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Fractures of the proximal femur are a severe, life-threatening injury with enormous social, medical and economic consequences. Even with a well-organized system of medical care, up to 12-17% of patients die within the first year after injury, and the long-term risk of death doubles. Specially designed population-based studies in the Russian Federation have shown a high incidence of hip fractures in patients at the age of 50 and older. However, there is currently no unified system of medical care organization for all regions of Russia, which allows hospitalization and operation of patients with hip fractures during the first hours after trauma. Hip fracture in an elderly person is an absolute indication for the hospitalization. However most patients have severe comorbidities, osteoporosis, an increased risk of falls and mortality because of any reason. The main surgical treatments for hip fractures include osteosynthesis of the fracture or hip arthroplasty. It is well known that after the occurrence of any fragility fracture the risk of subsequent fractures increases by 2-3 times. To ensure the continuity of patient management, provide prescription of anti-osteoporotic drugs and long-term follow-up of patients it is necessary to manage them within the special Fracture Liaison Services (FLS). The article is devoted to the organization of medical care in patients of older age groups who have received hip fractures. A review of modern approaches to the treatment and organization of care for elderly patients with hip fractures is based on the methodological recommendations «Complex measures aimed at preventing falls and fractures in the elderly» developed in the framework of the federal project «The Older Generation», the draft national clinical guidelines «Fractures of the proximal femur», as well as the results of our own research.

The objective: to compare the effectiveness of visceral and renal protection methods during thoracoabdominal aortic (TAA) repair: left atrial-femoral bypass (LAFB) and cardiopulmonary bypass (CPB) in conjunction with selective perfusion (SP) of these organs.Subjects: 81 patients who underwent TAA repair were enrolled in retrospective analysis: LAFB was used in 29 patients (Group 1), CPB and SP ‒ in 52 patients (Group 2).Results. In Group 2, there were lower intraoperative blood loss volume (1,500 ml vs 4,200 ml, p < 0.001), significantly lower levels of direct bilirubin, blood creatinine, blood alpha-amylase in postoperative period, significantly shorter duration of hospital stay, ICU stay and duration of mechanical ventilation. Also in this group, there were lower incidence of multiple organ dysfunction (11.5% vs 37.9%, p = 0.005), stroke (0 vs 10.3%, p = 0.043), lower need for requirement (3.8% vs 20.7%, p = 0.022) and mortality (3.8% vs 27.6%, p = 0.003).Conclusion: During TAA repair, CPB in conjunction with selective visceral and renal perfusion is more beneficial for organ protection as compared with LAFB.

Background In this study, surgical tactic features and juxtarenal and pararenal treatment immediate results were analyzed depending on the use of various surgical approaches. Methods Between 2015 and 2019, a total of 89 patients received surgical treatment, of which 52(58%) had juxtarenal aneurysms and 37 (42%) – pararenal aneurysms. During repairs, three types of surgical approaches were used: midline laparotomy, extended retroperitoneal approach and thoraco-phreno-retroperitoneal approach. The patients were divided into three groups accordingly. Results At the immediate postoperative period, mortality rate equaled 2 (2.2%). The reasons were pulmonary embolism and sepsis. Statistically reliable data were obtained, confirming the advantages of midline laparotomic approach over the lateral retroperitoneal ones, which consisted in a shorter operative time, less pronounced pain syndrome, lesser blood loss, fewer postoperative days. The disadvantages were that enteroparesis occurred more often when the midline laparotomy was used in comparison to extended retroperitoneal or thoraco-phrenoretroperitoneal approaches. Conclusion Thus, open repairs of juxtarenal and pararenal aortic aneurysms have some specific technical and strategical features which are associated with intraoperative renal ischemia. During open surgical intervention, it is important to first consider the possibility of repair with midline laparotomy. However, lateral retroperitoneal approaches can also be used on a case-by-case basis noting their advantages and disadvantages.

The thermal decomposition of acetylene to hydrogen and acetylene soot was studied, and the results of this study are presented. The experiments on acetylene decomposition were performed in a modified internal combustion engine (ICE) and in a flow-type reactor with external heat supply at a constant temperature (1000 ± 10°C). The experiments were performed without any oxidant additions. In the experiments with ICE, the engine work on acetylene was shown to be possible, and the composition of the gaseous reaction products was determined. In the experiments with a flow-type reactor, the effects of pressure in the reactor, acetylene flow rate, and the presence of a tungsten gauze in the working zone of the reactor on the degree of acetylene decomposition and the composition of gaseous reaction products was determined. Some properties of soot were analyzed: specific surface area, average particle size, bulk density, and combustion heat.

We present results from experimental studies supporting the use of electrolytic glow discharge plasma to destroy renal concretions. The rate of fragmentation of urinary stones was assessed in relation to the power of the plasma discharge and the duration of treatment. The process of plasmakinetic lithotripsy was found to be effective for fragmentation of different types of urinary stone. The results lead to the conclusion that plasmakinetic destruction of renal concretions is a fundamentally novel, effective, and economical method which combines well with technologies using radio-frequency surgery in saline for the treatment of pathological processes in urology.

Background. In conditions of permanent progress in the quality of surgical care in various areas of surgery, it is very important to allow patients themselves to evaluate provided treatment. Aims: this paper analyzes the quality of life in individuals with acute lower limb ischemia who have undergone lower limb revascularization surgery. Materials and methods. An assessment of the quality of life of 122 patients with acute lower limb ischemia (ALI) of II degree who were treated at the Moscow Сity Сlinical Hospital оf S.S. Yudin from 2016 to 2018 (average age 72.1 14.7 years) was performed. The quality of life was assessed using the medical Outcomes Study-Short Form (MOS SF-36) quality of life assessment methodology. Results. When assessing the quality of life of patients, it was found that the psychological and physical components of patients health are significantly affected by the angiotropic effect of the affecting factor associated with the presence of diabetes mellitus. 1 month after surgical restoration of blood flow against the background of the initial embolism, 83.6% of the respondents who did not suffer from diabetes noted a persistent improvement in their General condition and quality of life. Conclusion. This method of assessing the quality of life after surgical restoration of blood flow in patients with acute lower limb ischemia can be used in angiosurgical practice and clearly reflects of patient satisfaction with the treatment.

Relevance. An increase in the number of revisions is an inevitable consequence of the growth of primary arthroplasty number. The imperfection of implants and the lag in patient’s seeking medical help significantly increase the number of complex revisions. Extensive bone defects after removal of an unstable implant urge us to think about the better methods of these defects compensation and implants fixation. The purpose — was to assess the modern telemedicine opportunities for improving the preoperative planning of the complex revision arthroplasties. Materials and Methods. The study comprised 13 patients undergone revisions for implant instability in a regional orthopedic department using telemedicine differed advices including 11 hip and 2 knee arthroplasties. All patients had extensive bone defects. Results. In 12 cases, the surgeries were performed according to the recommendations from the expers of the Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation. In one case, an individual system had been proposed as the main choice, but the preoperative plan was changed in favor of standard revision components. The short-term results of the surgeries were assessed as satisfactory. Conclusion. The use of modern information technologies for preoperative planning makes it possible to more accurately determine the indications for choosing implants. In particularly difficult cases, it becomes necessary to use individual implants. The right final choice depends on high-quality preoperative planning and effective interaction among medical hospitals of various levels.

