The article presents a brief historical sketch on the development of cardiovascular surgery in Tomsk. The main achievements and clinical and research activities of the Department of Cardiovascular Surgery at Cardiology Research Institute are presented. The article is intended for cardiologists, internal medicine specialists, cardiac surgeons, and anesthesiologists.  

 The article discusses the modern clinical and fundamental aspects of the diagnosis and treatment of patients with ischemic cardiomyopathy (ICMP). The pathophysiological, morphological, and immunohistochemical aspects of left ventricular remodeling in ICMP are reviewed. A detailed description is given and the role of methods for assessment of myocardial functional reserves in ICMP is shown. The attention is focused on the methods of surgical treatment for ICMP. The article is intended for cardiologists, therapists, and cardiac surgeons. 

 It is assumed that the characteristics of stents including design of device may be predictors of adverse outcomes in carotid stenting. New stent designs enter the market and the stent manufacturers declare their ability to prevent periprocedural and postprocedural embolisms. The article provides an overview of clinical trials comparing the incidence rates of restenosis and ischemic complications in carotid artery stenting with various stent designs.  In theory, the closed-cell stents and doublelayer stents are superior to the  open-cell stents in preventing the postprocedural cerebral embolisms.  However, the clinical significance of this phenomenon has not been proven, and the data on the effect of various carotid stent types on the stenting results remain controversial. In many cases, the choice of stent depends on the anatomy of the target vessel. The results of new randomized controlled clinical trials may clarify the clinical relevance of various stent designs.  

 This literature review focuses on the damage to the heart in the presence of coronavirus disease (COVID-19). A point-of-care ultrasound (POCUS) protocol for patients with COVID-19 is presented. The advisability of assessing the mechanics of the left and right ventricles in COVID-19 patients is demonstrated. 

 The review analyzes the etiopathogenetic relationships of atrial fibrillation occurring in a structurally unchanged heart. The role of genetic, biological, and psychological prerequisites in the manifestation of the disease is presented. The importance of a comprehensive clinical analysis of atrial fibrillation as a key to its successful treatment is emphasized based on the principles of holism. 

The review analyzes data from domestic and foreign sources focusing on the current state of a common problem of obstructive sleep apnea syndrome. The article describes the main mechanisms of development and the possible relationships between the cardiovascular diseases, main risk factors in patients, and the sleep-related breathing disorder symptom-complex. The article provides the status update on the problem of continuous positive  airway pressure (CPAP) therapy consisting in creating positive airway pressure ventilation and provides rationale for studying its effects on cardiovascular risk factors in various subgroups of comorbid patients.

 Objective. The aim of study was to determine the tactics of choosing the optimal diameter of stent-graft in open hybrid repair of thoracic aorta based on the analysis of literature and the experience of Petrovsky National Research Centre of Surgery.

Material and Methods. A hybrid approach using the frozen elephant trunk (FET) technique is currently the safest and most optimal approach for thoracic aorta repair in case of extended pathology of all thoracic aorta segments, including the arch and descending thoracic aorta. Despite this technique has been used for over 15 years, there is no agreement in the current literature regarding the algorithm for choosing the optimal stent-graft diameter. A total of 135 FET procedures were performed at our centre from 2013 to 2020. The average age of patients was 52.8 ± 11.5 years. We analyzed our own experience and current literature to determine the optimal tactics for sizing the hybrid stent-graft for FET procedure.

Results. One of the main factors influencing the tactics of selecting the stent-graft diameter is the nature of pathology. The experience of most surgeons suggests that the size of stent-graft should not excessively exceed the diameter of a true canal in chronic dissection and the overall diameter in case of acute aortic dissection. In case of aneurysms, most authors use stent-grafts with the diameters exceeding distal landing zone diameter by 10–20%. Some authors consider it necessary to preoperatively measure the calculated diameter based on multislice computed tomography (CT) data, whereas many other authors prefer intraoperative measurements.

Conclusion. The use of a stent-graft, which is too large, can result in a high risk of new fenestration at the distal end level during the postoperative period and follow-up complications, whereas stent-graft, which is too small,  would not allow the adequate fit in the distal part. Therefore, the choice of optimal stent-graft size remains one of the key issues in hybrid thoracic aortic surgery. 

 Aim. To evaluate the effect of the duration of graft cold ischemia on the long-term prognosis of orthotopic heart transplantation (OHT).

