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Postpericardiotomy syndrome (PCTS) is one of the most frequent cardiac surgery complications seen in 9-65% of patients. Despite its widespread occurrence, the mechanisms of the development of PCTS are still understudied. drug. The use of colchicine in cardiac surgery patients is of particular interest. Due to the ability of this drug the colchicine mechanisms of action are able to inhibit the mobilization of the NLRP3 inflammasome assembly, to suppress the activation of caspase-1. As a result, it can prevent the release of proinflammatory cytokines, namely IL-1β and IL-18. There are conflicting data on the effect of colchicine on the PCTS progression within the systemic inflammatory response after cardiac surgery. In this regard, it was important to study the dynamics of serum levels of IL-6, IL-10, IL-1β, and TNFα in patients before coronary artery bypass grafting (T1), 6 hours (T2), and 10 days (T3) after surgery, and to evaluate the effect of colchicine on the development of PCTS. The results of our research showed a significant increase of IL-10 in both groups 6 hours after surgery. However, on the 10th day, the increase in the level of IL-10, compared with the initial values, was higher in the 1st group – 2 times, compared with the 2nd group. In both groups, showed significant increase in serum concentration of IL-6 after 6 h surgery, with a subsequent decrease in the expression at the stage of T3, while the IL-6 levels in the 2nd group was statistically notably higher than T1. The incidence of pleurisy was lower in the group of patients taking colchicine. Only in the 1st group IL-6 levels were directly associated with IL-10. In patients with pleurisy, the level of released IL-10 and TNFα was significantly higher in the 2nd group. There were no significant intergroup differences in serum levels of IL-1β and TNFα, as well as significant changes in IL-1β between the stages of observation. Analysis of TNFα expression revealed significant differences in TNFα content in the 1st group between the T1-T3 and T2-T3 stages. In both groups, multiple positive associations were found between the studied indicators. Thus, data were obtained indicating the antiinflammatory effect of colchicine in cardiac surgery patients. This was clinically expressed in a tendency to a lower incidence of pleurisy, and was accompanied by increased expression of IL-10, which has an antiinflammatory and immunomodulatory effect against the background of the drug in the postoperative period.

BACKGROUND: According to different studies, diabetes mellitus type 2 (DM2) is associated with higher mortality after undergoing coronary artery bypass grafting (CABG). Perioperative hyperglycaemia, even in non-DM2 patients, is associated with adverse outcomes after CABG. Thus, successful perioperative blood glucose control (BGC) is mandatory to reduce the risk of death and postoperative complications. Nowadays, the most effective method for BGC in the operating room is still unknown. AIMS: To assess the continuous glucose monitoring (CGM) efficacy in association with insulin pump therapy in patients with coronary artery disease (CAD) and DM2 undergoing CABG in intra- and early postoperative periods. METHODS: The study involved 97 patients undergoing isolated CABG. Patients were divided into two groups: 48 patients with DM2 and 49 patients without DM2. In both groups of patients, we used CGM in intra- and early postoperative periods (72 hours). In some patients with DM2, CGM was associated with insulin pump therapy (MiniMed Paradigm Veo 554/754) to successfully control postoperative glucose level. Besides commonly used tests (such as HbA1C and lipid profile), we analysed high sensitive C-reactive protein (hs-CRP) levels before surgery, and then at 1 hour, 12 hours and 7 days after CABG in order to estimate their prognostic value. RESULTS: During the 48 hours after CABG, there was a trend towards having higher glucose levels in both groups of patients with and without DM2 according to CGM. In patients with DM2, the glucose level was significantly increased (р

Objective: to study the functional characteristics of innate immunity in the formation of postpericardial syndrome (PPS) in patients undergoing coronary artery bypass graft ing (CABG).Materials and methods: the study involved 60 people, 40 of them made up the main group of patients with coronary artery disease, which retrospectively aft er 1 month of observation was divided into 2 groups. Group I CABG and PPS, group II CABG without PPS. The control group consisted of 20 patients without IHD. Before surgery, aft er 5, 14 days and 1 month, the expression of toll-like receptors (TLRs) 2, 4, 9, the content of CD16+ and Granzyme B lymphocytes, the HCT test and serum α-defensin were evaluated in blood cells. Statistical analysis of the results of the study was carried out using the program Statistica 12.0 (StatSoft , USA). The difference in mean values between groups was evaluated by the Mann-Whitney test. Statistical signifi cance was considered signifi cant at p ≤ 0.05.Results: when comparing the initial indices of the main groups and the control group, an increase in the expression of TLRs 2, 4, 9 was revealed. An increase in the content of CD16+, as well as an increase in the cytotoxic activity of natural killers and an increase in the production of α-defensin.Conclusions: on the basis of the study, activation of the cellular link of innate immunity, an increase in the cytotoxic potential of natural killers and a signifi cantly high level of α-defensin both before and aft er CABG were revealed, which can play an important role in the development of PPS.