Dispersible tablet form (ODT) of drugs is convenient for patients to take; the effectiveness of its use increases significantly with non-compliance treatment of mental disorders. Upon the expiration of the patent for the original drug, the production of generics with the same pharmacologically active ingredient often starts. Due to differences in fillers and manufacturing techniques, even high-quality copies of the original product may not be equivalent to it. Therefore, the aim of this study was to evaluate the bioequivalence of the ODT form of the original drug and generic with 10 mg olanzapine. After taking the original drug and generic in two stages, on an empty stomach from healthy volunteers, from the vein were sampled bloods into vacuum heparin tubes. The washout period between doses of the drugs was 21 days. The extraction (LLE) of olanzapine was carried with a mixture of n-hexane:isopropanol (3:1) at pH 8.0, and analyzed by liquid chromatography-tandem mass spectrometry (quadrupole-linear ion trap). The degree of extraction olanzapine from bloods (model samples, 20 ng/ml) was 75.2% (CV 4.6%). The quantitative limit for olanzapine by HPLC-MS/MS (LLOQ) was 0.50 ng/ml (CV 2.0%, accuracy 17.6%). Conducted on an open randomized cross scheme studies showed a satisfactory bioavailability and bioequivalence profile of the original drug and generic containing olanzapine. The calculated pharmacokinetic parameters for the logarithmically converted mean values verified with a 90% confidence interval were: Сmax - 95.93-99.80% (average value 97.64%); AUC0 – t - 95.43-100.35% (average value 97.75%); Сmax / AUC0 – t - 94.44- 101.73% (average value 97.87%).

We present here results obtained using hightech bipolar instruments with an electrosurgical device and a non-linear dynamic feedback system for excision of large tissue blocks. The effectiveness of using bipolar scissors with blades made of nanostructured zirconium dioxide and thermostabilized bipolar forceps was assessed using high amputation of the lower limbs as an example. Significant results were obtained showing that the use of innovatory electrosurgical technologies for transfemoral amputation in patients with terminal-stage peripheral arterial disease increases the typical clinical measures of efficacy by an average of 39%. The results can be taken as the basis for a new method of using electrosurgical technology for high amputations of the lower limbs.

Aim Evaluation of efficacy and safety of minimally invasive, valve-sparing interventions on the aortic root and a comparative analysis of outcomes versus a group of patients with a complete sternotomy intervention using the method of propensity score matching (PSM).Materials and methods From 2016 through 2019, 458 interventions on the aortic root were performed, including 160 (36.6 %) interventions with mini-sternotomy. The study included 106 patients with the valve-sparing surgery (David procedure). Two groups of 30 patients each were formed using PSMC: group 1, complete sternotomy (CS) and group 2, J-shaped mini-sternotomy (MS). Immediate and long-term outcomes were evaluated at 13.8±10.3 (1–38 months (min-max) in the MS group and 42±21 (1–61 months (min-max) in the CS group.Results Statistically significant differences in death rate, echocardiographic indexes, absence of reoperations and complications in the postoperative period were not observed. In group 2, durations of extracorporeal circulation (p=0.04) and period of myocardial ischemia (p=0.004) were increased. The same group showed decreased intraoperative blood loss (p=0.001), postoperative drainage losses (p=0.0001), extubation time (р=0.0001), duration of stay in resuscitation and intensive care units and in the department of reconstructive recovery cardiovascular surgery (p=0,005).Conclusion The David procedure with mini-sternotomy is a safe and effective alternative to the traditional approach. This technique significantly reduces the time of rehabilitation and duration of patients’ stay in the hospital without significant differences in the long-term period, which suggests advantages of this method. However, despite these promising results, the retrospective nature of this study, a small sample of patients, and a short follow-up period warrant further study.

The aim of the review: to present literature data on the role of laboratory methods in the complex diagnosis of acute mesenteric ischemia. The main provisions. To search for scientific publications, we used the PubMed database, the RSCI, the Google Scholar search engine, as well as cited references. Articles relevant to the purpose of the review were selected for the period from 1999 to 2019 in the following terms: “acute mesenteric ischemia”, “pathogenesis”, “diagnosis”, “biomarkers”. Inclusion criteria were limited to acute arterial mesenteric ischemia. Acute mesenteric ischemia is an emergency condition caused by a sudden violation of the blood flow through the mesenteric vessels, which rapidly progresses to a heart attack of the intestinal wall and is accompanied by high mortality. Four main mechanisms of OMI are distinguished: embolism from the left parts of the heart or aorta, thrombosis of arteries or veins of the intestine, non-occlusive acute mesenteric ischemia (NOMI), due to vascular spasm. In this case, destructive disorders occur in the intestinal wall, starting from the mucous membrane to the serous, which leads to bacterial translocation and the development of a systemic inflammatory response syndrome. Early bowel revascularization is a key factor in reducing complications and mortality associated with it. However, in the initial stages of the disease has no specific signs, which complicate its diagnosis. The only way to detect mesenteric blood flow disorders is MSCT with angiography, and with non-occlusive lesions, mesenteric angiography, which in normal clinical practice is not always possible. Conclusion. It can be assumed that the use of laboratory methods will expand the range of diagnostic measures and will make it possible to conduct timely treatment aimed at restoring the mesenteric blood flow and improve the prognosis in patients with acute mesenteric ischemia.

Bleeding is a significant cause of complications and mortality in surgery for ascending aorta and aortic root disease. This is especially true after complex reconstructions associated with hypothermic circulatory arrest and long-standing cardiopulmonary bypass. The review is devoted to modern methods of hemostasis in reconstructive aortic root surgery.Кровотечение является существенной причиной осложнений и смертности при хирургических вмешательствах на восходящей аорте и корне аорты, особенно после сложных, многокомпонентных и прецизионных реконструкций, гипотермического циркуляторного ареста, длительного искусственного кровообращения. Обзор литературы посвящен современным методам контроля гемостаза в реконструктивной хирургии корня аорты.

We have studied the impact of Nd : YAG laser radiation with a wavelength of λ = 1.44 μm on the myocardial tissue for the formation of channels in the treatment of coronary heart disease by transmyocardial laser revascularisation (TMLR). The mechanism of perforation of the myocardial tissue by a laser pulse is presented and an experimental setup for TMLR is developed. In experiments on biological objects, the optimal parameters of radiation energy and duration necessary for the formation of channels of a given size in a single laser pulse are determined. The exposure regime ensures the adequate character of myocardial tissue destruction, assessed by such criteria as the perforation force, exposure energy, size of the coagulation zone, and level of carbonisation.

A quantitative procedure was developed for determining total flavonoids in horse chestnut buds (Aesculus hippocastanum L.) using differential spectrophotometry at 422 nm and recalculation as rhamnocitrin or 7-O-methylkaempferol (3,5,4′-trihydroxy-7-methoxyflavone), the dominant flavonoid in this raw material. The error of a single determination of total flavonoids in horse chestnut buds with 95% confidence probability was ± 2.23%. The contents of total flavonoids in horse chestnut buds varied from (1.24 ± 0.01) to (2.31 ± 0.03)%.