Material and Methods. The study included 60 patients, who had receieved OHT in the Meshalkin National Medical Research Center since 2012. The influence of the duration of graft cold ischemia on the outcome of OHT in the long-term follow-up was evaluated. Survival, quality of life according to the SF-36 questionnaire, and parameters of cardiopulmonary exercise testing (CPET) were assessed.

Results. The duration of graft cold ischemia in the study group was 210 (175–340) minutes. The minimum duration time was 158 minutes; the maximum duration time was 430 minutes. Graft ischemia for more than 240 minutes was registered in 42% of cases. The survival rate was 87% in the long-term follow-up. Exercise capacity of patients corresponded to the level above average or high: peak oxygen consumption was 17 (14.7–21.0) mL/min/kg with a threshold load power of 100 (90–120) W. The levels of quality of life based on the SF-36 questionnaire scoring were 53 (50–55) points for the physical component of health and 52 (50–56) points for the psycho-emotional component of health. No significant associations of graft cold ischemia duration were found with the survival rate, quality of life, and CPET parameters.

Conclusion. The duration of graft cold ischemia did not show any negative effect on the results of OHT in the long-term followup. The study group of  recipients was characterized by high survival rate and high exercise capacity  in the long-term follow-up after OHT. 

 Material and Methods. A total of 29 patients with thoracoabdominal aortic pathology were operated in the Sukhanov Federal Center of Cardiovascular Surgery from January, 2016 to December, 2020. Among these patients, 19 patients had thoracoabdominal aortic aneurysm, six patients had type III aortic dissection, and four patients had corrected type I aortic dissection. The average age of patients was 58 ± 12 years and ranged from 29 to 73 years. To minimize the time of ischemia in visceral organs, we developed and implemented in clinical practice a new method for thoracoabdominal aorta reconstruction. The operations began with a distal bypass of the iliac arteries followed by a consecutive debranching of the left renal artery, superior mesenteric artery, and celiac trunk in the presence of natural blood circulation without clamping the aorta. The left ventricular bypass (pulmonary vein – branch of the prosthesis) was connected and aorta was clamped and opened only at the stage of prosthetic repair of the right renal arteries and intercostal arteries. The last step was a proximal anastomosis at the level of aortic isthmus.

Results. The rate of total postoperative mortality was 13.7% (four patients). Acute kidney injury requiring renal replacement therapy was detected in 10.3% of cases. Spinal complications such as temporal paraplegia were observed in two patients (6.9%). Respiratory failure was detected in four patients (13.7%). Bleeding requiring reoperation occurred in one patient
(3.4%).

Conclusion. The proposed new method for a surgical reconstruction of the thoracoabdominal aorta allowed to decrease aortic cross-clamp time, cardio-pulmonary bypass duration, and ischemia of the visceral organs and spinal cord, which directly contributed to the improvement of surgical treatment results in this category of severely ill patients. 

 Purpose. To determine the role of three-stage ultrasonic flowmetry of coronary bypass grafts for the purpose of early verification of technical errors during coronary bypass surgery.

Material and Methods. A total of 214 grafts were analyzed. The first stage of flowmetry was performed on the arrested heart with and without proximal loop test; the second stage was performed after weaning patient from the heart-lung machine; the third was done after inactivation of heparin until the closure of the chest wound.

Results. Among 214 grafts, flowmetry revealed insufficient blood flow in 4.2% (n = 9) of cases. Technical surgical errors in these shunts were confirmed during their revision. During the first measurement, non-optimal flowmetry parameters were observed in six cases (2.8%) including five cases (2.3%) where non-optimal blood flow was verified using a proximal loop test on the target coronary artery and one case (0.47%), which was not tested. Inadequate blood flow was found in one case (0.47%) during the second measurement, which confirmed technical errors in the proximal  anastomoses. Low blood flow parameters were found in two cases (0.93%) during the third measurement, which was associated with bending of the shunts due to their excessive length. All surgical errors were corrected immediately at the stage of their verification.

Conclusion. The strategy of three-stage flowmetry assessment makes it possible to ensure and document the adequate functionality of coronary bypass grafts at all stages of the operation. This allows for timely verification and immediate correction of any technical problems with coronary bypass grafts. 