Aim. To assess the predictive value of polymorphic variants analyzing of interleukin-6 (IL-6) gene in patients with postpericardiotomy syndrome (PPS) during open-heart surgery.Material and methods. The study included 200 patients. All patients were analyzed for acute phase parameters in serum, effusion fluid and region of IL-6 gene promoter sequence.Results. When analyzing the effusion fluid, in 15% of patients with early PPS, in accordance with the Light RW criteria, transudate was detected. Application of the Roth BJ criteria increased this proportion to 32%. An increase in the level of C-reactive protein (CRP), procalcitonin, and adenosine deaminase (ADA) activity indicated a systemic inflammatory response. The viral genome of cardiotropic viruses was detected in the effusion fluid in 10-12% of patients with PPS. Scanning mutations in the IL-6 500 bp region revealed one polymorphism of -174G>C. The frequency ofPPS in patients with different genotypes (-174GC, -174GG and -174CC) did not significantly differ. An association of the -174GG genotype of the IL-6 gene with a high risk of developing systemic inflammation in open-heart surgery and more frequent postoperative infectious complications has been established. In addition, the -174GG genotype was more often detected in patients with late PPS (p=0,017). There was nocorrelation between the occurrence of genotypes, as well as the distribution of IL-6 gene and coronary obstruction index. However, carriage of the G allele was more often detected in patients with injury of left main coronary artery.Conclusion. The presence of the -174GG genotype of the IL-6 gene and cardiotropic viruses contribute to the systemic inflammation during cardiosurgical interventions in extracorporeal circulation, but do not have predictive value for the PPS development.

Aim    To compare features of the disease course and the effectiveness of nonsteroidal anti-inflammatory drug (NSAID) treatment of postpericardiotomy syndrome (PPS) in patients after coronary bypass (CB) surgery who were treated with antiplatelet drugs and in patients after surgical correction of heart valve disease (CHVD) who received the anticoagulant warfarin for prevention of thrombotic complications. Material and methods    This study included 89 patients of whom 53 patients had underwent CB and 36 patients had underwent CHVD. At 15 [13; 15] days after surgery, the severity of inflammatory response, the state of coagulation hemostasis, and hematocrit were studied. At 5 days after the first test, blood count and measurement of C-reactive protein were repeated. Echocardiography was used to determine the presence and volume of pleural effusion. For prevention of thrombotic complications, antiplatelet drugs were administered after CB and warfarin was administered after CHVD. PPS was detected in 35 (66 %) patients after CB and 18 (50 %) patients after CHVD. The ibuprofen treatment (600 mg twice a day) was administered to all patients with PPS. If positive changes in inflammatory markers were absent during the NSAID treatment, ibuprofen was replaced with prednisolone 0.5 mg/kg body weight with subsequent laboratory and instrumental monitoring. Results    Patients after CHVD treated with warfarin had higher values of international normalized ratio (INR) and activated partial thromboplastin time (aPPT) and lower values of prothrombin index (PTI), fibrinogen (p<0.001 for all), hemoglobin (p=0.0016), and hematocrit (p=0,0032) than patients after CB treated with antiplatelet drugs. 21 (40 %) patients with PPS required changing the anti-inflammatory therapy from ibuprofen to prednisolone. These patients displayed hypocoagulation, which was evident as reduced PTI (p=0.0023) and fibrinogen (p=0.0209), increased INR (p=0.0291) and aPPT (p=0.0416), and a higher incidence of pericardial effusion (p=0.0080). The insufficient effectivity of NSAIDs that required administration of prednisolone was more frequently observed in patients after CHVD (61 % vs. 29 %, р=0.037).Conclusion    Hypocoagulation observed in patients after CHVD due to the anticoagulant treatment with warfarin was associated with more severe course of PPS and lower effectiveness of the NSAID treatment compared to patients after CB. This results in more frequent replacement of NSAIDs with glucocorticoids in the treatment of patients after CHVD.

76 patients with coronary artery disease who underwent aortocoronary bypass surgery were examined to study the role of paraoxonase, myeloperoxidase, arginase, asymmetric dimethylarginine and nitric oxide in the mechanisms of the pathogenesis of post-pericardiotomy syndrome (PPCS). Patients were divided into two groups: the 1st - patients with coronary artery disease, who did not have PPCS as a result of clinical studies; the 2nd- patients with ischemic heart disease (IHD who were diagnosed with PPCS. The results showed that the postoperative period after coronary artery bypass grafting is associated with inhibition of paraoxonase, activation of myeloperoxidase, increased activity of arginase, nitrite/nitrate level and asymmetric dimethylarginine, and may be accompanied by the development of endothelial dysfunction and increased systemic inflammatory response. In the present work, inverse correlation relationships between the arylesterase activity of paraoxonase and myeloperoxidase activity in plasma, as well as between the aryl esterase activity of paraoxonase in the blood plasma and the activity of arginase in erythrocytes of the patients of the two studied groups were established. tests were developed on basis of ratio of the enzymes activities to predict the development of post-pericardicotomy syndrome.

76 patients with coronary heart disease (who had undergone coronary artery bypass grafting) were examined to investigate the role of pro-inflammatory cytokines and enzymes involved in redox regulation, in the mechanisms of development of systemic inflammatory response syndrome. Patients were divided into 2 groups: 1st - patients with coronary heart disease, who as a result of clinical trials has not been set postpericardiotomy syndrome; 2nd - patients with coronary heart disease who have been diagnosed postpericardiotomy syndrome. The blood plasma of both groups indicated intensification of production of interleukin-6, intrleukin-8, as well as - an imbalance in the peroxiredoxin-1 and glutathione peroxidase. These changes by patients with postpericardiotomy syndrome are observed at the earliest time and differed depth of expression. The results of this work confirm the high potential of the investigated indicators for prevention and monitoring postpericardiotomy syndrome development.