Aim. To establish connection between the functions of 30-year survival rate and concentration of cholesterol high density lipoproteins (C-HDL) in men aged 40-59 years with a past history of a myocardial infarction (MI) and relying on the obtained data to determine the optimal level of C-HDL for the specified cohort.Material and methods. The study includes 141 patients who have had MI more than 6 months ago and observed in clinics of Metallurgical district of the city of Chelyabinsk within the third group of dispensary register. Specified MI cases refer to types 1, 2 of the Third universal definition of MI. The initial stage of study of the target group of men who have a past history of MI lasted from 03.06.1974 to 24.11.1975. Observation points were 0 and 30 years. The endpoint was death. Information about the dead established during the annual monitoring of the status of life. During the observation period 130 persons/92,2% died. Evaluation of survival was carried out according to the method of Kaplan-Meier, based on which a Cox regression model was built with the inclusion of successively higher minimum level of C-HDL, so that survival curves were significantly different. 95% confidence intervals were determined. The confidence bands of survival functions were built on the basis of on non-parametric Kolmogorov-Smirnov test.Results. The analysis of the function of 30-year survival in men aged 40-59 with past history of MI, depending on the level of HDL-C showed: the presence of statistically significant relationships between survival and levels of HDL-C. Optimal concentrations of HDL cholesterol for survival were the values of HDL-C ≥2,0 mmol/l. Statistically significant periods of survival differences are shown on survival curves at different levels of HDL-C. The possibility of prediction of survival of each patient to a certain time depending on the level HDL-C is determined. Initial levels of HDL-C determine the beginning, duration, end of periods of statistically significant survival differences on survival curves.Conclusion. The analysis of 30-year monitoring of the life status of cohort of men aged 40-59 with past history of MI showed a statistically significant dependence of survival on the initial level of HDL-C. The initial concentration of HDL-C are optimal for survival of indicated cohorts of men. HDL-C levels of 2,0-2,9 mmol/l can serve as a therapeutic target for men aged 40-59 with a past history of MI. The functions of 30-year survival in the cohort of middle-aged men who underwent MI, allow to determine the probability of survival of patients with this level of HDL-C to certain time.

We present here the results of studies of the mechanism of plasma formation and the kinetics of plasma glow discharge required for making electrosurgical instruments with controllable plasma temperature. Numerical data on the energy parameters of the high-frequency current required for stable heating of the plasma glow discharge at atmospheric pressure are presented. Scientifically based technical solutions for creating prototype high-quality electrosurgical instruments with controlled-temperature low-temperature plasma glow discharge are described. The value of using a single technical platform based on a modular design for the main functional elements of high-frequency electrosurgical instruments with biological tissue dissection and coagulation modes based on temperature-controllable plasma glow discharge is assessed.

To analyze the results of endocardial pulmonary vein cryoablation in patients with atrial fibrillation (AF) undergoing on-pump cardiac surgery.The authors report postoperative outcomes in 19 patients after on-pump coronary artery bypass grafting and/or heart valve surgery and endocardial pulmonary vein cryoablation for concomitant AF. All procedures were performed for the period from September 2018 to December 2020.Successful procedure was determined by restoration of stable sinus rhythm in postoperative period. In 14 (79%) patients, sinus rhythm was restored in early postoperative period. In 5 (21%) patients (2 women, 3 men), AF recurred within 6-12 days after surgery. In one patient, postoperative period was complicated by atrioventricular blockade grade I.Endocardial pulmonary vein cryoablation is effective for AF. This procedure is expedient in patients with concomitant cardiac disease scheduled for open heart surgery.Проанализировать результаты криоабляции устьев легочных вен у пациентов с фибрилляцией предсердий (ФП) при кардиохирургических операциях в условиях искусственного кровообращения.В статье представлены результаты лечения 19 пациентов, у которых в дополнение к коррекции коронарной и/или внутрисердечной патологии в условиях искусственного кровообращения и кардиоплегии была выполнена эндокардиальная криоабляция устьев легочных вен по типу box lesion по поводу сопутствующей ФП в период с сентября 2018 г. по декабрь 2020 г.Критерием успешности процедуры являлось восстановление синусового ритма и его сохранение в послеоперационном периоде. У 14 (79%) пациентов в раннем послеоперационном периоде восстановили синусовый ритм. У 5 (21%) пациентов (2 женщин, 3 мужчин) в течение 6—12 сут возобновилась ФП. У одного пациента послеоперационный период осложнился развитием атриовентрикулярной блокады I ст.Криоабляция устьев легочных вен является эффективным методом лечения ФП. Применение данной процедуры максимально целесообразно у пациентов с сопутствующей патологией сердечно-сосудистой системы, которым планируется выполнение кардиохирургических операций.

To present our experience in the treatment of severe patients with mega aorta syndrome.There were 49 patients with mega aorta syndrome for the period from May 2015 to March 2021. All patients underwent total aortic replacement from sinotubular junction (with staged aortic root repair, if necessary) to abdominal aorta bifurcation. All surgeries were elective. All patients were divided into two groups: group I (Both groups were comparable by pre-, intra- and postoperative parameters. The interval between surgeries for staged approach was 7.1±2.3 months. Rehabilitation time considering two stages was longer in group I (13±2 vs. 5.5±1.1 months,One-stage total aortic replacement via thoracophrenolumbotomy is safe surgical treatment for mega aorta syndrome, especially in young patients with low surgical risk. Favorable outcomes may be expected in specialized centers with extensive experience in aortic surgery. Compared to staged approach, total aortic replacement eliminates the risks of between-stage aortic rupture. Therefore, it is a worthy alternative to other methods.Сравнить методики этапного и одномоментного подходов по замене всей аорты при хирургическом лечении пациентов с синдромом мегааорты, используя собственный и мировой опыт. Этапный подход с использованием открытых и гибридных методов до сих пор остается методом выбора для хирургического лечения пациентов с синдромом мегааорты. В настоящее время в ФГБНУ «РНЦХ им. акад. Б.В. Петровского» активно развивается направление одномоментного лечения патологии всей аорты, которое показало потенциальные преимущества перед этапным подходом. Мы представляем наш опыт лечения тяжелой категории больных с синдромом мегааорты с использованием различных методов.В исследование включены 49 пациентов с синдромом мегааорты, которым с мая 2015 г. по март 2021 г. выполнена замена всей аорты от уровня синотубулярного гребня (при этапном протезировании в случае необходимости также выполнялась коррекция патологии корня аорты) до бифуркации аорты. Все вмешательства были плановыми. Пациентов разделили на две группы: 1-ю группу — 33 (67,3%) пациента с этапной заменой и 2-ю группу — 16 (32,7%) пациентов с одномоментной заменой всей аорты с применением торакофренолюмботомического доступа. Первичные конечные точки исследования — летальность, периоперационные параметры и осложнения. Важными параметрами оценки результатов также являлись отдаленные исходы — свобода от реопераций на аорте и выживаемость.Группы сопоставимы по основным периоперационным параметрам. Интервал между операциями при этапном протезировании составил 7,1±2,3 мес. Сроки реабилитации с учетом двух этапов были больше у пациентов 1-й группы (13±2 мес по сравнению с 5,5±1,1 мес,Одномоментная замена всей аорты с применением торакофренолюмботомического доступа является безопасным методом хирургического лечения синдрома мегааорты, особенно у молодых пациентов низкого хирургического риска, и обеспечивает удовлетворительные результаты при выполнении в центрах с большим опытом операций на аорте. По сравнению с этапным подходом одномоментная замена аорты исключает риск разрыва аорты в интервале между этапами, поэтому она является достойной альтернативой существующим методам.

