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Atherosclerosis is a chronic disease in which lipids, cells and various proteins accumulate in the walls of the arteries, forming atherosclerotic plaques. The growth of plaques leads narrowing of the lumen of the blood vessels. Atherosclerosis is accompanied by local inflammation, while the number of hematogenous macrophages are derived from monocytes increases in the vascular wall. The reasons why the inflammatory reaction cannot be completed and becomes chronic are not clear. To resolve inflammation and protect tissues from high concentrations of cytokines that can cause apoptosis, there is a mechanism of immune tolerance of innate immunity. Lipopolysaccharide (LPS) tolerance of monocyte-macrophages is a phenomenon in which cells reduce their sensitivity to repeated exposure to LPS. This condition is characterized by a decrease in the ability of macrophages to produce proinflammatory cytokines and promotes resolution of inflammation. We hypothesized that in atherosclerosis, tolerance violations in monocyte-macrophages are possible. The study included patients who were admitted to the department of cardiac surgery, Moscow Regional Research and Clinical Institute (MONIKI). Patients were divided into patients with coronary atherosclerosis (CAD) with detected stenosis in 2 or more arteries and healthy controls without stenosis in the arteries according to the results of coronary angiography. In the present study, we examined the ability of macrophages from 13 patients with CAD and 11 patients without CAD to develop tolerance to LPS. To do this, we isolated CD14+ monocytes from the blood by positive selection using immunomagnetic separation and subjected them to two sequential LPS stimulations, immediately after cell isolation and after 6 days of culture. The secretion of cytokines TNFα, IL-1b, IL-6, IL-10, IL-8, and CCL2 was measured in cell culture supernatants using by ELISA. Our results showed impaired macrophage tolerance for CCL2 secretion and improved tolerance for IL-8 secretion in macrophages from patients with CAD compared with patients without. Since IL-8 and CCL2 are chemoattractants for other immune cells, it can be assumed that the observed impairment of macrophage tolerance to LPS in atherosclerosis increases the infiltration of other monocytes into the inflammatory site, contributing to the chronicity of inflammation.

The end-stage stage of chronic diseases of solid organs is rather significant in the structure of morbidity and mortality among patients worldwide. To date, there are more than six million patients in this status worldwide. Heart, liver and kidney transplantation is the gold standard of treatment for these patients. The number of transplants is growing every year.At the end of 2019, the world faced a new type of viral infection – SARS-CoV-2 – a highly contagious systemic respiratory disease transmitted by airborne droplets, which in three months led to a pandemic and killed hundreds of thousands of people. The pandemic has made adjustments to the structure of planned medical care. The number of planned operations has decreased significantly, and the number of the infection-associated complications has increased.Patients with end-stage chronic diseases initially have weakened immunity and represent the category most susceptible to the infection. At the moment, the question of patient management tactics remains open. There is no consensus on the patient management tactics before surgery and in the posttransplantation period for patients at the end-stage chronic disease of different organs. This topic requires further study and the development of treatment algorithms for such patients.

Rationale. Secondary, or functional, mitral regurgitation is the most common complication of heart failure. Dysfunction of one or more mitral valve structures occurs in 39–74% of patients thus complicating the course of the disease and significantly worsening the prognosis in patients with left ventricle dilatation. An unfavorable prognosis in patients with the development of mitral regurgitation is conditioned by the progressive changes that form a vicious circle: the continuing volume overload and dilatation of the left ventricle cause its remodeling, leading to further dilatation of the mitral valve annulus. Dysfunctions of the papillary muscles lead to the increased tension of the left ventricle wall and increased mitral regurgitation. Clinically, this process is manifested by the congestive heart failure progression and worsened prognosis of the further course, which in the future may lead to considering the inclusion of this patient group on the waiting list for heart transplantation.Purpose. The purpose of this article is to review the role of surgical management in patients with heart failure complicated by mitral regurgitation.Conclusions. The main principles of the treatment for functional mitral regurgitation include the reverse left ventricular remodeling and mitral valve repair or replacement surgery which lead to an improved quality of life, the transition of patients to a lower functional class, reduced hospital admission rates, and also to a regression or slower progression of the heart failure and to an improved survival.

