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1. Efficacy of two-stage approach for interventional treatment of coexistent atrial fibrillation and typical atrial flutter for sinus rhythm maintenance in long-term: a prospective controlled clinical trial

Author

Igor A. Khamnagadaev, Igor A. Kovalev, Irina A. Bulavina, Mikhail L. Kokov, Aleksandr S. Zotov, Aleksandr V. Troitskiy, Igor I. Khamnagadaev, Maria A. Shkolnikova, and Leonid S. Kokov

Subjects
atrial fibrillation, typical atrial flutter, radiofrequency catheter ablation, cavotricuspid isthmus, pulmonary vein isolation, Medicine
Abstract

Background: Atrial fibrillation (AF) and coexistent typical atrial flutter (AFL) interventional treatment strategy remains unresolved in cardiology and cardiovascular surgery. Results of this approach remain suboptimal. There are several approaches to the interventional treatment of patients with coexistent AF and AFL: simultaneous pulmonary vein isolation (PVI) and cavotricuspid isthmus (CTI) radiofrequency catheter ablation (RFCA), PVI or CTI RFCA only and two-stage approach. To our knowledge, cumulative efficacy of two-stage approach has not been previously reported. The aim. This study aimed to evaluate the efficacy of two-stage approach for interventional treatment of coexistent AF and AFL for sinus rhythm maintenance in long-term. Methods: Patients (pts) (n=34) with AF and AFL aged 4182 years (11 women) were divided into two groups (1:1): One-stage Approach (group 1; n=17): PVI+СTI RFСA and Two-stage approach (group 2; n=17): first stage CTI RFCA (group 2.1); second stage PVI in case of AF recurrence after RFCA (group 2.2). Primary endpoint (PEP) was defined as any recurrent atrial tachyarrhythmia at the end of follow-up; group 2 events have been considered after PVI. Secondary endpoint (SEP) recurrent any atrial tachyarrhythmia in groups 1 and 2 after CTI RFCA in group 2. PEP and SEP were evaluated at the end of the blind period (3 months after procedure). Results: Registered recurrent atrial tachyarrhythmia in pts who reached PEP or SEP was AF. AFL has not been detected in any cases. PEP was noted in 8 (47.06%) pts in group 1 and 1 (5.88%) pts in group 2. Further, SEP was observed in 3 pts (17.65%) in group 1 and in 4 (23.53%) pts in group 2 (p=0.671). The probability of long-term maintenance of sinus rhythm was significantly higher in Two-stage approach than in One-stage approach (94.12% and 52.94%, respectively, p=0.001). Significant differences in procedure length and fluoroscopy time have been found. Those were longer in group 1 compared to group 2.1 (p 0.001) and in group 2.2 compared to group 2.1 (procedure duration p 0.001; fluoroscopy time p=0.013). No differences were noted in length of procedure and fluoroscopy time between groups 1 and 2.2 (p=0.374 and p=0.028, respectively). Conclusion: The two-stage approach for interventional treatment of coexistent AF and AFL results in better long-term arrhythmia-free survival than one-stage approach (94.12% and 52.94%, respectively, p=0.001). CTI RFCA alone in pts with coexistent AF and AFL cause 23.53% AF recurrence rate and associated with shorter procedure duration and fluoroscopy time compared to simultaneous PVI and CTI RFCA (p 0.001).

Published
2023
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2. Anticoagulation after typical atrial flutter ablation

Author

Irina A. Bulavina, Igor A. Khamnagadaev, Igor I. Khamnagadaev, Mikhail L. Kokov, Aleksandr V. Troitskiy, Aleksandr S. Zotov, Leonid S. Kokov, and Maria A. Shkolnikova

Subjects
anticoagulants, typical atrial flutter, atrial fibrillation, radiofrequency ablation, Medicine
Abstract

The specifics of the anticoagulant therapy after radiofrequency ablation of the cavotricuspid isthmus have not been sufficiently studied, therefore, the recommendations for prescribing the anticoagulant therapy usually do not distinguish between atrial flutter and atrial fibrillation. In contrast to the case of atrial fibrillation, the effectiveness of the interventional treatment for typical atrial flutter reaches 90%. This procedure may save the patient from a long-term anticoagulant therapy in the absence of recurrence of typical atrial flutter. The decision to stop the anticoagulant therapy after successful radiofrequency ablation of the cavotricuspid isthmus should take into account the potential induction of atrial fibrillation in patients undergoing the interventional treatment. In addition to the CHA2DS2-VASc scale, which characterizes the patient's comorbidity, it is important to take into account the echocardiographic morphofunctional criteria to assess the risk of atrial fibrillation. Currently, this protocol is not regulated in the clinical guidelines. The analysis of the literature data and the authors' own experience allow us to conclude that the optimal time for stopping the anticoagulant therapy is a relapse-free period of 34 months after the radiofrequency ablation of the cavotricuspid isthmus, since it is at this time that the effectiveness of the interventional treatment can be objectified.