To evaluate the early outcomes of surgical treatment of heart valve disease and cardiac tumors via the right-sided minithoracotomy.There were 77 interventions via the right-sided minithoracotomy for the period from 2017 to March 2021 (29 men (37.7%) and 48 women (62.3%) aged 50.9±13 years (95% CI 48-53.9)). Heart failure NYHA class III prevailed (45.5%). The following interventions were performed: mitral valve replacement - 32 (41.5%) patients, mitral valve repair - 22 (28.6%) patients, atrial septal defect closure - 13 (16.9%) patients, resection of the left atrial myxoma - 4 (5.2%) patients, atrial septal defect closure + tricuspid valve repair - 2 (2.6%) patients, tricuspid valve replacement - 2 (2.6%) patients, mitral valve repair + atrial septal defect closure - 1 (2.6%) patient, mitral valve repair + atrial septal defect closure + right middle lobectomy - 1 (2.6%) patient.There were no in-hospital mortality and major cardiac events. Conversion was required in 1 case (1.3%). Enlargement up conventional to thoracotomy was required in 1 case (1.3%). Surgery time was 217 min (Q1-Q3 188-258), cardiopulmonary bypass time - 106 min (Q1-Q3 91-124), aortic cross-clamping time - 82±29 min (95% CI 76-89). Intraoperative blood loss was 500 ml (Q1-Q3 400-600). Mean postoperative hospital-stay was 6.7±1.8 days (95% CI 6.3-7.1).Heart valve surgery and resection of cardiac tumors via the right-sided minithoracotomy is a safe and effective approach to ensure chest stability, fast postoperative recovery and favorable cosmetic result. Surgery time is decreased along the learning curve.Оценить непосредственные результаты коррекции приобретенных и врожденных пороков сердца, удаления опухолей сердца с использованием правостороннего мини-торакотомического доступа.С 2017 г. по март 2021 г. в отделении хирургии приобретенных пороков сердца ФГБНУ «РНЦХ им. акад. Б.В. Петровского» выполнено 77 оперативных вмешательств с использованием правосторонней мини-торакотомии. Мужчин прооперировано 29 (37,7%), женщин — 48 (62,3%). Возраст пациентов составил 50,9±13 лет (95% ДИ 48—53,9 года). Большинство (45,5%) пациентов относились к III функциональному классу хронической сердечной недостаточности по классификации NYHA. Спектр выполненных операций: протезирование митрального клапана (МК) — 32 (41,6%) пациента, пластика МК опорным кольцом — 22 (28,6%) пациента, пластика дефекта межпредсердной перегородки (ДМПП) заплатой из ксеноперикарда — 13 (16,9%) пациентов, удаление миксомы левого предсердия — 4 (5,2%) пациента, пластика ДМПП заплатой из ксеноперикарда совместно с пластикой трикуспидального клапана (ТК) по Де Вега — 2 (2,6%) пациента, протезирование ТК — 2 (2,6%) пациента, пластика МК совместно с пластикой ДМПП — 1 (1,3%) пациент, пластика МК, ТК, пластика ДМПП, удаление средней доли правого легкого — 1 (1,3%) пациент.Летальные исходы и большие кардиальные события не зарегистрированы. Отмечалось по 1 (1,3%) случаю конверсии доступа в срединную стернотомию и расширения доступа до торакотомии. Средняя длительность операций составила 217 мин (Q1—Q3 188—258 мин), средняя длительность искусственного кровообращения — 106 мин (Q1—Q3 91—124 мин), а длительность ишемии миокарда — 82±29 мин (95% ДИ 76—89 мин). Средняя интраоперационная кровопотеря — 500 мл (Q1—Q3 400—600 мл). Количество послеоперационных койко-дней — 6,7±1,8 (95% ДИ 6,3—7,1).Коррекция приобретенных и врожденных пороков сердца, удаление опухолей сердца с использованием правосторонней мини-торакотомии безопасны, эффективны, способствуют сохранению каркасной функции грудной клетки, ускоренному послеоперационному восстановлению, обеспечивают хороший косметический эффект. С увеличением опыта выполнения подобных вмешательств их длительность уменьшается.

In the pattern of abdominal complications after cardiac surgery, acute mesenteric ischemia is rare but high-mortality pathology. In the initial stages, the disease has no specific signs, which makes it difficult to perform early multislice computed tomography to diagnose it. Risk stratification and an individual approach to the choice of diagnostic and therapeutic measures aimed at early restoration of mesenteric blood flow will reduce the mortality in this complication.

According to the results of modern researchers, the main techniques used in congenital pathology of the aortic valve in children include balloon catheter dilatation of the aortic valve, surgical valvuloplasty, the Ross procedure and replacement of the aortic valve with a mechanical prosthesis. Many surgeons point out that these techniques in congenital pathology of the aortic valve yield suboptimal results. This is often due to the lack of a clear-cut definition between surgeons as to what operation should be performed in a particular age group. According to the reports of the majority of researchers, biological prostheses undergo early degeneration and structural changes in paediatric cardiac surgery and yield the worst results. Comparing the main techniques, optimal haemodynamics is observed after the Ross procedure. A disadvantage of this operation is the necessity of repeat intervention on the right ventricular outflow tract, which is required in 20 to 40%. Concomitant surgery of the mitral valve and/or aortic arch during the Ross procedure significantly increases the lethality and the risk of postoperative complications. Compared with an adult cohort of patients, children after prosthetic repair of the aortic valve using a mechanical prosthesis are more often found to have postoperative complications and a higher mortality rate. Yet another problem encountered in paediatric valve surgery is the unavailability of commercial prostheses sized ?19 mm. The duration of the intraoperative parameters for reconstructions of the aortic valve, the Ross procedure, and replacement of the aortic valve by the results of many studies averagely amounts to 74±34 min, 100±56 min, and 129±71 min, respectively. Yet another method which can be used for neocuspidization of the aortic valve in reconstructive surgery of the aortic root in paediatric patients is the use of glutaraldehyde-treated autologous pericardium. In our opinion, given the simplicity of the procedure, duration of the intraoperative parameters, and acceptable initial results reported by some researchers, the Ozaki procedure may be performed in children.По результатам современных исследователей основными методиками, которые применяются при врожденной патологии аортального клапана у детей, являются баллонная катетерная дилатация аортального клапана, хирургическая вальвулопластика, процедура Росса и замена аортального клапана механическим протезом. Многие хирурги отмечают, что данные методики при врожденной патологии аортального клапана имеют субоптимальные результаты. Это часто связывают с отсутствием четкого определения между хирургами, в каких возрастных группах какую операцию нужно выполнять. По сообщениям большинства исследователей, биологические протезы подвергаются ранней дегенерации и структурным изменениям в детской сердечной хирургии и демонстрируют наихудший результат. При сравнении основных методик оптимальная гемодинамика наблюдается после процедуры Росса. Недостатком данной операции является необходимость повторного вмешательства на выходном тракте правого желудочка, который достигается от 20 до 40%. Сопутствующая хирургия митрального клапана и/или дуги аорты при процедуре Росса существенно увеличивает летальность и риск послеоперационных осложнений. При сравнении со взрослой когортой больных у детей после протезирования аортального клапана механическим протезом чаще наблюдаются послеоперационные осложнения и летальность. Еще одной проблемой детской клапанной хирургии считается то, что коммерческих протезов менее ?19 мм не существует. Продолжительность интраоперационных параметров для реконструкций аортального клапана, процедуры Росса и замены аортального клапана по результатам многих исследований составляет в среднем 74±34 мин., 100±56 мин. и 129±71 мин. соответственно. Еще одним методом, который возможно применять для неокуспидизации аортального клапана в реконструктивной хирургии корня аорты у детей является использование обработанного глутаровым альдегидом аутоперикарда. По нашему мнению, учитывая простоту техники, продолжительность интраоперационных параметров и первые приемлемые результаты у некоторых исследователей, процедура Ozaki может быть выполнена у детей.

