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Aim. To assess the changes in endothelial dysfunction in patients undergoing cardiac surgery with minimally invasive extracorporeal circulation (MiECC). Methods. The study included 50 patients who were undergoing coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). The patients were divided assigned to either a minimally invasive cardiopulmonary bypass system (group 1, n=15) or standard extracorporeal circuit (group 2, n=35). Changes in the laboratory parameters were assessed 5 times: before the operation, 5 minutes after protamine sulfate administration, 12 hours after the operation, 7 days after the patient's discharged from the hospital and one month after the operation. The activity of von Willebrand factor, factor VIII, and the number of activated platelets were examined in all patients in venous blood. Results. After protamine sulfate administration, the activity of von Willebrand factor was increased to 164% in the group 1, and up to 193% in the group 2, with a tendency to increase the indicator after 12 hours. The peak of endothelial dysfunction, with the growth of von Willebrand factor and factor VIII, occurs on the 7th day after the operation. In patients of the group with MiECC, von Willebrand factor activity was decreased at the hospital discharge and returned to normal in 1 month. The number of activated platelets increases mainly in group 2 (6% versus 4% in group 1, p=0.29). The expression of P-selectin was significantly higher in group 2 at the hospital discharge (5.5% versus 3.1% in group 1, p 0.001), and in 1 month (4.5% versus 2.3% in group 1, p 0.001). Conclusion. In patients with minimally invasive cardiopulmonary bypass, platelet activation decreases, endothelial dysfunction, accompanied by an increase in the von Willebrand factor and factor VIII activity, is less pronounced; the seventh day after surgery is a period of the high risk of thrombogenic complications.

Aim. To assess the incidence of unfavorable in-hospital outcomes (fatal and non-fatal complications) following coronary artery bypass grafting (CABG), depending on the age of the patient and the presence of comorbidities. Material and methods . In the period from 2011 to 2012 we included in the study 680 patients for elective CABG (single-site, register, prospective study). Combined clinical endpoint (CCE) included the presence of myocardial infarction (MI), multiple organ dysfunction syndrome (MODS), heart failure (HF), new atrial fibrillation (AF) after CABG, repeat mediastinotomy (of one or more complications) and/or deaths. Results. There is a high prevalence of comorbidities among the patients referred to CABG. One hundred fifty two (22,40%) patients reached the CCEs. The highest rate of the CCEs was recorded in the group of patients undergoing concomitant CABG, compared to the group of patients after isolated CABG. Patients’ age was associated with the development of CCE in the early postoperative period. The highest number of CCEs was registered in the group of patients with combined surgical interventions. Conclusion . Factors associated with the probable development of unfavorable nosocomial outcomes either fatal or non-fatal following is the age of patients 61 years and older, concomitant CABG, and the extracorporeal circulation.

Post-hypoxic encephalopathy is a brain damage manifested by neurological, neuropsychiatric, and mental disorders, which is caused by a reduction in cerebral blood flow and by a resultant effect of an episode of hypoxia of various etiology and duration. This complication is most characteristic of patients who have undergone cardiac surgery in view of the high prevalence and severity of clinical manifestations, worse quality of life, the longer length of hospital stay, and the higher cost of treatment and rehabilitation. To determine the individual management tactics for such patients, combining both successful surgical treatment, by reducing perioperative stress, and prevention of cerebral complications, it is necessary to analyze the patterns of their development. The role of pathophysiological risk factors, including preoperative, perioperative and postoperative ones, for posthypoxic encephalopathy, is considered. Its preoperative risk factors include age, gender, concomitant diseases, education level, and cognitive functions before surgery, cardiac morphofunctional changes, and depressive disorders. There are surgery-related (type and duration of anesthesia, operating-suite temperatures, and hyperglycemia) and postoperative (pain syndrome after surgical intervention, sleep disorders, and the environment) risk factors. Emphasis is placed on the technical characteristics of on-pump operations, among which there are cerebral hypoperfusion, microembolism, non-pulsatile flow, and duration of extracorporeal circulation. Classifications of cerebral complications are presented. Different types of brain dysfunction are analyzed to assess their incidence rates, clinical features, and dynamics in the postoperative period.

