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Background Invasive coronary angiography (ICA) is essential to detect significant coronary artery disease (CAD) but is generally not recommended in patients with infective aortic valve endocarditis. This study aimed to evaluate the risks and benefits of preoperative ICA in patients before aortic valve replacement. Methods Between March 2008 and September 2020, 232 patients were surgically treated for infectious endocarditis of the aortic valve. Sixty-seven (29%) of them underwent preoperative diagnostic ICA and were compared with the patients without preoperative ICA. We collected their baseline characteristics, including the neurological status, previous cardiac surgical procedures, and reviewed the preoperative echocardiograms and the ICA data. The intraoperative data and clinical outcomes after ICA and after surgery were evaluated. Results ICA revealed a CAD in the majority of our patients (n = 36; 54%): One-vessel disease n = 19 (28%), two-vessel disease n = 6 (9%), and three-vessel disease n = 11 (16%). We observed no adverse events following preoperative diagnostic ICA, particularly no thromboembolic complications, including stroke, visceral, or lower body ischemia were detected. During surgical aortic valve replacement, concomitant coronary artery bypass grafting was performed in 20 patients (30%). In patients with preoperative ICA, postoperative in-hospital mortality was significantly lower (n = 8 [12%] vs. n = 30 [18%]; p < 0.001), while the incidence of postoperative bleeding was higher (n = 18 [27%] vs. n = 22 [13%]; p = 0.022). The new-onset stroke incidence was 5% in each group. Conclusion Taking a multidisciplinary team approach, ICA is safe in selected patients with aortic valve infectious endocarditis with no adverse clinical outcomes, but significant clinical implications. [ABSTRACT FROM AUTHOR]

Myocardial revascularization has been known to not affect the prognosis in some patients. Coronary artery bypass graft (CABG) failure may develop one year after CABG surgery. This is accompanied by a high risk of developing myocardial infarction after complete myocardial revascularization in obstructive coronary artery disease (CAD) due to microvascular dysfunction. The study of microvascular dysfunction using intraoperative stress tests with adenosine triphosphate (ATP) allows for the assessment of the coronary bypass flow reserve (CBFR) and the risk of graft failure one year after surgery. The study included 79 CAD patients (238 grafts) who underwent dynamic single-photon emission computed tomography (SPECT) before CABG and dynamic transit time flow measurement (TTFM) during CABG at rest and at stress. The CBFR was calculated by the ratio of the mean graft flow (MGF) at stress to the MGF at rest. A multivariate regression model showed that the MGF at rest (p = 0.043), the MGF at stress (p = 0.026) and the CBFR (p = 0.0001) were significant independent predictors of graft failure. As a result of ROC analysis, the threshold CBFR < 1.67 units correlated with graft failure more closely (sensitivity 82%, specificity 90%) The CBFR is a significant independent predictor of graft failure for up to 16 months. [ABSTRACT FROM AUTHOR]