Published
2023
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3. The first experience of a hybrid approach in the surgical treatment of atrial fibrillation

Author

Aleksandr S. Zotov, Igor A. Khamnagadaev, Emil R. Sakharov, Oleg O. Shelest, Leonid A. Belousov, Mikhail L. Kokov, Marina S. Michurova, Irina A. Bulavina, Robert I. Khabazov, Natalya G. Mokrysheva, and Aleksandr V. Troitskiy

Subjects
ablation technique, atrial fibrillation, surgery, thoracoscopic ablation, hybrid approach, Medicine
Abstract

Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with an increased risk of death, progression of heart failure, and the development of cardiogenic thromboemboli. Despite the significant success in the management of AF in the paroxysmal form, the results of the treatment for patients with persistent forms of AF remain unsatisfactory. Though the surgical approach provides higher rates of efficiency regarding the restoration of a sinus rhythm, transmural lesions are not always attainable, as a result, the rate of AF recurrence in the long-term period remains fairly high. It is also impossible to create ablative patterns to the mitral and tricuspid valves during thoracoscopic epicardial ablation, which can cause the development of recurrent AF, perimitral and typical atrial flutter. Therefore, the development of hybrid approaches combining the advantages of catheter and thoracoscopic techniques is an urgent task of contemporary surgical and interventional arrhythmology. Aims: to estimate the immediate results of a hybrid approach in the management of patients with persistent AF. Methods: We report the first experience of a hybrid treatment of patients with persistent AF. 6 patients aged 53-64 years (1 female, 5 males) were included in the study. At the first stage, thoracoscopic epicardial bipolar ablation was performed (modified GALAXY protocol); the second stage (in 3 to 6 months after the thoracoscopic stage) included an intracardiac electrophysiological study with three-dimensional endocardial mapping followed by endocardial ablation. Results: The thoracoscopic stage of the hybrid treatment included ablation according to the box lesion scheme using a bipolar irrigation equipment. No lethal outcomes and severe, life-threatening complications were registered. The duration of the inpatient period was 510 hospital-days. The 2nd stage of the hybrid treatment was limited to intracardiac electrophysiological examination only in 2 patients. In 4 patients, epicardial radiofrequency ablation was complemented by endocardial radiofrequency exposure. In 3 of the 4 patients who underwent endocardial radiofrequency ablation, catheter ablation of the mitral and cavotricuspid isthmus was required because of the induction of perimitral and typical flutter, respectively. After the 2nd stage of the hybrid treatment, at the time of discharge all the patients maintained a stable sinus rhythm. There were no severe complications or lethal outcomes. Conclusion: a hybrid approach in the AF management is a safe and effective method of treatment, which combines the advantages of minimally invasive surgery and endocardial intervention in patients with persistent AF. The technique is safe and has acceptable short-term results.

Published
2023
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4. Long-term results of two-stage ablation approach in coexistent atrial fibrillation and typical atrial flutter: prospective randomized study

Author

Igor A. Khamnagadaev, Igor A. Kovalev, Irina A. Bulavina, Mikhail L. Kokov, Alexander S. Zotov, Aleksandr V. Troitskiy, Igor I. Khamnagadaev, Maria A. Shkol'nikova, and Leonid S. Kokov

Subjects
General Earth and Planetary Sciences, General Environmental Science
Abstract

Background One of the most arrhythmias associated with atrial fibrillation (AF) is typical atrial flutter (AFL). The main methods of surgical treatment of these arrhythmias is catheter ablation. The problem of catheter ablation strategy for these coexistentarrhythmias is not solved. Purpose: To assess the effectiveness of long-term maintenance of sinus rhythm in a two-stage approach to the interventional treatment of atrial fibrillation associated with typical atrial flutter. Methods: The study included 34 patients aged 41-82 years with AF and coexistent typical AFL. Female 11 (32,35%), male 23 (67,35%). Randomization 1:1. Group 1 (n=17) has been performed radiofrequency ablation (RFA) of the cavotricuspid isthmus (CTI) with radiofrequency catheter isolation of the PV. Group 2 (n=17) has been performed only RFA of CTI. AF and AFL recurrences rate has been evaluated in both groups. Follow-up period 12 months. Results: Procedure duration and fluoroscopy time were less in group 2 that those in group 1. Extended intervention in group 1 was accompanied with complications in two cases. There were no significant differences in AF recurrence rate in both groups (p=0,43183). AFL recurrences has not been found in both groups. Conclusion: One stage ablation approach in AF patients with coexistent AFLassociated with increaseprocedure duration and fluoroscopy time. The frequency of AF recurrence in patients who underwent extended intervention (catheter isolation of the PV and RFA CTI) and in patients who underwent only the elimination of typical atrial flutter, was not statistically significantly different (p = 0.43183). In the presence of AF and typical atrial flutter, a two-stage approach to interventional treatment should be regarded as appropriate.