 Objective. To analyze the early clinical results of frozen elephant trunk repair using the domestic hybrid stent-graft MedEng (Penza, Russia).

Material and Methods. From September, 2019 to September, 2020, a total of 12 patients underwent surgical reconstruction of the thoracic aorta with an implantation of the MedEng hybrid stent-graft. All interventions were performed under conditions of moderate hypothermia (25–28 °C) and antegrade unilateral cerebral perfusion through the brachiocephalic trunk.

Results. The technical success of the operation was achieved in 100% of cases. In the early postoperative period, there were no cases of acute cerebrovascular accidents, episodes of delirium, and paraplegia. There was no need for a resternotomy for bleeding. The extended respiratory support was required in two cases (16.7%). One patient (8.3%) required renal replacement therapy for acute renal injury. Hospital mortality rate reached 16.7%.

Conclusion. Surgical reconstruction of the thoracic aorta using the MedEng hybrid stent-graft was characterized by satisfactory clinical results in the early postoperative period. 

 Aim. The aim of the study was to analyze the effectiveness of  comprehensive lung protection in patients who underwent thoracic aortic surgery using circulatory arrest.

Material and Methods. A total of 57 patients undergoing operations for aneurysms and thoracic aortic dissection were enrolled in the prospective study. The patients were divided into two groups. The experimental group of patients (n = 27) underwent comprehensive lung protection with pulmonary artery perfusion and mechanical ventilation. Patients in the control group (n = 30) did not undergo comprehensive lung protection measures.

Results. The median duration of mechanical ventilation in the postoperative period was 14 hours in the experimental group and 23 hours in the control group of patients (p < 0.001). The incidence of analyzed pulmonary complications did not significantly differ between the groups during the early postoperative period. The number of pneumonia cases was 8 (14%) including 4 (15%) cases in the experimental group and 4 (13%) episodes in the control group (p = 0.87).

Conclusion. Selective pulmonary artery perfusion in combination with low tidal volume mechanical ventilation during operations on the thoracic aorta using circulatory arrest significantly reduced the duration of postoperative  mechanical ventilation.  

 Purpose. The purpose of this work was to study the midterm results after the implantation of a frame-mounted xenopericardial bioprosthesis into the aortic position with the easy-change system.

Material and Methods.A total of 166 patients with mean age of 69.5 years underwent aortic valve replacement by bioprosthesis with the easy-change system at Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences between October, 2016 and October, 2020. Preoperative aortic valve peak pressure gradient was 79.6 mmHg; the mean gradient was elevated up to 46.3 mmHg. Echocardiography studies of  aortic prosthesis and the left ventricle (LV) were performed in all patients by Vivid 7, GE, and IE 33 systems (Philips) preoperatively, before the discharge (day 14 after surgery on average), and 6–12 months after surgery.

Results. The control echocardiography studies, performed 6–12 months after surgery, showed that the hemodynamic characteristics of MedEng-BIO aortal bioprostheses were satisfactory. No statistically significant changes in the LV function were detected. The effective orifice areas of MedEng-BIO valves were 0.87 cm2 for the valve size 21, 1.1 cm2 for size 23, and 1.47 cm2 for size 25 mm. The peak pressure gradient decreased by 57.8% and the mean  gradient decreased by 51.9% two years after surgery.

Conclusion. Obtained data suggest that the implantation of MedEng-BIO aortal xenopericardial bioprosthesis into the aortic position lead to adequate correction of hemodynamic parameters. 

 Introduction. This article provides an overview of the problem of sinus node dysfunction after surgical treatment for longstanding persistent atrial fibrillation and the methods for diagnosing the initial states of cardiac activity and conduction.

Purpose. To identify predictors of initial sinus node dysfunction in patients with long-standing persistent atrial fibrillation.

Material and Methods: The study comprised a total of 65 patients with long-standing persistent atrial fibrillation complicating mitral valve disease. The state of autonomic nervous system was analyzed in patients with long-standing persistent atrial fibrillation. The associations between the analyzed data and electrophysiological parameters were investigated.

Results. The study allowed to identify the cutoff points for the contents of neurohumoral factors in the coronary circulation in patients with intact sinus node function and sinus node dysfunction. Prognostic criteria for the development of bradyarrhythmias in the postoperative period requiring pacemaker implantation were proposed and introduced into clinical practice. 