Introduction. In recent decades, the number of patients with coronary artery disease and diffuse coronary artery disease has significantly increased. Performing the full volume of myocardial revascularization in such patients is not always possible due to the nature of the lesion of the coronary bed, and the risk of shunt dysfunction in the early postoperative period remains high. Therefore, the use of ultrasound intraoperative flowmetry in coronary bypass surgery is especially necessary, but the issues of optimal indicators of graft patency remain unresolved.The Objective was to evaluate the possibilities of using intraoperative ultrasound flowmetry in patients with diffuse coronary bed lesion.Methods and Materials. The study included 188 patients with diffuse coronary bed lesion who underwent coronary bypass surgery at the St. George Thoracic and Cardiovascular Surgery Clinic, Pirogov National Medical and Surgical Center and the Center for Cardiology and Cardiovascular Surgery, Rostov-on-Don. Ultrasound Doppler flowmetry was performed in all patients, the following indicators were evaluated: the average volumetric blood flow rate (MGF – mean graft flow), the pulsation index (PI – pulsation index) and the percentage of diastolic volume filling (DF – diastolic filling). Coronaroshuntography was performed in 29 patients in the early postoperative period (within 2–6 hours after surgery). The comparison of angiographic data (slowing of blood flow through the shunt, stenosis, occlusion) with intraoperative parameters of ultrasound flowmetry was carried out.Results. 405 primary intraoperative flowmetry samples were analyzed in 188 patients with diffuse coronary lesion. It was found that 19.7 % of intraoperative flowmetry indicators were less than the recommended values: 9.3 % of autoarterial and 25 % of autovenous shunts to the anterior descending artery; 20.8 % of autovenous shunts to the diagonal artery; 33.3 % – to the envelope and 21.9 % – to the right coronary artery. In 21 % of the observations, technical problems were identified (defect of proximal or distal anastomoses; bend of the conduit; dissection of the autoarterial shunt), which were eliminated; in other cases, no technical problems were identified. When comparing the data of intraoperative ultrasound flowmetry and shuntography in the early postoperative period, statistical differences were revealed in patients with normal patency of venous shunts and their dysfunction: MGF 53±18 (46–59) vs. 38±15 (29–47), p=0.014; PI: 3±1 (2–3) vs. 7±1 (6–8), p≤0.001; DF: 79±15 (64–91) vs. 48±17 (41–60), p=0.005. There are differences in the flowmetry of autoarterial shunts depending on the risk of their dysfunction: MGF 32±11 (28–44) vs. 20±5 (13–24), p=0.005; PI: 2±1 (1–4) vs. 7±2 (5–9), p≤0.001; DF: 70±12 (61–85) vs. 50±15 (45–64), p=0.005.Conclusion. Intraoperative ultrasound flowmetry is a safe and effective tool for assessing blood flow through conduits during coronary bypass surgery in patients with coronary artery disease and diffuse coronary bed lesions. According to our study, to predict the normal patency of shunts in the early postoperative period, it is advisable to use targets MGF above 28 ml/min for internal thoracic artery and 65 ml/min for venous shunts, PI less than 5.0 for all types of conduits, DF above 60 % for autoarterial shunt, and more than 68 % for autovenous graft.

Myocardial revascularization has been known to not affect the prognosis in some patients. Coronary artery bypass graft (CABG) failure may develop one year after CABG surgery. This is accompanied by a high risk of developing myocardial infarction after complete myocardial revascularization in obstructive coronary artery disease (CAD) due to microvascular dysfunction. The study of microvascular dysfunction using intraoperative stress tests with adenosine triphosphate (ATP) allows for the assessment of the coronary bypass flow reserve (CBFR) and the risk of graft failure one year after surgery. The study included 79 CAD patients (238 grafts) who underwent dynamic single-photon emission computed tomography (SPECT) before CABG and dynamic transit time flow measurement (TTFM) during CABG at rest and at stress. The CBFR was calculated by the ratio of the mean graft flow (MGF) at stress to the MGF at rest. A multivariate regression model showed that the MGF at rest (p = 0.043), the MGF at stress (p = 0.026) and the CBFR (p = 0.0001) were significant independent predictors of graft failure. As a result of ROC analysis, the threshold CBFR < 1.67 units correlated with graft failure more closely (sensitivity 82%, specificity 90%) The CBFR is a significant independent predictor of graft failure for up to 16 months.