Post-infarction ventricular septal defect (VSD) is a rare but formidable complication of myocardial infarction following mortality rate up to 90% without invasive treatment. Surgical closure is preferred for VSD. The authors report successful surgical treatment of a patient with post-infarction LV aneurysm and residual post-infarction VSD in 5 years after implantation of two occluders.Постинфарктный дефект межжелудочковой перегородки (ДМЖП) — редко встречающееся, но грозное осложнение инфаркта миокарда, летальность при котором в отсутствие инвазивного лечения достигает 90%. «Золотым стандартом» коррекции постинфарктного ДМЖП является хирургическое закрытие дефекта. В публикации представлен случай успешного хирургического лечения больной с постинфарктной аневризмой ЛЖ и реканализацией постинфарктного ДМЖП спустя 5 лет после имплантации двух окклюдеров.

Connective tissue dysplasia (CTD) is an urgent problem, especially in young and employable people. Damage to cardiovascular system and, in particular, aorta is predominant factor determining the incidence of various complications and mortality in patients with CTD. The authors report surgical treatment of aortic hypoplasia in an adolescent patient with connective tissue dysplasia syndrome and combined deficiency of coagulation factors.Дисплазия соединительной ткани (ДСТ) является достаточно актуальной проблемой, в том числе у лиц молодого и трудоспособного возраста. Поражение сердечно-сосудистой системы и, в частности, аорты является ведущим фактором, определяющим частоту различных осложнений и смертность пациентов с ДСТ. В статье описано хирургическое лечение гипоплазии аорты у пациента подросткового возраста с синдромом соединительно-тканной дисплазии и комбинированным дефицитом плазменных факторов свертывания.

The potential use of low-temperature plasma (LTP) for therapeutic purposes has aroused the concern of many researchers. This paper examines the effect of LTP on the morphofunctional state of human bone marrow stem cells (BMSC). It has been established that LTP-induced oxidative stress has a dual effect on the state of stem cells. On the one hand, a cell culture exposed to LTP exhibits the progression of a destructive processes, which is manifested by the perturbation of the cell&rsquo, s morphology, the initiation of lipid peroxidation and the accumulation of products of this process, like diene conjugates and malondialdehyde, as well as the induction of mitochondrial dysfunction, leading to cell death. On the other hand, the effect of LTP on BMSC located at a distance from the plasma is accompanied by the activation of proliferative processes, as evidenced by the tendency of the activity of mitochondrial biogenesis and fission/fusion processes to increase. The paper discusses the role of mitochondria and reactive oxygen species (ROS) in the cellular response to LTP.

Baroreflex is an important mechanism for controlling arterial blood pressure (BP). The effectiveness of the baroreflex action is very important diagnostic indicator of cardiovascular system regulatory mechanisms. To assess the effectiveness of baroreflex action, it is necessary to analyze the relationship between the systemic hemodynamics, and in particular, between the signals of beat-to-beat values of blood pressure and heart rate (HR). The paper proposes an algorithm for the joint analysis of these signals. The purpose of the algorithm is the allocation of signal sections with predominantly in-phase and antiphase relationships. The algorithm is based on the window Fourier transform analysis and window calculation of the correlation coefficient, wherein window width is determined from the standard frequency ranges of the cardiac rhythm. Spectral and spectral-temporal analysis is used for generalized qualitative assessment of the interdependence between the signals of beat-to-beat BP values and heart rate. To test the algorithm, we performed synchronous recording of BP and heart rate for 300 s in healthy subjects under conditions of calm wakefulness with eyes closed. The results of their analysis with proposed algorithm are presented.

Elderly and aged patients appear to have a significantly increased risk from a cardiosurgical intervention combining three-valve reconstruction and prosthetic repair of the ascending portion of the aorta. Triple-valve pathology in pronounced mitral insufficiency is often accompanied by concomitant dilatation of the left atrium, i. e., atriomegaly. With the aim to eliminate the syndrome of compression of surrounding tissues and normalize intracardiac haemodynamics, reduction of the left atrium should become an inherent procedure for atriomegaly in patients with multiple-valve pathology.У больных старческого и преклонного возраста риск от кардиохирургического вмешательства существенно увеличивается при сочетанном выполнении трехклапанной реконструкции с протезированием восходящего отдела аорты. Трехклапанная патология при выраженной митральной недостаточности часто сопровождается сопутствующей дилатацией левого предсердия – атриомегалией. С целью ликвидации синдрома сдавления окружающих органов и нормализации внутрисердечной гемодинамики редукция левого предсердия должна стать неотъемлемой процедурой при атриомегалии у пациентов с многоклапанной патологией.

This study aimed to assess the main risk factors contributing to postoperative separation of the sternum and to substantiate the recommendations on the optimal number of sternal polyspast and multi-twist knots based on data from international literature and our own experience. In this study, the indicators such as gender, age, height, body weight, body mass index, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, separation during the surgery of the internal thoracic artery, and re-exploration were evaluated. A key indicator was the sutures applied on the sternum after sternotomy, precisely the suture type (polyspast and multi-twist) and number. The study was conducted in the Federal Cardiovascular Surgery Center of the Ministry of Health of Russia (Chelyabinsk). The final sample was 1 051 patients in 2019. The patients were distributed into two groups; those without separation of the sternum in the postoperative period (n= 1 038) and those with sternum separation (n= 13). In the course of this study, we found that the most significant factors were the height and weight of patients. The multivariate analysis of variance showed that for multi-twist sutures, an additional sternal knot was required for every 4 cm of height, starting from 163 cm, and for every 7 kg of body weight, starting from 81 kg. For polyspast sutures, one additional sternal knot was required for every 5 cm of height, starting from 165 cm, as well as for every additional 5 kg of body weight, starting from 76 kg. When planning the number of sternal sutures, the height and weight of the patients body should be taken into account in aggregate, and the number of knots should be formed according to a more significant indicators.

The aim of this study was to analyze quality-of-life parameters in patients with coronary heart disease in Chelyabinsk region. The number of patients with coronary heart disease who took part in this research was 830 people. The data were collected with using of application form that was supplemented by the Russian-language questionnaire SF-36. We determined the medical and social characteristics, the assessment of the conditions and lifestyle of patients with coronary heart disease, and the subjective assessment of the quality of life by themselves. We have been revealed statistically significant differences in assessing the quality of life by patients of different territorial groups. The data should be differentially use in developing of regional and territorial programs in order to reduce mortality from coronary heart disease.