 A clinical case of successful surgical treatment in a patient with severe New York Heart Association (NYHA) functional class IIIIV heart failure, critical aortic stenosis, and extremely low left ventricular (LV) ejection fraction (EF) (16%) is presented. Aortic valve leaflet replacement was performed according to the Ozaki technique. The postoperative course was uneventful and the patient was discharged from hospital on day 11 after the operation. Clinical status and  echocardiographic data were assessed   at six months and one year after  surgery. The results of follow-up showed clinical improvement, a decrease in the  functional class of heart failure to NYHA I, restoration of global contractility of the right and left ventricles, a decrease in the severity of myocardial hypertrophy, and normal functioning of the autopericardial valve. 

 Septal myectomy is one of the most reliable methods of treating obstructive forms of hypertrophic cardiomyopathy. Most often, this operation is performed using a transaortic approach. Good immediate and long-term results of the operation are observed in more than 90% of cases. The limited visualization of interventricular septum through the aortic valve orifice is one of the reasons for myectomy ineffectiveness and some complications. This problem can be solved by using an extended transaortic approach to the interventricular septum, implying the intersection of the  fibrous ring of aortic valve.

Aim. To assess the effectiveness of extended transaortic approach to the interventricular septum by dissecting and restoring the fibrous ring of aortic valve in the commissural zone with subsequent assessment of its obturator function in the experiment.

Material and Methods. Cadaveric porcine hearts were used as experimental models. The aortic root was exposed; the coronary arteries were ligated. A total of 30 experimental dissection operations were performed, followed by a restoration of one commissure of the native aortic valve. The effect of investigated method for the commissural restoration of the diameter to the fibrous ring of the aortic valve was evaluated. The obturator function of the aortic valve after the restoration of annulus fibrosus was studied using a special device by performing water test with a maximum pressure of 200 mm Hg and regurgitant volume estimation.

Results. The aortic wall suture variant for the restoration of native aortic valve commissure was theoretically substantiated and studied in the experiment. When assessing the sufficiency of aortic valve after the dissection and restoration of commissure, no significant regurgitation on the aortic valve was observed in all cases. Direct measurements showed no significant decrease in the diameter of the annulus fibrosus of aortic valve after the reconstruction. The diameter of annulus fibrosus did not change
in 26 (87%) cases; the diameter after correction decreased by 1 mm in 4 (13%) cases (p = 0.570).

Conclusion. The experiment showed a possibility of the dissection and successful restoration of the annulus fibrosus of aortic valve in the commissural zone without disrupting its function and significantly changing the diameter of annulus fibrosus. This technique can become a key one in the development of both extended transaortic approach to the  interventricular septum and new options for the valve-sparing interventions at the aortic root. 

 Relevance. The frozen elephant trunk technique is recognized as a safe and effective method of surgical treatment for aneurysms and dissections of the thoracic aorta. The hybrid prostheses, available on the territory of the Russian Federation, are foreign-made, characterized by a high price, and, accordingly, unpopular. Due to unavailability of domestic hybrid prostheses in the home market, the development of domestic prosthesis is the key  point to further progress in aortic surgery in the Russian Federation.

Aim. The aim of the study was to evaluate the implantation characteristics of prototype hybrid thoracic aorta prosthesis in the pig model and the transformation of the prosthesis in the postoperative period.

Material and Methods. The hybrid prosthesis consists of two parts including the vascular part and a stent graft. The prosthesis is made of Dacron and Z-shaped nitinol wire stents. A Landrace pig aged six months with body weight of 120 kg underwent open reconstruction of the descending aorta through the left-sided lateral thoracotomy, under conditions of extracorporeal bypass with a roller pump from the left subclavian artery to the descending aorta. The animal was removed from the experiment after six months as planned. The macro- and microscopic evaluation of the removed implant was performed.

Results. The technical success of implantation of hybrid stent graft prototype was confirmed. Macroscopy of the stent graft, removed after six months, demonstrated a complete coverage of the neointimal inner surface of the synthetic prosthesis. The lumen of the product was patent. Histological examination revealed the neointima presented as a structured connective tissue without signs of inflammation. The luminal surface was lined with a single layer of evenly spaced endotheliocytes. The thickness of the neointima in the vascular part was significantly greater than in the stent-graft part (p = 0.0121).