The aim of the study was to investigate the effect of carbohydrate metabolism disorders and insulin resistance indices on the immediate results of coronary artery bypass grafting (CABG). Method. Patients with coronary artery disease who underwent CABG (n = 383) were examined to determine glycemic status, free fatty acid and fasting insulin levels, and insulin resistance indices (Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), McAuley index, Quantitative Insulin Sensitivity Check Index (QUICKI), Revised-QUICKI). Patients were assessed for the development of perioperative complications and their length of stay in the hospital. Two groups were formed: group 1, patients with a combined endpoint (CEP, any complication and/or duration of hospital stay >10 days), n = 291; and group 2 (n = 92) without a CEP. Perioperative characteristics were analyzed, and predictors of hospital complications and prolonged hospital stay were evaluated. Results. Patients in the CEP group were older, and there were more women among them (p = 0.003). Additionally, in this group, there were more patients with diabetes mellitus (37.5% vs 17.4%, p < 0.001), obesity (p < 0.001), and a higher percentage of combined operations (p = 0.007). In the group with a CEP, the levels of glucose (p = 0.031), glycated hemoglobin (p = 0.009), and free fatty acids (p = 0.007) and the Revised-QUICKI (p = 0.020) were higher than in the group without complications. In a regression analysis, the independent predictors of complications were combined operations (p = 0.016) and the predictors of a long hospital stay (>14 days) were female gender, the left atrium size, and diabetes mellitus (p < 0.001). The predictors of a composite endpoint included female gender, age, the left atrium size, and free fatty acid levels (p < 0.001). Conclusions: In the group with in-hospital complications after CABG, not only was the presence of diabetes mellitus more often detected, but there were also higher levels of free fatty acids and a higher Revised-QUICKI. Therefore, additional assessments of insulin resistance and free fatty acid levels are advisable in patients before CABG. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to compare short-term outcomes and long-term survival in patients following coronary artery bypass grafting in whom second arterial conduit or saphenous vein was used as well as to find out the most optimal second arterial graft. Methods Between January 2006 and June 2018, 7,857 patients met the inclusion criteria and were divided into two groups: single internal thoracic artery (SITA) + Vein group (n = 7,140) and second arterial conduit group (n = 717), of these 537 patients received right internal thoracic artery (RITA) and 180 patients received radial artery (RA). We obtained 701 propensity-matched pairs for final comparison. Short-term outcomes included: 30-day mortality and major adverse cardiac and cerebral events (MACCE), reoperation for bleeding, and deep sternal wound infection (DSWI). The long-term outcome was all-cause mortality. Results No significant differences were observed between second arterial conduit versus SITA + Vein groups and between RITA versus RA groups in terms of 30-day mortality, 30-day MACCE, reoperation for bleeding, and incidence of DSWI in the matched cohort. The use of second arterial conduit was associated with a significant reduction in long-term mortality by 24% in the matched cohort (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.60–0.96; p = 0.02). RA and RITA as second arterial conduit had comparable long-term mortality (HR: 1.12; 95% CI: 0.69–1.82; p = 0.62). Conclusion The use of second arterial conduit, irrespective of type, is safe and associated with improved long-term survival compared with the second venous aortocoronary graft. [ABSTRACT FROM AUTHOR]

Background Cardiac surgery remains a significant challenge in patients with coagulation factor VIII (FVIII) deficiency, especially in those with multiple factor deficiencies. Case summary A 79-year-old man with combined FVIII and factor XI (FXI) deficiency was admitted for heart failure treatment. Transthoracic echocardiography revealed aortic stenosis (AS) with decreased left ventricular ejection fraction (LVEF) of 40%, mean aortic pressure gradient of 21 mmHg, and aortic valve area of 0.58 cm2. Coronary angiography revealed significant triple-vessel disease. The patient had multiple comorbidities, including diabetic end-stage renal disease treated with hemodialysis and liver cirrhosis (Child–Pugh score of A). Considering the high surgical risk, a two-stage treatment strategy was developed: the first with off-pump coronary artery bypass grafting (CABG), and the second with transcatheter aortic valve implantation if AS symptoms were significant after CABG. A perioperative hemostatic protocol by the author's heart team was used to appropriately replenish recombinant FVIII concentrates and fresh frozen plasma. The target preoperative and postoperative FVIII coagulation activity values were set at 80–100% and 60–80%, respectively, whereas the target perioperative FXI coagulation activity value was set at 30–45%. Off-pump CABG without aortic manipulation was completed without bleeding events. Transthoracic echocardiography conducted 20 months postoperatively revealed LVEF of 65% and mean aortic pressure gradient of 31 mmHg. The patient leads a normal life 21 months after surgery. Discussion The hemostatic protocol and risk-reduction surgery provided satisfactory surgical results in a patient with significant coronary artery disease and AS, high-surgical-risks, and combined FVIII and FXI deficiency. [ABSTRACT FROM AUTHOR]

The first part of the article was dedicated to the problem of comorbidities in cardiac surgery patients with coronary artery disease (CAD), considered modern literary sources discussing endocrinopathies, connective tissue diseases, COVID-19-associated autoimmune processes, chronic kidney disease and diseases of the gastrointestinal tract. The aim. To continue the analysis of current literature data on comorbidities in patients hospitalized for surgical myocardial revascularization. Results. When assessing the preoperative status of a cardiac surgery patient with CAD, not only their cardiological status and the percentage of stenotic lesion of the coronary arteries are important, but also the presence of concomitant diseases and the degree of their compensation. According to the modern literary sources, 4-20.5% of patients undergoing coronary artery bypass grafting (CABG) have chronic pulmonary disease (COPD). In order to avoid bronchopulmonary complications in the postoperative period, high-quality preoperative diagnosis based on spirometric research is important. When verifying COPD, even of a moderate degree, a course of preventive therapy is required, and in the case of a severe course of COPD with a forced expiratory volume