Published
2023

5. Safety and efficacy of percutaneous coronary interventions performed via anatomical snuffbox access in elderly patients

Author

K Berezhnoi, A Vanyukov, and L Kokov

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Funding Acknowledgements Type of funding sources: None. Background Radial artery thrombosis is a potential complication of transradial catheterization. For elderly patients greater attention should be paid to preserve radial arteries due to rather common comorbidities, such as renal failure and systemic atherosclerosis. Radial arteries in such cases may be required for hemodialysis, coronary artery bypass grafting and vascular reconstruction surgery. Presumably, the distal radial access can provide additional benefits in reducing the incidence of radial artery occlusion. Purpose To evaluate the radial artery thrombosis incidence and other complications in elderly patients undergone a percutaneous coronary intervention via anatomical snuffbox radial access. Methods This research (Jan 2018 – Aug 2020) was conducted as a single-center, prospective study in 141 patients over the age of 75 who had a percutaneous coronary intervention via the conventional radial access (n = 57) and radial access in the anatomic snuffbox (n = 84). The primary endpoints were: thrombosis; radial artery spasm; cannulation site hematoma with a diameter larger than 1 cm; crossover to the different access. We also evaluated the time for access establishment and total duration of the procedure. Results The groups had no significant differences in age and sex (the mean age was 81.9 ± 4.6 years, 67.9% females). The percutaneous coronary intervention was performed for STEMI in 73 (51.2%) patients, NSTEMI in 39 (27.7%) patients, or CAD in 35 (21.1%) patients. Two (2.4%) cases of vascular access crossover were reported in the anatomical snuffbox group compared with two (2.6%) cases in the conventional radial access group (p = 0.684). There were no statistically significant differences in the access time between the groups. It was 3.43 ± 0.78 min in the conventional radial access group versus 3.28 ± 0.76 min (p = 0.891) in the anatomical snuffbox access group. The total duration of percutaneous coronary intervention was also comparable in two groups (44.1 ± 15.6 min versus 45.9 ± 16.5 min, p = 0.936). The radial artery occlusion incidence was significantly lower in the anatomical snuffbox access group compared with the conventional radial access group (2 (2.4%) versus 8 (14.5%), respectively, p = 0.008). Also, radial artery spasm occurred significantly less frequently in the anatomical snuffbox access group compared with the conventional one (2 (2.4%) versus 7 (12.7%), respectively, p = 0.018). The incidence of cannulation site hematoma was significantly lower in the anatomical snuffbox access group than in the conventional access group (5 (6%) versus 10 (18.2%), respectively, p = 0.025). Conclusion Access via the anatomical snuffbox reduces the incidence of radial artery occlusion, cannulation-related spasm, and cannulation site hematoma. So it may be considered preferred to conventional radial access in elderly patients. However, randomized studies are needed to further investigate these results.