To evaluate bacterial flora in patients with deep sternal wound infection and the effect of negative pressure wound therapy on eradication of the pathogen.There were 102 patients with deep wound infection after cardiac surgery. Mean age was 66.9±9.9 years. Diabetes mellitus was detected in 21 (20.5%) cases, chronic obstructive pulmonary disease - in 15 (14.7%). Wound debridement via daily dressings was performed in 64 patients; vacuum-assisted dressings were applied in 38 patients. Bacteriological analysis of discharge was carried out every week.Results. Mixed infection was observed in 38 (37.3%) patients.Negative pressure wound therapy accelerates eradication of Gram positive pathogens but does not affect eradication of Gram negative microbes.Частота развития глубокой инфекции грудины после стернотомии по-прежнему высокая и достигает 3,2%. В последние годы все чаще используют вакуум-ассистированные повязки для лечения этого осложнения.Оценить бактериальную флору при стерномедиастинитах и влияние применения вакуум-ассистированных повязок на эрадикацию возбудителя.В исследование включены 102 пациента с глубокой инфекцией раны после кардиохирургических вмешательств. Средний возраст больных составил 66,9±9,9 года. Сахарный диабет выявлен у 21 (20,5%) больного, хроническая обструктивная болезнь легких — у 15 (14,7%). Санацию раны выполняли с помощью ежедневных перевязок у 64 больных, вакуум-ассистированные повязки использовали у 38 больных. Всем пациентам проводили бактериологический анализ отделяемого из раны 1 раз в неделю.У 38 (37,3%) больных получили рост нескольких микроорганизмов. Наиболее часто типировалиПрименение вакуум-ассистированных повязок позволяет ускорить очищение раны от грамположительной флоры, но не влияет на эрадикацию грамотрицательной флоры.

To study the reactions of the cardiovascular system during continuous monitoring in the dynamics of their development and analysis of the main hemodynamic parameters during the movement and orientation of the subjects (postural loads), a vector-based method was developed for assessing changes in systemic hemodynamics parameters: stroke index and mean arterial pressure. The vector representation allows us to get an idea of the intensity of changes in the patient’s hemodynamic status, expressed through the length of the vector. Based on the proposed method, a classification of hemodynamic reactions was developed.

Results obtained using an erbium laser to produce directed angiogenesis in transmyocardial laser revascularization in experiments using an animal model of chronically ischemic myocardium are presented. An assessment of the efficacy of using the erbium laser to produce targeted angiogenesis is presented. The optimum operating regimes for erbium laser pulse irradiation of the myocardium, taking account of thermal tissue lesions, are identified. Morphological changes are investigated and morphometric analysis in tissues in the area of the transmyocardial laser channels are analyzed in a model of chronic ischemic heart disease (IHD) in dogs. Studies were performed for subsequent development and introduction of the new method into clinical practice in patients with IHD with diffuse coronary artery lesions.

Co-encapsulation of abiraterone acetate (AbrA) and docetaxel (Dtx) in polymeric nanoparticles as novel prototypes for prostate cancer treatment combining hormonal and chemotherapy was designed. Nanoparticles (NPs) composed of poly(dl-lactide-co-glycolide) (PLGA) were prepared by single-emulsion solvent evaporation technique and characterized in terms of morphology with atomic force microscopy and transmission electron microscopy. HPLC method for simultaneous determination of AbrA and Dtx encapsulation efficacy was developed. Also differential scanning calorimetry and Fourier-transform infrared spectroscopy were provided. To study the effectiveness of cellular internalization and distribution of NPs with AbrA and Dtx co-encapsulation (NP-AbrA/Dtx), a fluorescence microscopy was utilized. NPs prepared had size 256.3 ±9.4 nm and zeta potential -18.4 ±1.4 mV. Encapsulation efficacy for AbrA was 68.7% and for Dtx was 74.3%. NPs were able to control the AbrA and Dtx release within 24 h. The mathematical model of drug release was performed. The results obtained from confocal microscopy showed the effective accumulation of the NP-AbrA/Dtx in the cytoplasm of cells. Synthesized NPs possessed satisfactory parameters and a biphasic release profile, proceeding by the Fick diffusion mechanism, which provide prolonged release of the drugs and maintenance of their concentration. It was shown that NPs loaded with AbrA and Dtx exhibited a high cytotoxic activity on the LNCaP cell line, similar to the combination of free drugs of AbrA and Dtx, but in contrast to the combination of substances, had a synergistic mechanism of action. Our findings support the potential use of developed NPs in further in vivo studies. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1150-1158, 2019.

Prevention and treatment of multi-organ failure after complicated surgeries on heart and major vessels remain to be crucial. The objective: to evaluate the potential use and efficiency of high-volume plasmapheresis for prevention and early therapy of multiple organ failure syndrome. Methods: high-volume plasmapheresis was used in 246 patients with the most disseminated complications of the peri-operative period. Plasmapheresis was done during the first 4–6 hours after surgery (157 patients) and in 6–12 hours after surgery (41 patients) and later than 12 hours (48 patients). Results. After complicated surgeries with in vitro hemoperfusion, the activation of system inflammatory response and endotoxicosis was more intensive versus patients with no complications. Plasmapheresis in 4–6 hours after surgery promoted metabolic normalization and in the majority of cases prevented of multiple organ failure (if at least 50% of circulating plasma was removed). After early plasmapheresis, the level of markers of system inflammatory response and endotoxicosis reduced by 28–30%, which allowed preventing serious renal disorders and cytolysis manifestations. Conclusion: Post-operative high-volume plasmapheresis performed in 4–6 hours after complicated cardiac surgeries is effective for prevention of multiple organ failure syndrome in 64% of cases.

The purpose of the study was to evaluate the efficacy and safety of rivaroxaban in patients after surgical treatment for the lower extremity fractures. Patients and methods. Retrospective multicenter study included 663 patients with femur fractures, 43 patients with complications after total hip arthroplasty (periprosthetic femur fractures, recurrent dislocation) and 10 patients with shinbone fractures. The majority (81.99%) of patients were elderly or senile. In postoperative period all patients received a standard prophylactic dose of anticoagulants. Out of them 75 (main group) - rivaroxaban (10 mg/day), 241 (control group) - other drugs (enoxaparin - 40 mg/day and dabigatran etexilate 150 or 220 mg/day). The efficacy of prophylaxis was assessed by clinical picture and Doppler ultrasound scans. Results. Average bed day made up 9.28. During hospitalization no cases of PE were recorded. In the main and control groups the rate of deep vein thrombosis with clinical manifestations made up 1.89 and 3.31%, respectively. No cases of fatal bleeding occurred. Signs of continuous bleeding in the area of surgical intervention (soaking dressings or recurring wound hematomas) in the main group was recorded rarely (3.15%) than in the control one (8.29%). Conclusion. Reduction of VTE rate with no increase in bleeding risk indicates the feasibility of rivaroxaban use for postoperative PE prophylaxis in patients with lower extremity fractures.

The article describes an aqueous suspension of activated carbon particles containing unbound water used for treatment of dystrophic gynecological diseases. The treatment is based on the method of controlled shock wave destruction of pathological tissues using laser radiation poorly absorbed by the tissues. A technology for saturating internal micropores of activated carbon particles with unbound water and preparing the aqueous suspension is described. The results of histological in vitro studies of the zone of necrosis caused by exposure of model biological objects (mucous membrane of miniature pig vagina) to shock waves are presented. It is shown that the thickness of the necrosis zone decreases with increasing intensity of laser radiation.