INTRODUCTION The cause of heart failure in patients with coronary artery disease after anterior myocardial infarction may be dilatation of the cavity of the left ventricle (LV) with subsequent unfavorable course of the disease. In the case of early reperfusion, which prevents transmural myocardial necrosis, the damaged segment more often becomes akinetic than dyskinetic. Surgical remodeling of the left ventricle (SRLV) is aimed at reducing the volume and restoring its elliptical shape by eliminating scars in the akinetic and/or dyskinetic segments.AIM OF STUDY To evaluate the survival of patients with chronic heart failure (CHF) who had anterior wall myocardial infarction in the early and late periods after surgical remodeling of the left ventricle, in combination with coronary bypass grafting and/or interventions on the mitral valve.MATERIAL AND METHODS The study included 99 patients with coronary artery disease (CAD) who had myocardial infarction of the anterior LV wall and with severe heart failure, who underwent surgical LV remodeling in the period from 2002 to 2020. The analysis of early and long-term results was carried out. The risk factors influencing lethality were determined.The mean age of the patients was 56.0±10.2 years (from 23 to 81 years). The vast majority of patients (90%) were men. LV ventriculoplasty was combined with coronary bypass grafting in 97 (98%) patients, with mitral valve repair in 2 (2%) patients, with mitral valve replacement in 2 (2%) patients.RESULTS In the early postoperative period, all patients showed an improvement in global LV systolic function. The ejection fraction (EF) of the left ventricle increased from the average preoperative average value of 34.2±3.7% to 43±4.2% in the postoperative period (р60 mm Hg. were risk factors for hospital mortality. The overall fifteen-year survival rate was 59.8±0.13%. The absence of readmission to the hospital due to recurrent angina pectoris, mitral valve dysfunction and progression of heart failure (HF) was 72% among surviving patients.CONCLUSION Surgical remodeling reduces the volume of the dilated left ventricle and restores its elliptical shape in patients with CAD after anterior myocardial infarction. The results of our study demonstrate an improvement in LV systolic function in all patients in the early postoperative period and low mortality, an acceptable fifteen-year survival rate, and a low readmission rate due to the progression of chronic heart failure (CHF).

This article provides data from the current Russian (National guidelines for the management of patients with diseases of the brachiocephalic arteries of 2013; Recommendations “Blockage and stenosis of the carotid artery” of the Ministry of Health of the Russian Federation, 2016) and foreign (European Society of Cardiology / European Society of Vascular Surgeons for Diagnosis and Treatment Peripheral Artery Diseases 2017; Recommendations for myocardial revascularization of the European Society of Cardiology and the European Association of Cardio-Thoracic Surgeons 2018) recommendations regarding the choice of a revascularization strategy for combined coronary and carotid artery disease. Conclusions are drawn about the unresolved issue. A literature review of the largest series of Russian articles by one institution devoted to this topic was carried out. Hospital and long-term outcomes have been demonstrated, as well as predictors of complications for various revascularization strategies. The stages of creation and the results of approbation of a new computer program for risk stratifi cation, which makes it possible to determine the mathematical probability of the development of unfavorable cardiovascular events during the implementation of various surgical tactics, taking into account the individual characteristics of the patient. A conclusion was made about the effectiveness of this development.