Published
2022

6. Poster session 2

Author

J. M. Perez-Pomares, A. Ruiz-Villalba, A. Ziogas, J. C. Segovia, M. Ehrbar, R. Munoz-Chapuli, A. De La Rosa, J. N. Dominguez, L. Hove-Madsen, B. Sankova, D. Sedmera, D. Franco, A. Aranega Jimenez, G. Babaeva, N. Chizh, S. Galchenko, B. Sandomirsky, M. Schwarzl, S. Seiler, P. Steendijk, S. Huber, H. Maechler, M. Truschnig-Wilders, B. Pieske, H. Post, S. Simrick, R. Kreutzer, C. Rao, C. M. Terracciano, P. Kirchhof, L. Fabritz, T. Brand, M. Theveniau-Ruissy, P. Parisot, A. Francou, E. Saint-Michel, K. Mesbah, R. G. Kelly, H.-T. Wu, S.-S. Sie, C.-Y. Chen, T.-C. Kuan, C. S. Lin, Z. Ismailoglu, M. Guven, A. Yakici, Y. Ata, S. Ozcan, E. Yildirim, Z. Ongen, V. Miroshnikova, E. Demina, T. Rodygina, P. Kurjanov, A. Denisenko, A. Schwarzman, A. Rubanenko, Y. Shchukin, A. Germanov, M. Goldbergova, J. Parenica, J. Lipkova, N. Pavek, P. Kala, M. Poloczek, A. Vasku, I. Parenicova, J. Spinar, C. Gambacciani, E. Chiavacci, M. Evangelista, N. Vesentini, C. Kusmic, L. Pitto, A. Chernova, S. U. Y. Nikulina, D. A. Arvanitis, I. Mourouzis, C. Pantos, E. G. Kranias, D. V. Cokkinos, D. Sanoudou, T. E. Vladimirskaya, I. A. Shved, S. G. Kryvorot, I. M. Schirmer, A. Appukuttan, L. Pott, K. Jaquet, Y. Ladilov, C. R. Archer, M. D. Bootman, H. L. Roderick, A. Fusco, D. Sorriento, G. Santulli, B. Trimarco, G. Iaccarino, M. Hagenmueller, J. Riffel, E. Bernhold, H. A. Katus, S. E. Hardt, A. Maqsood, M. Zi, S. Prehar, L. Neyses, S. Ray, D. Oceandy, N. Khatami, P. Wadowski, V. Wagh, J. Hescheler, A. Sachinidis, W. Mohl, B. Chaudhry, D. Burns, D. J. Henderson, N. A. M. Bax, M. H. Van Marion, B. Shah, M. J. Goumans, C. V. C. Bouten, D. W. J. Van Der Schaft, A. A. M. Van Oorschot, S. Maas, J. Braun, J. Van Tuyn, A. A. F. De Vries, A. C. Gittenberger-De Groot, S. Bageghni, M. J. Drinkhill, T. F. C. Batten, J. F. X. Ainscough, B. Onate, G. Vilahur, R. Ferrer-Lorente, J. Ybarra, A. Diez-Caballero, C. Ballesta-Lopez, F. Moscatiello, J. Herrero, L. Badimon, E. Martin-Rendon, D. M. Clifford, S. A. Fisher, S. J. Brusnkill, C. Doree, A. Mathur, M. Clarke, S. M. Watt, R. Hernandez-Vera, D. Kavanagh, A. I. Yemm, J. Frampton, N. Kalia, Y. Terajima, T. Shimizu, S. Tsuruyama, H. Ishii, H. Sekine, N. Hagiwara, T. Okano, K. R. Vrijsen, S. A. J. Chamuleau, J. P. G. Sluijter, P. F. M. Doevendans, R. Madonna, S. Delli Pizzi, L. Di Donato, A. Mariotti, L. Di Carlo, E. D'ugo, M. A. Teberino, A. Merla, A. T, R. De Caterina, L. Kolker, N. N. Ali, K. Maclellan, M. Moore, J. Wheeler, S. E. Harding, R. A. Fleck, J. M. Rowlinson, N. Kraenkel, R. Ascione, P. Madeddu, J. F. O'sullivan, A. L. Leblond, G. Kelly, A. H. S. Kumar, P. Metharom, C. K. Buneker, N. Alizadeh-Vikali, B. G. Hynes, R. O'connor, N. M. Caplice, M. Noseda, A. J. De Smith, T. Leja, P. H. Rao, F. Al-Beidh, M. S. Abreu Pavia, A. I. Blakemore, M. D. Schneider, K. Stathopoulou, F. Cuello, E. Ehler, R. S. Haworth, M. Avkiran, H. Morawietz, C. Eickholt, H. Langbein, M. Brux, C. Goettsch, W. Goettsch, A. Arsov, C. Brunssen, L. Mazilu, I. R. Parepa, A. I. Suceveanu, A. P. Suceveanu, F. S. De Man, C. Guignabert, L. Tu, M. L. Handoko, I. Schalij, E. Fadel, P. E. Postmus, A. Vonk-Noordegraaf, M. Humbert, S. Eddahibi, C. Del Giudice, A. Anastasio, L. Fazal, F. Azibani, N. Bihry, R. Merval, E. Polidano, J.-L. Samuel, C. Delcayre, Y. Zhang, Y. M. Mi, L. L. Ren, Y. P. Cheng, R. Guo, Y. Liu, Y. N. Jiang, A. D. Kokkinos, P. Tretjakovs, A. Jurka, I. Bormane, I. Mikelsone, D. Reihmane, K. Elksne, G. Krievina, J. Verbovenko, G. Bahs, N. Lopez-Andres, A. Rousseau, L. Calvier, R. Akhtar, C. Labat, K. Cruickshank, J. Diez, F. Zannad, P. Lacolley, P. Rossignol, K. Hamesch, P. Subramanian, X. Li, A. Thiemann, K. Heyll, K. Dembowsky, E. Chevalier, C. Weber, A. Schober, L. Yang, G. Kim, B. Gardner, J. Earley, M. Hofmann-Bowman, C.-F. Cheng, W.