Despite the widespread use of mechanical circulatory support systems, modern optimal drug therapy and various interventional methods of heart transplantation remain the "gold standard" for the treatment of end-stage heart failure patients.At the same time the required number of heart transplants is significantly increasing due to the progressively increasing number of patients needing transplants and the actual donor pool. In recent years there has been a trend towards the increase in the number of recipients and the decrease in the number of donor organs. However, the use of donor hearts with pathological changes, including left ventricular myocardial hypertrophy, remains a controversial topic. It is believed that the use of expanded criteria significantly increases the risk of graft failure in the post-transplant period and leads to deterioration of immediate and long-term results. This work aimed to analyze the data on using donor hearts with left ventricular myocardial hypertrophy for allotransplantation.Authors declare no conflict of interest.

In recent years, the mechanical support of blood circulation has proved to be a vital therapy for a terminal heart failure, and is considered as a "bridge" to transplantation or is used on a permanent basis in a patient who can not be included in the waiting list for a donor organ. Recent studies of the critical heart failure treatment during an assist device in situ have shown the myocardial recovery at the molecular and cellular levels. However, the transition of these changes to a functionally stable recovery of the heart function, which would allow the long-term results to be achieved without a heart transplant or switching off the mechanical support, is now rather an exception to the rule. At this time, the cause of the discrepancy between the high rate of recovery at the cellular and molecular levels and the low rate of cardiac function recovery remains poorly understood. Patients with chronic progressive heart failure can demonstrate the normalization of many structural myocardial abnormalities after a mechanical support that is actually a reverse remodeling. However, the reverse remodeling is not always considered equivalent to clinical recovery. The aim of this research is to study a significant improvement in the structure and function of the myocardium during the mechanical support of blood circulation.

Currently, the analysis of the fibrosis severity during the restructuring of the surrounding extracellular matrix (ECM) is studied in most of the research works devoted to “cardiac remodeling”. At the same time, the role of the basal membrane of cardiomyocytes in heart diseases was not studied. The basal membrane of cardiomyocytes is a highly organized layer of the ECM which is located on the outer side of the sarcolemma. Degradation of ECM components is carried out by different types of matrix metalloproteinases (MMP), which have proteolytic activity and are actively involved in the process of ECM remodeling, destroying its components such as collagen, elastin, fibronectin, glycosaminoglycans and other structural components.Aim. To evaluate the ECM status in patients with coronary artery disease and its effect on left ventricular myocardial remodeling.Material and methods. Morphological and immunohistochemical (IHC) examination of left ventricular myocardial biopsies was performed in 16 patients undergoing left ventricular reconstruction in combination with coronary artery bypass grafting.Results. The IHC study revealed the accumulation of matrix metalloproteinase-9 in the cytoplasm of cardiomyocytes. This accumulation was combined with partial or complete destruction of the basal membranes (BM) of cardiomyocytes formed by type IV collagen.Conclusion. Type IV collagen destruction in basal membranes of left ventricular cardiomyocyteswasrevealed. It iscausedbytheactionofmatrixmetalloproteinase-9, which accumulates in the cell cytoplasm.

Aim. To analyze approaches to pretransplant treatment of potential heart recipients and heart donation criteria, directed to reduction of mortality on a waiting list and to increase of volume and effi ciency of heart transplantations.Methods and results. Data on 285 HT recipients (performed in 2008–2013) were analyzed. The analysis and comparison of patients with circulatory support before heart transplantation, using «high-risk» donors (aged over 40 years, with left ventricular hypertrophy ≥ 1.5 cm, after cardiopulmonary resuscitation, with the reduced systolic function of the left ventricle (< 40%), with potentially repair pathology of the heart valve and coronary arteries); to high risk recipients (over 60 years, with high pulmonary hypertension and earlier operated) were made.Conclusion. The proposed scientifi c, technological and organizational solutions made possible the timely performance of heart transplantation to patients with an inevitable lethal outcome as a result of heart failure.