The aim of the study was to investigate the effect of carbohydrate metabolism disorders and insulin resistance indices on the immediate results of coronary artery bypass grafting (CABG). Method. Patients with coronary artery disease who underwent CABG (n = 383) were examined to determine glycemic status, free fatty acid and fasting insulin levels, and insulin resistance indices (Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), McAuley index, Quantitative Insulin Sensitivity Check Index (QUICKI), Revised-QUICKI). Patients were assessed for the development of perioperative complications and their length of stay in the hospital. Two groups were formed: group 1, patients with a combined endpoint (CEP, any complication and/or duration of hospital stay >10 days), n = 291; and group 2 (n = 92) without a CEP. Perioperative characteristics were analyzed, and predictors of hospital complications and prolonged hospital stay were evaluated. Results. Patients in the CEP group were older, and there were more women among them (p = 0.003). Additionally, in this group, there were more patients with diabetes mellitus (37.5% vs 17.4%, p < 0.001), obesity (p < 0.001), and a higher percentage of combined operations (p = 0.007). In the group with a CEP, the levels of glucose (p = 0.031), glycated hemoglobin (p = 0.009), and free fatty acids (p = 0.007) and the Revised-QUICKI (p = 0.020) were higher than in the group without complications. In a regression analysis, the independent predictors of complications were combined operations (p = 0.016) and the predictors of a long hospital stay (>14 days) were female gender, the left atrium size, and diabetes mellitus (p < 0.001). The predictors of a composite endpoint included female gender, age, the left atrium size, and free fatty acid levels (p < 0.001). Conclusions: In the group with in-hospital complications after CABG, not only was the presence of diabetes mellitus more often detected, but there were also higher levels of free fatty acids and a higher Revised-QUICKI. Therefore, additional assessments of insulin resistance and free fatty acid levels are advisable in patients before CABG.

This literature review covers the publications of Russian vascular surgeons in recent years and deals with debatable issues of carotid surgery, including: 1. What is the best technique for carotid endarterectomy (CEA)? 2. Why does restenosis of the internal carotid artery (ICA) develop and how to eliminate it? 3. How to operate on bilateral ICA stenosis? 4. Should carotid glomus be preserved? 5. Is CEA safe in the acute phase of cerebrovascular accident (CVA)? 6. Is CEA safe in elderly patients? 7. How to operate on patients with combined internal carotid and coronary artery involvement? The evidence presented in this publication makes it possible to draw the following conclusions: 1. When choosing a CEA technique, the classical technique with patch angioplasty should be avoided due to the high risk of ICA restenosis. 2. To eliminate ICA restenosis, carotid angioplasty with stenting (CAS) should be used. When performing primary CEA with ICA transposition over the hypoglossal nerve, reCEA can be used 3. In the absence of contraindications, bilateral ICA stenosis can be operated at the same time using CEA. 4. CEA with carotid glomus preservation is the operation of choice in the treatment of patients with hemodynamically significant ICA stenosis due to the elimination of the risks of postoperative hypertension and the formation of hemorrhagic transformation. 5. If there are indications for cerebral revascularization in the most acute period of stroke, CEA should be abandoned in favor of CAS. 6. In old age, CAS is the safest treatment strategy. 7. In the presence of a combined ICA and coronary involvement, the choice of treatment tactics should be carried out only by a multidisciplinary commission, taking into account the risk stratification of adverse cardiovascular events.

Diffuse atherosclerosis and calcification of the coronary arteries (CA) create serious difficulties for coronary artery bypass grafting (CABG). The aim of this study was to compare demographic indicators, lipids, and clinical results one year after CABG in patients with different phenotypes of coronary artery (CA) disease. In total, 390 patients hospitalized for elective CABG were included in a single-center prospective study. Demographic data, lipids (total, low-density lipoprotein and high-density lipoprotein cholesterol, and triglycerides), and lipoprotein(a) (Lp(a)) concentrations were analyzed for all patients. Major adverse cardiovascular events (MACE) included myocardial infarction, stroke, percutaneous coronary intervention, and death from cardiac causes within one year after surgery. No significant outcome differences were found between the groups with diffuse vs. segmental lesions, nor the groups with and without calcinosis for all studied parameters except for Lp(a). Median Lp(a) concentrations were higher in the group of patients with diffuse compared to segmental lesions (28 vs. 16 mg/dL, p = 0.023) and in the group with calcinosis compared to the group without it (35 vs. 19 mg/dL, p = 0.046). Lp(a) ≥ 30 mg/dL was associated with the presence of diffuse lesions (OR = 2.18 (95% CI 1.34–3.54), p = 0.002), calcinosis (2.15 (1.15–4.02), p = 0.02), and its combination (4.30 (1.81–10.19), p = 0.0009), irrespective of other risk factors. The risk of MACE within one year after CABG was higher for patients with combined diffuse and calcified lesions vs. patients with a segmental lesion without calcinosis (relative risk = 2.38 (1.13–5.01), p = 0.02). Conclusion: Diffuse atherosclerosis and coronary calcinosis are associated with elevated Lp(a) levels, independent of other risk factors. The risk of MACE in the first year after surgery is significantly higher in patients with diffuse atherosclerosis and coronary calcinosis, which should be considered when prescribing postoperative treatment for such patients. [ABSTRACT FROM AUTHOR]