-S. Lian, H. Lin, N. J. Jinjolia, G. A. Abuladze, S. H. T. Tvalchrelidze, I. Khamnagadaev, M. Shkolnikova, L. Kokov, I. Miklashevich, I. Drozdov, I. Ilyich, B. O. Bingen, S. F. A. Askar, D. L. Ypey, A. Van Der Laarse, M. J. Schalij, D. A. Pijnappels, C. H. Roney, F. S. Ng, R. A. Chowdhury, E. T. Y. Chang, P. M. Patel, A. R. Lyon, J. H. Siggers, N. S. Peters, A. Obergrussberger, S. Stoelzle, A. Bruggemann, C. Haarmann, M. George, N. Fertig, D. Moreira, A. Souza, P. Valente, J. Kornej, C. Reihardt, J. Kosiuk, A. Arya, G. Hindricks, V. Adams, D. Husser, A. Bollmann, P. Camelliti, J. Dudhia, P. Dias, J. Cartledge, D. J. Connolly, M. Nobles, S. Sebastian, A. Tinker, A. Opel, H. Daimi, A. Haj Khelil, J. Be Chibani, A. Barana, I. Amoros, M. Gonzalez De La Fuente, R. Caballero, A. Aranega, A. Kelly, O. Bernus, O. J. Kemi, R. C. Myles, I. A. Ghouri, F. L. Burton, G. L. Smith, M. Del Lungo, L. Sartiani, V. Spinelli, M. Baruscotti, D. Difrancesco, A. Mugelli, E. Cerbai, A. M. Thomas, Q. Aziz, T. Khambra, J. M. A. Addlestone, E. J. Cartwright, R. Wilkinson, W. Song, S. Marston, A. Jacquet, N. M. Mougenot, A. J. Lipskaia, E. R. Paalberends, K. Stam, S. J. Van Dijk, M. Van Slegtenhorst, C. Dos Remedios, F. J. Ten Cate, M. Michels, H. W. M. Niessen, G. J. M. Stienen, J. Van Der Velden, M. I. Read, A. A. Andreianova, J. C. Harrison, C. S. Goulton, D. S. Kerr, I. A. Sammut, M. Wallner, D. Von Lewinski, D. Kindsvater, M. Saes, I. Morano, A. Muegge, B. Buyandelger, S. Kostin, S. Gunkel, J. Vouffo, K. Ng, J. Chen, M. Eilers, R. Isaacson, H. Milting, R. Knoell, M.-E. Cattin, C. Crocini, S. Schlossarek, S. Maron, A. Hansen, T. Eschenhagen, L. Carrier, G. Bonne, R. Coppini, C. Ferrantini, I. Olivotto, L. Belardinelli, C. Poggesi, M. C. Leung, A. E. Messer, O. Copeland, S. B. Marston, A. M. Mills, T. Collins, P. O'gara, T. Thum, K. Regalla, K. T. Macleod, T. Prodromakis, U. Chaudhry, A. Darzi, M. H. Yacoub, T. Athanasiou, A. Bogdanova, A. Makhro, M. Hoydal, T. O. Stolen, A. B. Johnssen, M. Alves, D. Catalucci, G. Condorelli, L. G. Koch, S. L. Britton, U. Wisloff, V. Bito, P. Claus, K. Vermeulen, C. Huysmans, R. Ventura-Clapier, K. R. Sipido, M. N. Seliuk, A. P. Burlaka, E. P. Sidorik, N. V. Khaitovych, M. M. Kozachok, V. S. Potaskalova, R. B. Driesen, D. T. Galan, D. De Paulis, T. Arnoux, S. Schaller, R. M. Pruss, D. M. Poitz, A. Augstein, R. C. Braun-Dullaeus, A. Schmeisser, R. H. Strasser, P. Micova, P. Balkova, M. Hlavackova, J. Zurmanova, D. Kasparova, F. Kolar, J. Neckar, F. Novak, O. Novakova, S. Pollard, M. Babba, A. Hussain, R. James, H. Maddock, A. S. Alshehri, G. F. Baxter, B. Dietel, R. Altendorf, W. G. Daniel, R. Kollmar, C. D. Garlichs, R. Sirohi, N. Roberts, D. Lawrence, A. Sheikh, S. Kolvekar, J. Yap, M. Arend, G. Walkinshaw, D. J. Hausenloy, D. M. Yellon, A. Posa, R. Szabo, Z. Szalai, P. Szablics, M. A. Berko, K. Orban, Z. S. Murlasits, L. Balogh, C. Varga, H. C. Ku, M. J. Su, R.-M. Chreih, C. Ginghina, D. Deleanu, A. L. B. J. Ferreira, A. Belal, M. A. Ali, X. Fan, A. Holt, R. Campbell, R. Schulz, C. Bonanad, V. Bodi, J. Sanchis, J. M. Morales, V. Marrachelli, J. Nunez, M. J. Forteza, F. Chaustre, C. Gomez, F. J. Chorro, T. Csont, V. Fekete, Z. Murlasits, E. Aypar, P. Bencsik, M. Sarkozy, Z. V. Varga, P. Ferdinandy, G. D. Duerr, M. Zoerlein, D. Dewald, B. Mesenholl, P. Schneider, A. Ghanem, S. Rittling, A. Welz, O. Dewald, E. Becker, C. Peigney, C. Bouleti, A. Galaup, C. Monnot, B. Ghaleh, S. Germain, A. Timmermans, A. Ginion, C. De Meester, K. Sakamoto, J.-L. Vanoverschelde, S. Horman, C. Beauloye, L. Bertrand, N. Maroz-Vadalazhskaya, E. Drozd, L. Kukharenko, I. Russkich, D. Krachak, Y. Seljun, Y. Ostrovski, A.-C. Martin, B. Le Bonniec, T. Lecompte, B. Dizier, J. Emmerich, A.-M. Fischer, C.