Aim of our clinical study was evaluation own initial experience of high-urgency ortotopic heart transplantation (OHT) in recipients, who were bridged on peripheral Vena-Arterial Extracorporeal Membrane Oxygenation (VA ECMO). Materials and methods. In this study was included 17 patients (14/3 M/F, age 16–66 (40.1 ± 4.2 yrs)) who underwent OHT while on peripheral ECMO support. In all cases we used peripheral surgical can- nulation technique via femoral vessels – arterial cannula 15–19 Fr, venous cannula – 21–25 Fr, arterial cannula or vascular catheter 8–10 Fr for anterograde leg’s perfusion. Results. Duration Vena-Arterial Extracorporeal Membrane Oxygenation before OHT was 81 ± 17 h. VA ECMO support was blood flow 4.8 ± 0.6 l/min or 2.63 ± 0/04 l/min/m2, gas flow 4.8 ± 0.6 l/min, FiO2 0.86 ± 0.07. Vena-Arterial Extracorporeal Membrane Oxygenation support was continued in “protective mode” (blood flow 1.9 ± 0.2 l/min) 4.3 ± 0.5 days after OHT. Thirteen pa- tients (76.4%) were weaned from VA ECMO successfully and survived to be discharged. ICU and hospital LOS after orthotopic heart transplantation was respectively 6.7 ± 0.8 and 32.3 ± 4.6 days in group of survived patients. The reasons of a lethal outcome (n = 4, 23.5%) were sepsis and multiorgan failure (n = 3), sudden cardiac arrest (n = 1). Conclusion. Vena-Arterial Extracorporeal Membrane Oxygenation is a favorable short-term method of circulatory support in patients who needed in high-urgency heart transplantation.

Aim of study. The demonstration of our own experience in heart transplantation after valve reconstruction. Methods and results. From May 2012 to March 2013 3 mitral valve annuloplasties were performed to recipi- ents, requiring urgent HT and having extremely unfavorable prognosis of survival without HT. The recipients were classified as United Network for Organ Sharing (UNOS) IB, and all of them were on inotropic support. In one case, HT was performed after reconstruction of rheumatic mitral stenosis, in two other cases – after dege- nerative mitral regurgitation. The technical aspects are reviewed of ex-vivo mitral and tricuspid valves repair with concomitant heart transplantation. All patients were discharged from the hospital having excellent postope- rative recovery. Conclusion. Taking into consideration the demonstrated satisfactory result of surveillance and presence of significant experience in performing of reconstructive valve surgery among no-HT cardiosurgical patients, an increase in the pool of suitable donor organs is expected due to the liberalization of the selection criteria and the possibility of the innovative valve reconstruction procedures ex vivo.

The decision to install cardiac resynchronization device in patients may be associated not with the apparent clini- cal effectiveness, but for other reasons that require medical consultation. This may be due to the need to create a «bridge» to heart transplantation (HT), for example. In order to predict the outcome of CRT, we observed 54 pa- tients with HF, III–IV functional class NYHA, on the waiting list for HT. Cardiomyopathy was diagnosed in 36 patients, various forms of ischemic heart disease was diagnosed in 17 patients, all with the ECG determined left bundle branch block with QRS complex duration of less than 120 ms. All patients performed gated SPECT before and after CRT with standard methods of research. LVEF at baseline did not exceed 35%. Monitoring was continued for 2 years after the start of the CRT. The results were divided into two groups. Group 1 consisted of patients who need HT for 2 years, in spite of the CRT (11 patients). Group 2 consisted of patients who have an increase in LVEF of at least 10% after CRT (28 patients). When comparing the initial and final performance with the help of the Main- Whitney in both groups, most significant differences were found in the assessment of myocardial perfusion relation- ships lateral walls of LV and RV. The decrease in the ratio between the level of perfusion of the lateral walls of LV and RV < 2,0 reduces the effectiveness of CRT, and within two years, there occured a need for a heart transplant.