Currently, there is a global trend of growing frequency of concurrent lung malignant tumors and cardiac vascular pathology, in particular, ischemic heard disease. The literature review demonstrates, that development of surgery, anesthesiology and intensive care allows expanding limits for treatment of such patients through simultaneous surgery when lungs and heart are operated at the same time. The article analyzes the personal experience of the authors and international publications, it contemplates on safe performance of simultaneous and mult i-o rgan surgeries, involving respiratory and blood circulation systems, different approaches to surgery, its specific features, benefits, and limitations. Specialists from Russian Surgery Research Center named after B.V. Petrovsky find it preferable to perform simultaneous staged surgery of the lungs, mediastinum and cardiac vascular system. There is a certain sequence of stages. It demonstrates that the first stage may include isolation of abnormal masses of the lung (mediastinum) and lung hilus, if necessary. After that cardiac surgery is performed, and as a final stage, the whole abnormal focus is isolated and resected.

A central role in the formation of the natural environment of Prebaikalia is played by vegetation having the environment-forming and environment-protective functions. Nowadays, it is experiencing ever increasing anthropogenic impacts which lead to disturbances in its structure and decrease its ecological potential. This creates certain challenges of a local and regional character, because the main territory of the region is within the zone of atmospheric influence and within the western portion of the central ecological zone of the Baikal natural territory focus on preserving the ecosystem of Lake Baikal as the UNESCO World Natural Heritage site. Therefore, the main direction of nature conservation activity aimed at improving the quality of the region’s natural environment remains focused on the preservation and recovery and of its primary vegetation. Some measures are suggested concerning ecologically oriented nature management in Prebaikalia. We have defined the goals for the scientific accompaniment of the measures for the preservation of vegetation as an important factor of the environmental quality. The paper demonstrates the effectiveness of integrated study into the entire florocenotic diversity of modern vegetation, its evolutionary-genetic basis and the ecological and dynamical potentials of plant communities for the purposes of forecasting the ecologically oriented development of the region’s natural environment. The recommendations are formulated in accordance with the State Ecological Program for the period until 2030. The map entitled “Protection of vegetation in Prebaikalia (recommendations for optimization of the ecological policy)” has been developed, which provides information on territories with a different environmental quality having regard to the ecological potential. The legend includes the following parts of the map: special preservation of primary vegetation (full and partial), recovery of disturbed vegetation (active and passive recovery of primary forests), and economic rational (ecologically oriented) use of vegetation.

This article describes the use of nanostructured zirconium dioxide to provide high performance characteristics for novel electrosurgical instruments. Design solutions providing major functional improvements are described. A clinical study evaluated the effectiveness of using the new electrosurgical instruments with a special high-frequency generator in surgical operations on the thyroid gland.

The article substantiates a new method of treatment of degenerative diseases in gynecology by controlled destruction with laser shock waves poorly absorbed by biological tissues. The shock-wave process is initiated using finely dispersed absorbing particles deposited on the surface of pathological tissues. Absorption of laser radiation by the particles leads to their explosion accompanied by generation of elastic waves. Propagation of these waves in the surface layer of the surrounding biological tissue leads to its destruction. Such destruction can provide a precision therapeutic effect with controlled depth and area.

Background Aortic coarctation is a hereditary disease often accompanied by ascending aortic aneurysm and aortic valve disease. We introduce a single-stage surgical treatment option for patients with aortic coarctation, ascending aortic aneurysm, and aortic valve disease, with a comparative analysis of the results. Methods The study included six patients with aortic coarctation, ascending aortic aneurysm, and aortic valve disease. All operations were performed by a full median sternotomy. For a comparative analysis, the patients were divided into two groups: 3 patients underwent ascending-to-descending aortic bypass, and the other 3 underwent surgical aortic coarctation repair. The short- and medium-term postoperative periods were monitored. The mean duration of monitoring was 27 months. Results When comparing the 2 groups, we observed a tendency for improvement in all intraoperative parameters in the 2nd group. There was no mortality in the postoperative hospital period. One (16.7%) patient died of stroke in the medium-term postoperative period. The other 5 patents showed no signs of procedure-related complications. Conclusion We recommend performing a single-stage procedure for surgical treatment of coarctation of the aorta with concomitant aneurysm of the ascending aorta and aortic valve disease. Compared to ascending-to-descending aortic bypass, surgical repair of aortic coarctation is more physiological, feasible via a sternotomy, and tends to improve intraoperative factors.

To assess the dynamics of blood flow in patients with hemodynamically significant pathological kinked internal carotid arteries (PK ICA) with their orthostatic and rotational positions.Eighty-six patients, including 35 with PK ICA due to fibromuscular dysplasia (FMD) and 51 with PK ICA due to hypertensive heart disease, and 20 healthy people were examined. All patients underwent Doppler ultrasound scanning. All indicators were evaluated in the position of the patient lying on his back and functional stress tests (orthostatic, rotational).The peak systolic velocity, end diastolic velocity, peripheral resistance index did not differ significantly in patients with PK ICA due to FMD and hypertensive heart disease. The increase of blood flow in bends was significantly higher with S-shaped kinking, regardless of the reason for their formation (p0.05). In orthostatic position, significant changes of hemodynamic parameters in ICA in healthy people did not occur. Moreover, more frequent formation of turbulent blood flows in the group with hypertensive heart disease (78%) and a decrease in LBFV in the standing position were found in patients with PK ICA due to FMD. Rotational position did not alter the hemodynamics in ICA in healthy people and significantly influenced the values of LBFV in patients with PK ICA.Changes in hemodynamic parameters in the area of kinking with orthostatic and rotational positions of ICA demonstrate more significant impairments in patients with PK ICA due to hypertensive heart disease compared to patients with FMD. The rotational position of PK ICA is the most informative for identifying turbulent blood flow and an increase in peak systolic velocity in the area of kinking.Оценка динамики характера кровотока у пациентов с гемодинамически значимыми патологическими извитостями (ПИ) внутренних сонных артерий (ВСА) при их ортостатической и ротационной транспозициях.Обследованы 86 пациентов (35 с ПИ ВСА на фоне дисплазии соединительной ткани и 51 с ПИ ВСА вследствие гипертонической болезни) и 20 условно здоровых людей. Всем больным было проведено дуплексное сканирование. Все показатели оценивали в положении пациента лежа на спине и при функциональных нагрузочных пробах (ортостатической; ротационной).Пиковая систолическая, конечная диастолическая скорость кровотока и индекс периферического сопротивления значимо не отличались у пациентов с ПИ ВСА на фоне гипертонической болезни и дисплазии соединительной ткани. Прирост линейной скорости кровотока в изгибах был достоверно выше при S-образных извитостях вне зависимости от причины их формирования (p0,05). При ортостатической транспозиции значимых изменений показателей гемодинамики во ВСА не происходило у здоровых людей, выявлено более частое формирование турбулентных потоков крови в группе с гипертонической болезнью (78%) и снижение линейной скорости кровотока в положении стоя у пациентов с ПИ ВСА на фоне дисплазии соединительной ткани. Ротационная транспозиция не изменяла гемодинамики во ВСА у здоровых людей и значимо влияла на показатели линейной скорости кровотока у пациентов с ПИ ВСА.Изменения показателей гемодинамики в области извитости при ортостатической и ротационной транспозициях ВСА демонстрируют более значимые нарушения у пациентов с ПИ ВСА на фоне гипертонической болезни по сравнению с пациентами с дисплазией соединительной ткани. Ротационная транспозиция ПИ ВСА является наиболее информативной для выявления турбулентных потоков крови и прироста пиковой линейной скорости кровотока в зоне извитости.

