwent different cardiosurgery operations with cardio- pulmonary bypass. The patients were divided into two groups on the basis of the volume of cardioplegic solution. Research group (Group № 1) consists of 33 patients who were administered «Custodiol» in low volume limited by 1000 ml. The control group (Group № 2) consists of 24 patients who were ad- ministered standart volume of the solution corresponding to the manufacturer's instructions: 1 ml per 1 g of myocardial mass during 6-8 minutes. The results has indicated that the use of low volume of car- dioplegic «Custodiol» in a single administration manner provides a complete antiischemic protection of the myocardium during the correction of valvular heart disease, including combination with coronary artery bypass grafting. usage of low volume «Custodiol» solution method does not increase the need of inotropic and vasopressor usage and pacing time. The use of low volumes of «Custodiol» helps to reduce transfusion requirements of blood and its components.

В основе статьи лежит собранный материал обзора литературы по современному состоянию проблемы острого повреждения почек (ОПП) у больных с ишемической болезнью сердца с сопутствующим метаболическим синдромом. Рассмотрена концепция эндотелиальной дисфункции как ключевого звена патогенеза сердечнососудистых заболеваний и почечной патологии. Отражен положительный эффект применения статинов в профилактике ОПП., Presented article is based on collected material of a literature review on the current state of the problem of acute kidney injury (AKI) in patients with coronary heart disease (CHD) with associated metabolic syndrome. The concept of endothelial dysfunction (ED) is considered as a important element in the pathogenesis of cardiovascular diseases and renal pathology. We described the positive effect of the use of statins in the prevention of AKI., №2(66) (2019)

Aim: The study was designed to evaluate the accuracy of cardiac output (CO) measurements based on pulse wave transit time (PWTT) as compared to transpulmonary thermodilution (TPTD) in perioperative off-pump coronary artery bypass grafting (OPCABG).Methods: 20 patients scheduled for elective OPCABG were enrolled for a prospective study. Parallel measurements of CO by using PWTT (COPWTT) and TPTD (COTPTD) were carried out at five stages intraoperatively and at three stages postoperatively. Also analyzed was the agreement between CO absolute values and its ability to monitor cardiac output dynamics. Results: All in all, 153 pairs of CO data were obtained. According to Bland–Altman analysis, the mean intraoperative difference between the methods was 1.2 L/min, with boundaries of agreement reaching ± 2.9 L/min and a percentage error amounting to 64%. The intraoperative analysis of a polar plot revealed an increased angular difference of 6.9º and radial boundaries of agreement of ± 70.4º, and a decreased polar concordance rate (55%). The postoperative analysis of the data showed better agreement between the methods: mean difference was 0.4 L/min with boundaries of agreement of ± 2.3 L/min and percentage error of 41%. The postoperative trending ability was also more accurate (angular difference of 3.2º, angular boundaries of agreement ± 39º, polar concordance rate 81%).Conclusion: Poor accuracy and reproducibility of non-invasive COPWTT and its insufficient trending ability to monitor cardiac output during off-pump coronary artery bypass grafting makes it impossible to recommend this technology to be used intraoperatively as an alternative to transpulmonary thermodilution technique. The calibration and trending ability of COPWTT improved after OPCAB.

Aim. To study predictors of long-term post-operation cognitive dysfunction (POCD) in patients with diabetes mellitus 2 type (DM), underwent coronary bypass grafting (CBG) under on-pump conditions. Material and methods. Totally, 54 men included, with DM 2 type, underwent scheduled on-pump CBG, at the age 45-69 y.o. All patients, together with standard clinical assessment, were neurophysiologically tested on the 3-5th day after operation, on 7-14th day and in 1 year after CBG. As factors, suggestively significant for persistent POCD development, were selected: integral parameter of patents adherence to treatment, moderate cognition disorders (MCD) before operation, anxiety level (AL) and progression of carotid arteries (CA) stenoses, measured in 1 year before the operation. Results. In DM2 patients after on-pump CBG, the following most significant factors were identified as predictors for POCD: CA stenoses progression, high AL, low integral parameter of adherence; this allows for high probability level of prediction of POCD in 1 year after CBG. Conclusion. The obtained data demonstrated significance of the factors as CA stenoses progression, high LA and low adherence to treatment for development of persistent POCD in DM2 patients after on-pump CBG.