In a review of the comparative analysis of methods and tools for long-term mechanical circulatory support with continuous flow and pulsatile flow implantable pumps. Particular attention is paid to the choice of the optimal modes of the operation of pumps based on the physical principles of the interaction between a the steady flow of blood to the pulsatile mechanics of the heart chambers.

The basic variants of cytokines reactions defining type of organ dysfunctions are revealed in the course of car- diopulmonary bypass and in the early postoperative period. Their character and expression, depends on gravity preoperative an immunodeficiency and initial degree of heart insufficiency. Diphasic dynamics of development of system inflammatory reaction is confirmed after cardiopulmonary bypass: increase of levels proinflammatory cytokines is in the first phase and anti-inflammatory cytokines with development immunodepression and cellular anergy in is the second phase. Also, key role IL-1Ra is revealed in restraint of hyperactivation of system inflam- matory reaction. Blood whey levels IL-6, IL-8, G-CSF, TNF-α and IL-1Ra should be defined to cardiopulmonary bypass, in 10–12 hours, 24 hours and 3 days after cardiopulmonary bypass and may be used as prognostic criteria of development of postoperative complications.

In the article there is described the case of the accelerated humoral (antibody-mediated) rejection of the cardiac allograft with morphologic and immunohistochemical details revealed at the investigation of the endomyocardial biopsy and myocardial autopsy.

The review presents the data on the results of recovery the myocardial function in patients with end-stage chro- nic heart failure and prolonged using of the systems assist device. The most effective treatment of the chronic heart failure was received by the combination of the left ventricular bypass and the medical therapy aimed at normalizing the cellular, structural and functional characteristics of the myocardium («reverse remodeling»). An important step in restoring the myocardium to explantation pump is to create the conditions for the «physiologic hypertrophy» of the heart. The application of this technology will open the way for the treatment of patients with dilated cardiomyopathy, alternative heart transplantation.

The differentiation of the cases of the right ventricular failure in transplanted heart should be complex and challenging. The 28-year old man with dilated cardiomyopathy underwent orthotopic heart transplantation. After transplantation developed right ventricular failure. The biopsy (n = 5) didn’t reveal any signs of myocardial rejection. There were noted some signs of inflammation in lateral right ventricular wall only by gated SPECT. The right ventricular failure increased and 6 months later there was successfully performed the heart retransplantation on the patient. The virusological study revealed the Epstein–Barr virus in myocardium. The explanted heart research excluded limphoproliferative disease by immunogystochemical tests. The final diagnosis is myocarditis.

We analyzed the dynamics of the interaction of rotary pump, connected to the scheme «the left ventricle – aor- ta», and left ventricle in norms and heart failure, using data obtained on the mock circulatory system. Adverse pumping states such as suction and regurgitation can be detected. These limits depend on the degree of cardiac failure, which confirms the need to control the speed of rotation of the impeller in the range of the cardiac failure from pathology to normal. It has been shown that the pulsating pressure at the inlet of the pump modulates the flow of the pump, making it a pulsating, what positively affects on the dynamics of cardiac output.