Surgical coronary bypass has evolved continually, and most analyses currently favor performing coronary grafts with autologous living arterial conduits to obtain better long-term patencies and clinical outcomes. With bilateral internal mammary artery grafts and both radial arteries, 4 excellent arterial conduits exist for creating "all-arterial" revascularization in the majority of multivessel disease patients, including those with valve disorders. Using contemporary surgical techniques, it is possible to obtain greater than 95% overall early graft patencies that translate into better late outcomes, including improved survival, freedom from myocardial infarction, fewer percutaneous coronary interventions, and redo coronary bypass procedures. The overall goal is to revascularize the 2 most important coronary systems with internal mammary artery grafts, and the rest with radial arteries, depending on the anatomy, experience, and choice of the surgeon. Using highly validated management strategies, early postoperative complications, including the incidence of sternal infections, are extremely uncommon, and in many practices, multi-arterial grafts currently are used in the majority of multivessel patients, including those with concomitant valve disease. Because patencies and outcomes are significantly better than with saphenous vein bypass or percutaneous coronary interventions, referring physicians frequently favor multi-arterial bypass procedures as the primary therapy for patients with prognostically serious multivessel disease. Thus, coronary bypass using predominantly autologous arterial conduits should play an increasingly important role in the future management of severe coronary atherosclerosis., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aim. To evaluate the mid-term outcomes of surgical myocardial revascularization in combination with coronary endarterectomy in patients with diffuse coronary artery disease (CAD).Material and methods. In this cohort, non-randomized, retrospective, longitudinal study, we compared the mid-term outcomes of surgical myocardial revascularization in combination with coronary artery endarterectomy in patients with diffuse CAD with the outcomes of surgical myocardial revascularization without endarterectomy in patients without diffuse CAD. The study group included 93 patients, while the control group — 99 patients. Mid-term mortality, morbidity, and angiographic outcomes of surgical revascularization were assessed.Results. The mean follow-up period was 46,7±18,5 months. Mid-term mortality was 5,5% (n=5) in the coronary endarterectomy group and 3,1% (n=3) in the isolated coronary artery bypass grafting (CABG) group (p=0,486). Angina recurrence was noted in 14,3% (n=13) of patients in the endarterectomy group and in 14,4% (n=14) of cases in the isolated CABG group (p=0,977). Coronary artery stenting was required in the mid-term period in 4,4% (n=4) of patients in the endarterectomy group and 4,1% (n=4) (p=1000) in the isolated CABG group. A stroke in the mid-term period occurred in 1 (1,1%) patient of the study group and 3 (3,1%) patients in the control group (p=0,334). Graft patency in the anterior interventricular artery was 90,9%, while in the circumflex artery — 100% and in the right coronary artery — 80,4%. There were no significant differences in the patency level between the study and control groups. Quality of life did not differ significantly between groups in the mid-term period.Conclusion. Coronary endarterectomy is not associated with an increase in mortality and morbidity in the mid-term period, and is accompanied by satisfactory angiographic patency rates. There was no negative effect of coronary endarterectomy on the quality of life in the mid-term period.