-M. Samama, A. Godier, S. Mogensen, E. M. Furchtbauer, C. Aalkjaer, W. L. Choong, A. Jovanovic, F. Khan, J. M. Daniel, J. M. Dutzmann, R. Widmer-Teske, D. Guenduez, D. Sedding, M. M. Castro, J. J. C. Cena, W. J. C. Cho, G. G. Goobie, M. P. W. Walsh, R. S. Schulz, J. Dutzmann, K. T. Preissner, W. Sones, M. Kotlikoff, K. Serizawa, K. Yogo, K. Aizawa, M. Hirata, Y. Tashiro, N. Ishizuka, A. Varela, M. Katsiboulas, D. Tousoulis, T. G. Papaioannou, S. Vaina, C. H. Davos, C. Piperi, C. Stefanadis, E. K. Basdra, A. G. Papavassiliou, C. Hermenegildo, M. Lazaro-Franco, A. Sobrino, C. Bueno-Beti, N. Martinez-Gil, T. Walther, C. Peiro, C. F. Sanchez-Ferrer, S. Novella, M. Ciccarelli, A. Franco, G. W. Dorn, P. Cseplo, O. Torok, Z. S. Springo, Z. Vamos, D. Kosa, J. Hamar, A. Koller, K. J. Bubb, A. Ahluwalia, E. L. Stepien, A. Gruca, J. Grzybowska, J. Goralska, A. Dembinska-Kiec, J. Stolinski, L. Partyka, H. Zhang, D. Sweeney, G. N. Thomas, P. V. Fish, D. P. Taggart, S. Cioffi, M. Bilio, S. Martucciello, E. Illingworth, A. Caporali, S. Shantikumar, M. Marchetti, F. Martelli, C. Emanueli, M. Meloni, A. Al Haj Zen, G. Sala-Newby, S. Del Turco, C. Saponaro, B. Dario, S. Sartini, A. Menciassi, P. Dario, C. La Motta, G. Basta, V. Santiemma, C. Bertone, F. Rossi, E. Michelon, M. J. Bianco, A. Castelli, D. I. Shin, K. B. Seung, S. M. Seo, H. J. Park, P. J. Kim, S. H. Baek, Y. S. Choi, S. H. Her, D. B. Kim, J. M. Lee, C. S. Park, S. Rocchiccioli, A. Cecchettini, G. Pelosi, L. Citti, O. Parodi, M. G. Trivella, D. Michel-Monigadon, F. Burger, S. Dunoyer-Geindre, G. Pelli, B. Cravatt, S. Steffens, A. Didangelos, U. Mayr, X. Yin, C. Stegemann, J. Shalhoub, A. H. Davies, C. Monaco, M. Mayr, S. Lypovetska, S. Grytsenko, I. U. Njerve, A. A. Pettersen, T. B. Opstad, V. Bratseth, H. Arnesen, I. Seljeflot, I. E. Dumitriu, P. Baruah, R. F. Antunes, J. C. Kaski, I. Trapero, I. Benet, C. Alguero, F. J. Chaustre, A. Mangold, S. Puthenkalam, K. Distelmaier, C. Adlbrecht, I. M. Lang, T. Koizumi, I. Inoue, N. Komiyama, S. Nishimura, O. N. Korneeva, O. M. Drapkina, L. Fornai, A. Angelini, A. Kiss, F. Giskes, G. Eijkel, M. Fedrigo, M. L. Valente, G. Thiene, R. M. A. Heeren, T. Padro, L. Casani, R. Suades, B. Bertoni, R. Carminati, V. Carlini, L. Pettinari, C. Martinelli, N. Gagliano, G. Noppe, P. Buchlin, N. Marquet, N. Baeyens, N. Morel, A. Baysa, J. Sagave, C. P. Dahl, L. Gullestad, A. Carpi, F. Di Lisa, M. Giorgio, J. Vaage, G. Valen, E. Vafiadaki, V. Papalouka, G. Terzis, K. Spengos, P. Manta, C. Gales, G. Genet, E. Dague, O. Cazorla, B. Payre, C. Mias, A. Ouille, A. Lacampagne, A. Pathak, J. M. Senard, M. Abonnenc, P. Da Costa Martins, S. Srivastava, M. Gautel, L. De Windt, L. Comelli, C. Lande, N. Ucciferri, L. Ikonen, H. Vuorenpaa, K. Kujala, J.-R. Sarkanen, T. Heinonen, T. Ylikomi, K. Aalto-Setala, H. Capros, N. Sprincean, N. Usurelu, V. Egorov, N. Stratu, V. Matchkov, E. Bouzinova, N. Moeller-Nielsen, O. Wiborg, P. S. Gutierrez, R. Aparecida-Silva, L. F. Borges, L. F. P. Moreira, R. R. Dias, J. Kalil, N. A. G. Stolf, W. Zhou, K. Suntharalingam, N. Brand, R. Vilar Compte, L. Ying, K. Bicknell, A. Dannoura, P. Dash, G. Brooks, I. Tsimafeyeu, Y. Tishova, N. Wynn, I. P. Oyeyipo, L. A. Olatunji, L. Maegdefessel, J. Azuma, R. Toh, U. Raaz, D. R. Merk, A. Deng, J. M. Spin, P. S. Tsao, L. Tedeschi, M. Taranta, I. Naldi, S. Grimaldi, C. Cinti, M. Bousquenaud, F. Maskali, S. Poussier, P. Y. Marie, H. Boutley, G. Karcher, D. R. Wagner, Y. Devaux, I. Torre, S. Psilodimitrakopoulos, I. Iruretagoiena, A. Gonzalez-Tendero, D. Artigas, P. Loza-Alvarez, E. Gratacos, I. Amat-Roldan, L. Murray, D. M. Carberry, P. Dunton, M. J. Miles, M.-S. Suleiman, K. Kanesalingam, R. Taylor, C. N. Mc Collum, A. Parniczky, M. Solymar, A. Porpaczy, A. Miseta, Z. S. Lenkey, S. Szabados, A. Cziraki, J. Garai, I. Myloslavska, S. M. Menazza, M. C. Canton, F. D. L. Di Lisa, S. H. V. Oliveira, C. A. S. Morais, M. R. Miranda, T. T. Oliveira, M. R. A. Lamego, L. M. Lima, N. S. Goncharova, A. V. Naymushin, A. V. Kazimli, O. M. Moiseeva, M. G. Carvalho, A. P. Sabino, A. P. L. Mota, M. O. Sousa, A. Niessner, B. Richter, P. J. Hohensinner, K. Rychli, G. Zorn, R. Berger, D. Moertl, R. Pacher, J. Wojta, M. Huelsmann, G. Kukharchik, N. Nesterova, A. Pavlova, L. Gaykovaya, N. Krapivka, I. Konstantinova, L. Sichinava, S. Prapa, K. P. Mccarthy, P. J. Kilner, X. Y. Xu, M. R. Johnson, S. Y. Ho, M. A. Gatzoulis, E. G. Stoupel, R. Garcia, D. Merino, C. Montalvo, M. A. Hurle, J. F. Nistal, A. V. Villar, A. Perez-Moreno, R. Gilabert, and E. Ros