Morphological research of canine cardiac tissues after implantation several types of implants has been made. The first group consisted of animals with implanted «Eslan+Elasto-POB» implants, the second was after im- plantation of «Eslan» implants, and the third group after «Ftorex» implants. Fabrics were implanted on canine heart muscular tissue. Muscular tissue with implant were examined by light microscopy. There were no early or late deaths of animals, no infectious complications in any groups and terms. The reactions in muscular tissue in response to implantation of implants were defined as typical pathological processes and manifested by alterative, exudative reactions with edema, ill-defined hydropic degeneration and formation of inflammatory infiltration in the early terms (20 days). The formation of mature granulation tissue was accompanied its invasion between pores of implants and giant-cell reaction (20 days). After that thin layer of connective tissue was formed at the periphery of implant (30 and 60 days). Development of ill defined fibrosis was revealed in late postoperative terms at the circumference of implant (30 days – 60 days). There were no substantial differences in features of tissue’s responses to implantation of all types of implants.

Despite all successes of a modern heart surgery, anesthesiology and resuscitation till now actual there is a ques- tion of improvement of results of surgical treatment of patients with chronic left ventricle postinfarction aneu- risms. Аfter left ventricular reconstructive surgery preoperative risk factors of development heavy myocardial dysfunctions in the postoperative period aren’t defined accurately now. We have made the analysis of 168 similar operations and have defined preoperative risk factors of development of severe heart failure in the intraoperative and early postoperative period. We have suggested methods to improve the results of operations in these patients using mechanical and pharmacological support of blood circulation. Use our suggested methods of preoperative preparation (Intraaortic balloon counterpulsation (VABK) and VABK + levosimendan) had significantly impro- ved results and significantly reduce mortality in patients with high risk of surgical treatment.

Cardiac transplantation (CTX) remains the gold standard for treatment of terminal forms of heart failure. Nevertheless, all over the world shortage of donors and postoperative complications leads to search of alternative therapeutic strategy. Cardiac resynchronization therapy is discussed alternative CTX. Besides, now it is not clear, whether it is possible to prevent CRT CTX in long-term prospect. Thus, we aspired to estimate long-term clinical results in the big group of candidates to CTX which have received CRT-systems in Institute of Transplantation last years. In total 70 patients are operated, from them 5 patients in connection with condition deterioration heart transplantation has been executed. The received experience shows that at patients with left ventricular dissinhroniсity, which are in a waiting list to heart transplantation, application of method CRT may to prevent or delay necessity for heart transplantation, or to become a link as «bridge» to transplantation.

The study has shown that early diagnosis of the type and degree of immune disturbances in preparation for the operation and the first signs of multiorgan failure and septic complications in the postoperative period in cardiac surgery patients were the rationale for the earlier substitution immunocorrection by immunomodulators of cytokine nature and intravenous immunoglobulin. It allowed increasing the efficiency of the treatment of postoperative complications and lower mortality after operations with artificial and assist circulation.

The high mortality and morbidity of patients in terminal heart failure are a therapeutic challenge to modern medicine. Surgically, cardiac transplantation is an excellent treatment for many patients. However, lack of donors combined with an increasing number of patients has led to the search for other surgical strategies. Although other common surgical methods’, such as Batista operation or dynamic cardiac myoplasty has a favorable outcome in selected patients, those method’s is currently not recommended for treatment of heart failure because of high surgical failure rates. The present paper reviews some of the relevant literature regarding surgical left ventricular remodeling in heart failure.

One of the most popular methods of myocardial revascularization is the surgery of coronary arteries. Our research results revealed that adequate myocardial blood flow is provided by hemo-perfusion from the left ventricle to coronary arter-ies.

The paper describes a rare case of successful surgical treatment for mitral insufficiency due to heart valvular apparatus damage in the acute period of severe concomitant injury. Prosthetic mitral valve replacement was done on day 3 after injury. The patient was switched to spontaneous breathing on day 7 postoperatively and transferred to a surgical unit on day 11. Timely diagnosis, a comprehensive therapeutic approach, active surgical policy, the availability of up-to-date medical equipment, and the presence of high-quality physicians allowed severe cardiopulmonary insufficiency to be eliminated and the patient was discharged from hospital in a satisfactory state on day 25 after injury. Key words: severe concomitant injury, blunt chest injury, mitral valve damage, cardiac surgery.