Aim. To determine the relationship between perioperative factors and cognitive function in patients after coronary bypass grafting (CABG) in combination with unilateral carotid endarterectomy (CE).Material and methods. We examined 56 men in the perioperative period with CABG combined with unilateral CE (mean age, 64,0±7,1 years). Cognitive assessment was performed before and 5-7 days after surgery with Status PF program. An advanced psychometric examination included an assessment of voluntary attention (Bourdon test), short-term memory (tests on memorizing 10 numbers, 10 words, and 10 syllables), neurodynamics (visual-motor reaction time, level of functional mobility of nervous processes, brain performance, as well as the number of errors in these tasks and missed positive signals). The concentration of neuron-specific enolase (NSE) and S100β protein in the blood serum of patients before surgery, 24 hours and 5-7 days after surgery was determined using enzyme immunoassay.Results. In the early postoperative period, an increase in reaction time (p=0,031) was accompanied by an increase in errors in this test (p=0,042) and a decrease in the number of memorized numbers (p=0,022). Twenty four hours and 5-7 days after surgery, there were no differences between the perioperative NSE level (p1-2-3>0.05). Twenty four hours after CABG surgery, the level of S100β protein increased by 9,0% (p=0,001), while regression of S100β protein to the preoperative level was observed 5-7 days after operation.Conclusion. A relationship was found between the CABG factor and the attention level (r=-0,518; p=0,031), functional mobility reaction time (r=0,476; p=0,041), and the number of errors (r=0,449; p=0,032). A correlation was found between the factor of neurochemical markers, the number of processed letters on the 1st minute of Bourdon test (r=-0,642; p=0,014), the total number of processed letters in Bourdon test (r=-0,617; p=0,017). The combined factor of perioperative period was associated with functional mobility reaction time (r=0,609; p=0,041), the number of processed letters at 4 min (r=-0,490; p=0,017), and the total number of processed letters in the Bourdon test (r=-0,334; p=0,006).

Background: Induction of short episodes of ischemia to remote organs, namely upper or lower limbs, literally known as remote ischemic preconditioning (RIPC) has been suggested as a preconditioning approach to ameliorate ischemia/reperfusion injury (IRI). RIPC has been demonstrated to effectively protect various vital organs, including heart, against the next ischemic events in preclinical studies. However, human studies are required to approve its clinical applicability. Present study was performed to evaluate the effect of RIPC on the myocardial protection and inflammatory response markers in patients undergoing coronary artery bypass graft surgery Methods: In this randomized clinical trial, 43 coronary artery bypass graft (CABG) patients from Imam Hossein educational hospital were allocated in two groups, RIPC (21 patients) and control (22 patients). Serum level of interleukin (IL)-4, IL-8, and IL-10, interferon (IFN)-γ and Cardiac Troponin-I (cTnI) were measured in (1) after induction of anesthesia (before incision of skin), (2) after separation from CPB and (3) 24 hours after ICU arrival. Results: increase pack cell transfusions were observed in control group in ICU. Serum level of IL-10 at 24 hours after ICU admission was significantly higher in the RIPC group. Significantly lower amounts of IL-8 at post-CPB time were observed in the RIPC group in comparison with control. Conclusion: RIPC regulates the circulatory inflammatory cytokines, IL-8 decrement and IL-10 elevation, which could be translated into protection against IRI. However, further studies with larger sample sizes with careful consideration of parameters such as use of propofol as an anesthetic in the patients should be conducted to consolidate the findings from the current study. [ABSTRACT FROM AUTHOR]

Background: The difficulty of suturing perfect anastomoses in limited-access conditions prevents the transition of traditional coronary artery bypass grafting (CABG) to sternal-sparing approaches, even in the robotic era. Automated coronary anastomotic connector technologies may address these difficulties, but to date, none have achieved broad adoption. Besides versatility, ease-of-use and cost-effectiveness, the key performance parameter of such technology is anastomotic patency. In this meta-analysis, we aim to evaluate published connector devices by examining their patency outcomes in distal anastomoses., Methods: The literature was systematically searched for studies comparing the angiographic patency of connector constructed coronary anastomoses to handsewn (HS) connections in adult patients undergoing CABG. The primary outcome was anastomosis patency across early (<30 days), mid-term (30 days to 1 year) and long-term (>1 year) follow-up. Random-effects meta-analyses were employed to analyze and compare patency using pooled risk ratios (RR) with 95% confidence intervals (CI)., Results: The search yielded 14 studies concerning eight connector devices. In 4,311 patients, a total of 4,328 anastomoses were constructed, 674 with connector devices and 3,654 with a HS technique. The pooled device patency over all timeframes was non-inferior to the HS technique (RR 0.90, 95% CI: 0.56-1.44). Technologies having a relatively large blood-exposed non-intimal surface area (BENIS, >15 mm 2 ) performed acceptably when applied to large target vessels [>2.0-2.5 mm inner diameter (ID)]. A tiny anastomotic orifice area (AOA, < ca. 4 mm 2 ) appeared to adversely affect results. Technologies realizing a generous AOA in combination with a limited BENIS showed superior results and applicability by performing well across the entire range of target coronary artery diameters (>1.0-1.5 mm ID)., Conclusions: The overall results suggest that connectors yield at least non-inferior anastomosis patency outcomes compared to HS techniques in all observed timeframes. Optimizing device characteristics like BENIS and AOA appear fundamental for broad applicability., Competing Interests: Conflicts of Interest: M.G. is a member of the EACTS-endorsed Robotic Cardiothoracic Surgery Taskforce. M.G. and W.J.L.S. are co-inventors of a new anastomotic technology being developed by OctoVascular BV and have a financial interest in this technology. The other author has no conflicts of interest to declare., (2024 Annals of Cardiothoracic Surgery. All rights reserved.)