Subjects
medicine.medical_specialty, Endocrinology, Physiology, Activator (genetics), Chemistry, Physiology (medical), Internal medicine, medicine, AMPK, Myocyte, Long-term potentiation, Metabolism, Cardiology and Cardiovascular Medicine
Published
2012

8. Evaluation of the immunomodulatory activity of Aronia in combination with apple pectin in patients with breast cancer undergoing postoperative radiation therapy

Author

Mariana P, Yaneva, Albena D, Botushanova, Liubomir A, Grigorov, Julii L, Kokov, Elena P, Todorova, and Maria G, Krachanova

Subjects
Adult, Adjuvants, Immunologic, T-Lymphocyte Subsets, Malus, Humans, Pectins, Breast Neoplasms, Female, Middle Aged, Combined Modality Therapy, Rosaceae, Aged, Phytotherapy
Abstract

The aim of the present study was to evaluate the immunomodulatory activity of Aronia in combination with apple pectin in patients with breast cancer in the course of postoperative radiation therapy. Monoclonal antibodies were used to assay specific T cell subsets. Tests were performed prior to and after 26 and 50 Gy of irradiation. The study comprised 42 women (19 to 65 years of age) receiving 15 g of apple pectin in combination with 20 ml of Aronia concentrate (Bioactive Substance Laboratory--Plovdiv) twice daily during postoperative irradiation. Irradiation was performed by a 60Co-Rokus according to individualized treatment schedules. The following T lymphocyte populations were tested--CD3 total T lymphocytes, CD4 helper and inducer T cells, CD8 suppressor and cytotoxic T cells and NK cells. The levels of the polypeptide tissue antigen (TPA), an oncofetal protein, were tested in parallel. The TPA was used to assess treatment outcome in our patients. A group of 25 age-matched women with breast cancer served as controls. Immune status analysis of controls was performed prior to and following postoperative radiation. A total of 880 serum samples were tested. Assays of immunity parameters in the patients receiving Aronia in combination with apple pectin showed that CD4 and CD8 T cell counts increased significantly (P0.01 and P0.05 respectively). In control patients CD3 T cell levels lowered, the other T cell levels remained unchanged. Initially the number of NK cells was increased in both groups of patients. It remained constant throughout the course of the study. The normal levels of TPA in both groups of patients indicated a good treatment outcome due to the adequacy of surgery and in combination with radiation therapy.

Published
2002

9. Combined interventional cardiac procedures in pediatric patients with congenital heart abnormalities and cardiac arrhythmias

Author

S. Termosesov, L. Kokov, I. Khamnagadaev, I M Miklashevich, I. Ilich, and Maria Shkolnikova

Subjects
Bradycardia, medicine.medical_specialty, Lung, business.industry, Radiofrequency ablation, Heart malformation, Cardiac arrhythmia, law.invention, medicine.anatomical_structure, law, Internal medicine, Anesthesia, Ductus arteriosus, Cardiac procedures, Cardiology, medicine, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Atrial tachycardia
Published
2013

10. Effects of complete revascularization on long-term treatment outcomes in patients with multivessel coronary artery disease over 80 years of age admitted for acute coronary syndrome.

Author

Berezhnoi K, Kokov L, and Vanyukov A

Abstract

Background: The effects of complete revascularization (CR) on long-term treatment outcomes in patients over 80 years of age with acute coronary syndrome (ACS) and multivessel coronary artery disease (MVD) have not been sufficiently investigated., Methods: In this study, we analyzed data obtained in 305 patients over 80 years of age with MVD who were admitted in the period from January 2014 to August 2017 for ACS. The patients were divided into two groups. CR was performed in 131 patients, and 174 subjects had an intervention on the symptomatic artery only [incomplete revascularization (ICR)]. The primary endpoint was one-year occurrence of the major adverse cardiac events (MACE) including death, non-fatal myocardial infarction, stroke. We also recorded cases of repeat coronary artery intervention, major bleeding events, contrast-induced nephropathy and stent thrombosis that occurred within a period of 1 year., Results: The MACE rate in patients undergoing CR was significantly lower during the 12-month observation period. No statistically significant differences were observed in the rates of repeat coronary artery intervention, bleeding events, contrast-induced nephropathy, and stent thrombosis., Conclusions: CR performed in patients over 80 years of age with ACS due to MVD decreases the incidence of MACE without increasing the risk of periprocedural complications., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Published
2019
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12. Poly(HEMA)--based embolic material in endovascular surgery of liver.