Aim. To find out the causal relationship of metabolic syndrome (MS) with acute kidney damage (AKD) in coronary bypass grafting patients (CABG). Material and methods. To the clinical comparative study totally 742 patients included (489 men и 253 women) at the age 53 to 67 y. o. (mean 62,1±4,7), who underwent CABG on-pump. Of those 477 (64,3%) did not have the metabolic criteria for MS (1st group), and 265 pts. (35,7%) had MS (2nd group). Depending on the maximum increase of serum creatinine (sCr) during early post-operation period ARF was diagnosed in the 1st group on 119 patients (24,9%) in the 2nd — 92 patients (34,7%). AKD was diagnosed by AKIN. Results. It was shown that early post operational cardiovascular complications significantly more frequently developed in AKD in both groups, and in the 2nd group comparing to the 1st. Also the procedures of hemodialysis in acute renal failure (3 stage of AKD) in the 1st group performed in 5,9% cases and in the 2nd — in 17,4% cases (p=0,015). In-hospital mortality was 2,0% to 16,3% depending on the development of AKD and MS. However in the 2nd group, in the development AKD as without this, intra-hospital mortality was significantly higher (p

Aim. To study interrelations of cardio-ankle vessel index (CAVI) with annual results of coronary bypass grafting (CBG) in patients with ischemic heart disease (CHD). Material and methods. On the first stage, we included 356 patients after CBG. All patients underwent CAVI assessment. In a year we analyzed the condition of 341 patient, and selected patients into groups: I (n=221) — CAVI >9,0 and II (n=120) group — CAVI

Aim. To evaluate coronary bypass grafting under artificial circulation conditions on endothelial and erectile dysfunction in patients with ischemic heart disease (CHD). Material and methods. Totally 117 patients participated in the study, with stable CHD at the mean age 55,8±5,3 y. o., planned to CBG. In all patients we used questionnaire “International Index of Erectile dysfunction” (IIED), registration of nocturnal penile tumescenses (NPT), post compression tests on brachial and cavernous arteries. All patients were divided into two groups, those with and without erectile dysfunction (ED) (n=60, n=57, resp.). Results. By the results of the investigation in patients with ED after CBG there was significant worsening of erectile function. It was found, that the existence of ED before operation is an important prognostic factor for its progression after the operation. Others, with non-affected erectile function, after the operation had higher chances to save it. Even more, it was found that in patients without preoperational ED by 6 months after CBG there was tendency to improvement of EZVD comparing with baseline values, but in group with ED this tendency was not found. Also in patients without ED in all stages of study there was significantly better vasoregulating function of endothelium on brachial artery comparing to ED patients. The same tendency was found and on cavernous arteries. While analyzing the prevalence of cardiovascular events after CBG it was found that in ED group 4 patients (7%) cardiovascular events developed, but without ED — did not. Conclusion. So the presence of ED might be a significant marker of worse outcome in CHD patients, underwent CBG.

Aim. To analyze structural chareacteristics and electroencephalographic (EEG) pattern of post-operation cognitive dysfunction (POCD) in patients after direct myocardial revascularization under artificial circulation (AI). Material and methods. Totally 114 male-patients included, underwent scheduled coronary bypass grafting (CBG) under the AI, with average age 55,9±5,3 y. In 3-5 days before operation and on 7-10 day after all patients underwent neurophysiological testing; of those 65 patients also underwent EEG. Results. The CBG operation with AI leads in 79% of cases to the early POCD. Cognitive impairment usually becomes prominent in the domains of neurodynamics and memory. It is shown that the early POCD is followed by EEG-signs of cortical dysfunction (increase of low-frequency theta-rhythm magnitude). Conclusion. According to the results of the study, in post-operative CBG with AI period the structure of POCD consists of injury of neurodynamics and memory, which might be a cause of decreased life quality of patients and efficacy of surgery itself.