Diffuse atherosclerosis and calcification of the coronary arteries (CA) create serious difficulties for coronary artery bypass grafting (CABG). The aim of this study was to compare demographic indicators, lipids, and clinical results one year after CABG in patients with different phenotypes of coronary artery (CA) disease. In total, 390 patients hospitalized for elective CABG were included in a single-center prospective study. Demographic data, lipids (total, low-density lipoprotein and high-density lipoprotein cholesterol, and triglycerides), and lipoprotein(a) (Lp(a)) concentrations were analyzed for all patients. Major adverse cardiovascular events (MACE) included myocardial infarction, stroke, percutaneous coronary intervention, and death from cardiac causes within one year after surgery. No significant outcome differences were found between the groups with diffuse vs. segmental lesions, nor the groups with and without calcinosis for all studied parameters except for Lp(a). Median Lp(a) concentrations were higher in the group of patients with diffuse compared to segmental lesions (28 vs. 16 mg/dL, p = 0.023) and in the group with calcinosis compared to the group without it (35 vs. 19 mg/dL, p = 0.046). Lp(a) ≥ 30 mg/dL was associated with the presence of diffuse lesions (OR = 2.18 (95% CI 1.34–3.54), p = 0.002), calcinosis (2.15 (1.15–4.02), p = 0.02), and its combination (4.30 (1.81–10.19), p = 0.0009), irrespective of other risk factors. The risk of MACE within one year after CABG was higher for patients with combined diffuse and calcified lesions vs. patients with a segmental lesion without calcinosis (relative risk = 2.38 (1.13–5.01), p = 0.02). Conclusion: Diffuse atherosclerosis and coronary calcinosis are associated with elevated Lp(a) levels, independent of other risk factors. The risk of MACE in the first year after surgery is significantly higher in patients with diffuse atherosclerosis and coronary calcinosis, which should be considered when prescribing postoperative treatment for such patients.

We report the technique of endoscopic vessel (radial artery and/or vein) harvesting for coronary bypass grafting. Clearly less invasive, this endoscopic approach therefore offers the following advantages for the patient: limited postoperative pain and therefore faster rehabilitation in terms of mobility, less postoperative care, the absence of a long scar and therefore a lower risk of surgical complications with a better aesthetic result, while allowing a quality and a permeability of the graft similar to those obtained after a classic surgical harvest.

This review of the literature discusses the solution of unresolved issues related to carotid endarterectomy in Russia: (1) A program has been created for choosing the tactics of revascularization of patients with simultaneous atherosclerotic lesions of the coronary and carotid arteries; (2) Using the methods of computer modeling, studying the genetics and morphology of restenosis, it was found that the classic carotid endarterectomy with plasty of the reconstruction zone with a patch is an unsafe type of revascularization; (3) An eversion carotid endarterectomy with transposition of the internal carotid artery over the hypoglossal nerve has been developed, which makes it possible to prevent damage to the latter during repeated carotid endarterectomy for restenosis; (4) It has been established that carotid endarterectomy is associated with a high risk of complications in patients over 75 years of age; (5) It has been proven that emergency carotid endarterectomy in the first hours after the development of a stroke is not safe because. combined with the maximum number of all non-favorable cardiovascular events; (6) 3 new types of carotid endarterectomy with carotid glomus preservation have been developed. [ABSTRACT FROM AUTHOR]

Porcelain aorta is not an absolute contraindication for aortic valve and/or coronary bypass grafting but it requires a special strategy and individualized approach to minimize the risk of embolic complications and technical problems during opening and/or closing the aortotomy., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)