Author

Horák D, Sitnikov A, Guseinov E, Kokov L, Titova M, Adamyan A, and Gumargalieva K

Subjects
Adolescent, Adult, Aged, Blood Cell Count, Blood Loss, Surgical prevention & control, Female, Hemolysis, Humans, Hydrogels adverse effects, Hydrogels chemistry, In Vitro Techniques, Liver Neoplasms therapy, Male, Middle Aged, Polyamines adverse effects, Polyhydroxyethyl Methacrylate adverse effects, Remission Induction, Thrombocytopenia chemically induced, Thrombosis etiology, Embolization, Therapeutic methods, Hemangioma therapy, Liver Diseases therapy, Materials Testing, Polyamines chemistry, Polyhydroxyethyl Methacrylate analogs & derivatives, Polyhydroxyethyl Methacrylate chemistry
Abstract

Physico-chemical and medico-biological methods, including hematology and cytology, were used in an evaluation of properties of poly(2-hydroxyethyl methacrylate) (poly(HEMA))-based embolic material indicated in the occlusion of branches of hepatic artery of patients with focal alterations of the liver. The elastographic method helped in predicting mechanical properties of the hydrogel material. Poly(HEMA) was mechanically stable for endovascular applications, exhibited no significant loss in elasticity and possessed consistency resembling the soft tissue of the organism. Analysis of blood in contact with poly(HEMA) hydrogel provided a control of its biological inertness. Recently, 315 patients with focal alterations of the liver, including hemobilic hemorrhages and both primary and metastatic tumors, underwent endovascular occlusion with poly(HEMA) emboli as a pre-surgical step or as a simple occlusive measure. Compared with a direct operation on hemangiomatous injuries in the liver without endovascular occlusion, embolization with poly(HEMA) allowed to reduce 2.5-3 times bleeding in the operational zone. At the same time, the poly(HEMA) embolic material induced activation of general hemostatic reaction in the postembolization period.

Published
2002

13. Targeted chemoembolization of tumors with poly(2-hydroxyethyl methacrylate) particles.

Author

Horák D, Guseinov E, Vishnevskii V, Adamyan A, Kokov L, Tsvirkun V, Tchjao A, Titova M, Skuba N, Trostenyuk N, and Gumargalieva K

Subjects
Anticoagulants therapeutic use, Carcinoid Tumor mortality, Carcinoid Tumor secondary, Carcinoid Tumor therapy, Colonic Neoplasms mortality, Colonic Neoplasms therapy, Dalteparin therapeutic use, Doxorubicin pharmacokinetics, Hemangiosarcoma mortality, Hemangiosarcoma secondary, Hemangiosarcoma therapy, Heparin, Low-Molecular-Weight therapeutic use, Humans, Liver Neoplasms mortality, Liver Neoplasms pathology, Rectal Neoplasms mortality, Rectal Neoplasms therapy, Survival Rate, Chemoembolization, Therapeutic methods, Doxorubicin administration & dosage, Fluorouracil administration & dosage, Liver Neoplasms secondary, Liver Neoplasms therapy, Polyamines, Polyhydroxyethyl Methacrylate analogs & derivatives
Abstract

Thirty-four patients suffering from various kinds of tumors, including metastasis, were treated by selective embolization with both spherical and cylindrical poly(2-hydroxyethyl methacrylate) [poly(HEMA)] particles and topical chemotherapy. Treatment of a patient with carcinoid metastases in the liver is discussed. Immediately after embolization, 5-fluorouracil, and later, doxorubicin and Lipiodol, were selectively infused into the tumorous tissue for approximately 1 week. Patient received four cycles of this infusion. Chemoembolization proceeded against the background of anticoagulant therapy using small doses of heparin or its low-molecular-weight analogue, dalteparin. This was followed by transcutaneous transhepatic portography and embolization. Finally, the tumor-feeding artery and portal vein were sealed by a hydrogel. After 1.5 months, the affected liver lobe was resected. Although 4 years from the beginning of treatment, the patient is still alive. Embolization with poly(HEMA) hydrogel particles in conjunction with an anticancer drug infusion via catheter is recommended as an efficient method of tumor treatment. The therapeutic effect has been shown to be a function of ischemia and slow local infusion of drug into the tumor, and systemic drug levels can be kept low., (Copyright 2000 John Wiley & Sons, Inc.)

Published
2000
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14. Endovascular occlusion of branches of hepatic artery with poly(2-hydroxyethyl methacrylate) emboli as a single occlusive measure in hepatology.

Author

Guseinov E, Horák D, Titova M, Adamyan A, Kokov L, Kubishkin V, Vishnevskii V, Skuba N, and Trostenyuk N

Subjects
Abdominal Neoplasms complications, Adolescent, Adult, Aged, Arterial Occlusive Diseases etiology, Carcinoid Tumor complications, Carcinoid Tumor secondary, Carcinoma, Hepatocellular complications, Carcinoma, Hepatocellular secondary, Carcinoma, Hepatocellular therapy, Chemoembolization, Therapeutic, Fluorouracil administration & dosage, Hemangioma complications, Humans, Hydrogel, Polyethylene Glycol Dimethacrylate, Liver Neoplasms secondary, Liver Neoplasms therapy, Middle Aged, Pancreatic Neoplasms complications, Pancreatic Neoplasms pathology, Arterial Occlusive Diseases therapy, Embolization, Therapeutic methods, Hepatic Artery, Liver Neoplasms complications, Polyamines, Polyhydroxyethyl Methacrylate analogs & derivatives
Published
2000

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