Cardiovascular diseases and malignancies are leading causes of mortality in the world. Two categories of advanced age patients with cancer are observed in clinical practice. These are patients with cardiovascular diseases as comorbidities and patients with cardiovascular diseases as a complications of targeted therapy for cancer. Cardiac toxicity of chemotherapeutic drugs results myocardial dysfunction, occurrence or progression of heart valve disease, coronary artery disease, arterial hypertension and thromboembolism. A patient who underwent aortic valve replacement and coronary artery bypass surgery is discussed in the article. Aortic valve disease and coronary artery disease were complications of targeted radio- and chemotherapy for sigmoid colon cancer followed by lung and liver metastases. Questions of timely diagnosis and treatment of advanced age patients in multi-field surgical clinic are also analyzed.Сердечно-сосудистые заболевания и злокачественные новообразования занимают лидирующие позиции в рейтинге смертности среди пожилого населения во всем мире. Все чаще в клинической практике встречаются две категории онкологических пожилых пациентов - те, у которых болезнь сердечно-сосудистой системы является коморбидным состоянием, и те, у которых сердечно-сосудистые заболевания возникли вследствие противоопухолевой таргетной терапии. Кардиотоксичность протовоопухолевых таргетных препаратов проявляется как в дисфункции миокарда, так и в возникновении и прогрессировании поражения клапанов сердца, ишемической болезни сердца, артериальной гипертензии, тромбоэмболии. Приводим клиническое наблюдение пациентки, перенесшей оперативное лечение аортального порока сердца и аортокоронарное шунтирование передней нисходящей артерии, развившихся вследствие таргетной лучевой и химиотерапии по поводу рака сигмовидной кишки с метастазами в легкие и печень.

To present current treatment modes for DeBakey type I aortic dissection, to compare their early and mid-term postoperative results, to evaluate predictors of negative aortic remodeling after surgery.Retrospective cohort analysis included 78 patients with DeBakey type I aortic dissection who underwent surgical treatment in 2009-2017. Patients were divided into 3 groups depending on type of intervention: group I (n=22) - Elephant Trunk procedure, group II (n=29) - hybrid interventions, group III (n=27) - proximal aortic replacement alone. Early postoperative results and aortic remodeling in mid-term postoperative period were compared.There were no significant differences in postoperative morbidity, in-hospital mortality and freedom from aortic death. However, 7 patients were lost for follow-up in group III. Analysis of false lumen patency showed results in favor of more aggressive approach (groups I and II) with significantly higher rate of false lumen thrombosis in segments 1 and 2 (p0,001 and p=0,004 respectively). Freedom from negative aortic remodeling was also significantly higher in groups I and II. Risk factors of patent false lumen were residual fenestration, large volume of false lumen in segment 2, dissection of supra-aortic vessels and connective tissue disorders. Risk factors of negative aortic remodeling were connective tissue disorders, patent false lumen and dissection of supra-aortic vessels.Advanced surgical approach (Elephant Trunk procedure or hybrid interventions) should be preferred for DeBakey type I aortic dissection.Представить современные варианты лечения расслоения аорты I типа по DeBakey, сравнить их результаты в раннем и среднеотдаленном послеоперационных периодах, выявить факторы, способствующие отрицательной динамике у больных после хирургического лечения.В ретроспективный когортный анализ вошли 78 пациентов с расслоением аорты I типа по DeBakey, прооперированные в 2009-2017 гг. В зависимости от выполненного вмешательства, больные разделены на три группы: в 1-й группе (n=22) выполнили протезирование восходящего отдела и дуги аорты по методике 'Хобот слона', во 2-й группе (n=29) - гибридное лечение, в 3-ю группу (n=27) вошли пациенты, у которых хирургическое лечение ограничилось протезированием проксимальных отделов аорты. Проведен сравнительный анализ ранних послеоперационных результатов, а также оценка ремоделирования аорты в среднеотдаленном периоде.Достоверной разницы по частоте послеоперационных осложнений, общей госпитальной летальности и свободе смерти от заболевания аорты между группами не выявлено (однако в 3-й группе утрачена связь с 7 пациентами). Анализ состояния ложного канала аорты выявил данные в пользу радикальных вмешательств (1-й и 2-й группы) c достоверно более высокой частотой его тромбирования в сегментах 1 и 2 (p0,001 и p=0,004 соответственно). Отсутствие негативного ремоделирования аорты также встречается достоверно чаще в группе радикальных операций. Факторами риска сохраненного кровотока в ложном канале стали наличие резидуальной фенестрации, больший объем ложного канала во втором сегменте аорты, наличие расслоения брахиоцефальных ветвей и дисплазии соединительной ткани. К факторам отрицательного ремоделирования были отнесены дисплазия соединительной ткани, сохраненный кровоток в ложном канале и расслоение брахиоцефальных ветвей.При расслоении всей аорты рекомендуется выполнение радикальных вмешательств на грудной аорте по типу 'Хобот слона' или гибридных операций.

The authors performed clinical studies based on modelling of an ascending aortic aneurysm in 37 patients and 10 apparently healthy subjects. Echocardiography was carried out in the B-mode using the Vivid E9 device (USA, GE). The linear dimensions of the aorta were assessed at three points - in the immediate vicinity of the valves, in the area of the maximum dilatation and in the area of decreased dilatation with registration of blood flow velocity in the aorta. The aortic walls were contoured with the division of equal intervals into 4 portions in order to obtain longitudinal shear deformation velocity during the cardiac cycle. We worked out a system of assessing the velocity vector fields with the help of transthoracic echocardiography in patients with an ascending aortic aneurysm, based on registration of blood flows, which made it possible to obtain the components of velocity. We also determined an optimal method of assessing turbulence in the aorta taking into account the direction of the vectors. Obtained were the numerical data of aortic wall deformation velocity in the longitudinal direction and calculation of the weighting function with the distinction between pathology and the norm. Based on the deformation, the distance between the registered points, and the movement of the vascular wall, we determined the reference values of blood flow velocity inside the aorta and immediately close to its walls.Выполнены клинические исследования, основанные на моделировании аневризмы восходящей аорты у 37 пациентов и 10 здоровых субъектов. Эхокардиографию выполняли в B-режиме на аппарате Vivid E9 (США GE). Оценивали линейные размеры аорты в трех точках – непосредственно у клапанов, в области максимального расширения и в области уменьшения расширения c регистрацией скорости кровотока в аорте. Стенки аорты оконтуривали с разбивкой ровных интервалов на 4 участка с целью получения продольного сдвига скорости деформации за сердечный цикл. Разработана система оценки полей векторов скорости с помощью трансторакальной эхокардиографии у пациентов с аневризмой восходящей аорты, основанная на регистрации потоков крови, что позволило получить составляющие скорости. Определен оптимальный метод оценки турбулентности в аорте с учетом направления векторов. Получены цифровые данные скоростей деформации стенки аорты в продольном направлении и расчетом весовой функции с отличием патологии от нормы. На основании деформации, расстояния между регистрируемыми точками, движения сосудистой стенки определены реперные значения скорости кровотока внутри аорты и непосредственно у стенок сосуда.