Conclusion. The study demonstrated the technical feasibility of implantation of the prototype hybrid prosthesis developed by Angioline Research LLC. The effectiveness of sealing impregnation was confirmed by the absence of active signs of bleeding during the perioperative and early postoperative stages. The prosthesis demonstrated satisfactory bio- and  hemocompatibility.  

 Aim. The aim of this study was to develop and substantiate the possibility of using a buccal graft for arterioplasty of great vessels.

Material and Methods. The experiments were carried out using 48 animals including 45 mongrel rabbits weighing 5–7 kg and three dwarf pigs of the minipig breed weighing 35–45 kg. Vascular wall injury was modeled from the median laparotomy in all animals on the example of infrarenal abdominal aorta followed by plastic surgery of the vessel with a buccal graft. The animals were removed from the experiment in time-frame of up to 270 days.

Results. No stenoses, deformities, or aneurysmal extensions of the abdominal aorta were detected according to data of instrumental studies. The morphodynamic processes occurring in the buccal graft were characterized by the changes in the internal lining of autograft in the form of restructuring and acquisition of morphological traits of endothelial lining of the vessel and disappearance of the features intrinsic to the non-keratinized stratified squamous epithelium present in oral cavity.

Conclusions. The use of buccal graft as a material for arterioplasty of the great arteries demonstrated high efficiency in the follow-up period of up to 270 days. The use of this autograft was not associated with the development of arterial pseudoaneurysms in the arterioplasty area. 

 Aim. To evaluate the effectiveness of education in patients with heart valve prostheses using online technologies.

Material and Methods. Two groups of patients were examined. Patients in group 1 (n = 122) underwent the standard education program; patients in group 2 (n = 86) underwent distant education using the online technologies (video teleconferencing). The quality of life, adherence to treatment, and time in therapeutic range (TTR) of international normalized ratio (INR) were assessed.

Results. The quality of life and adherence to treatment did not differ between groups of patients at baseline. At nine-month follow-up, mental health improved by 30% in patients undergoing their education using the online technologies (p = 0.0040). Similarly, their adherence to treatment increased by 1.4 times (p = 0.0002) and TTR expanded by 20% (p = 0.014).

Conclusion. Patient education using the online technologies demonstrated its beneficial potential and represents the priority area in rehabilitation of patients after cardiac surgery. 

 An assessment of sustainability of urban socio-ecological system development may be carried out based on the analysis of indicators from the mortality and life expectancy tables that are widely used as the systemic indicators for the levels of territorial socio-economic development and the quality of life and health of the population.

Aim. The aim of the study was to perform the structural-dynamic analysis and assessment of survival rates and life expectancy in the population of Angarsk, a large industrial city in the Irkutsk region, for the post-Soviet  period.

Material and Methods. The short tables of population mortality rates for the period of 1990–2019 were calculated based on official data from the Federal State Statistic Service. The epidemiological analysis of survival rates, life expectancy, and its component composition was carried out according to the method of C. Chandra Sekar.

Results. The population aged under 29 years had the highest survival rates in 2016–2019 and the lowest survival rates in the first half of the 1990s. Older working age cohorts demonstrated the highest survival rates in 1990–1991 and the lowest survival rates in 2003–2004. Cohorts of retirement-age men showed the highest survival rates in the mid-2010s whereas female cohorts had the highest rates mostly in 2018–2019; the lowest survival rates were observed in 1994–1996. The life expectancy rates decreased in men of almost all age groups in 1995; the most significant decreases were observed in the groups of 30–54 year-old men and 40–54, 60–69, and 85–89 year-old women. The second pronounced decrease in the life expectancy rates occurred in 2005: the rates significantly decreased (by 6.8 years) in the cohorts of men aged 20–44 and 50–54 years. The most pronounced decreases in life expectancy of women were observed in age groups of 15–34, 40–44, 50–54, and 85–89 year-olds in 2001.

Conclusion. In the 1990s and during the first half of the 2000s, the systemic socio-economic crisis caused pronounced decreases in the rates of survival and life expectancy in various age groups of the population of Angarsk. The dynamics of studied demographic indicators in 2010–2019 was characterized by a steady linear growth. Further changes in the indicators will depend on the extent of impact of unfolding COVID-19 pandemic on the population and pandemic-triggered crisis-related phenomena in the socio-economic sphere.