Most in-hospital strokes occur after cardiac or vascular surgeries, during invasive therapeutic and diagnostic procedures on the heart and blood vessels. The incidence of stroke after coronary artery bypass grafting is about 2%; that after valve surgery and percutaneous cardiac intervention is 1 to 10% and 0.03 to 0.4%, respectively. Objective: to analyze the risk factors, pathogenetic, clinical, and laboratory characteristics of stroke after cardiac surgery and invasive interventions. Patients and methods. The investigation enrolled in-hospital stroke patients who had undergone invasive cardiac or open-heart surgery in Sverdlovsk Regional Hospital One in 2011 to 2015. A comparison group consisted of 196 patients with community-acquired stroke. Results. Stroke after cardiac surgical or endovascular interventions developed in 88 patients (44.9% of all the in-hospital stroke cases registered in the above period). The incidence of stroke after open-heart surgery was 0.97% (63 cases), depending on the type of surgery. Stroke following open-heart surgery was recorded after combined correction (1.4%), two-valve replacement surgery (1.98%), aortic and mammary coronary artery bypass grafting under extracorporeal circulation (1%), and beating heart bypass surgery (0.25%). The severity of stroke and the degree of disability did not differ in patients after invasive cardiac and open-heart surgeries. Conclusion. Patients who have undergone cardiac surgery and are at high risk for in-hospital stroke should be followed up and should receive preventive treatment for stroke in the early postoperative period.

Aim. The study was designed to assess the efficiency of exogenous nitric oxide supply to the extracorporeal circulation line for myocardial protection against ischemic-reperfusion injury in acute myocardial infarction simulation during cardiopulmonary bypass (CPB) in the experiment. Methods. Acute ischemia was simulated in rabbits (n = 20) with subsequent myocardial reperfusion. All animals were anesthetized and mechanically ventilated through a nasotracheal tube. The experiment included occlusion of the left coronary artery by its clamping with a ligature for 45 min with subsequent reperfusion for 120 min during CPB. All animals were divided into 2 equal groups: 10 rabbits received nitric oxide supply to the extracorporeal circulation line in a dose of 40 ppm throughout the entire CPB period (the main group); 10 rabbits made up the control group. The ratio of the infarction area to the risk area was determined, and the quantity and nature of ventricular arrhythmias were accessed. Results. It was established that nitric oxide supply through the extracorporeal circulation line during CPB had a pronounced infarct-limiting effect, the infarct area to the risk area ratio decreased by 15% as compared to the control group, р = 0.0002. There was also a significant antiarrhythmic effect. A lesser quantity of polytopic and polymorphic ventricular extrasystoles were observed in the main group during periods of ischemia and reperfusion (p = 0.003 and p = 0.012). A statistically significant decrease in the venoarterial gradient of the partial pressure of carbon dioxide in the main group was associated with an increase in the urine flow rate amounting to 1.4 [1.3; 1.5] ml/kg/h in the main group and 1.15 [1; 1.3] ml/kg/h in the control group, p = 0.013. Conclusion. The data obtained during the experiment demonstrate the presence of cardioprotective properties of nitric oxide delivered to the extracorporeal circulation line when simulating myocardial ischemic-reperfusion injury. These properties manifest themselves as a 15% decrease of the infarction zone-risk area ratio, a fewer number of arrhythmias and improvement of tissue perfusion during CPB. Intraoperative myocardial protection by nitric oxide in patients operated with CPB should be the object of further clinical research.Received 19 June 2017. Revised 9 October 2017. Accepted 15 October 2017.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions: All the authors comply with 4 ICMJE authorship criteria and contributed equally at every stage of the study.Acknowledgement: The authors express their gratitude to Ekaterina S. Tokareva and Aleksandra A. Nenakhova for support in preparation of the article.

To analyze the factors contributing to the increased risk of persistent postoperative cognitive dysfunction (POCD) in patients undergoing coronary artery bypass surgery (CABS) under extracorporeal circulation (EC).257 male patients aged 45 to 69 years with coronary heart disease (CHD) undergoing elective CABS under EC were examined. In addition to conventional clinical examination, all the patients underwent neuropsychological testing 3-5 days before, 7-14 days and 1 year after CABS. Persistent POCD was diagnosed if there was a 20% decline in cognitive domains at 1-year postoperatively versus preoperatively in 20% of the tests of an entire neuropsychological battery. Binary logistic regression analysis was applied to identify the factors supposedly increasing the risk of persistent POCD.It was found that high baseline cognitive status, early POCD after CABG under EC, low adherence to the prescribed treatment regimen, as well as progressive carotid artery (CA) stenosis could predict with a high (85%) probability that persistent POCD might develop at 1 year after surgery.The findings are suggestive of the multifactorial origin of persistent POCD, a significant role in the development of which is played by not only the preoperative cognitive status, but also by postoperative factors, such as the degree of adherence to the prescribed treatment regimen, early POCD, and progressive CA stenosis.Цель исследования. Анализ факторов, способствующих увеличению риска развития стойкой послеоперационной когнитивной дисфункции (ПОКД) у пациентов, перенесших операцию коронарного шунтирования (КШ) в условиях искусственного кровообращения (ИК). Материалы и методы. Обследовали 257 пациентов мужского пола в возрасте от 45 до 69 лет с ишемической болезнью сердца (ИБС), которым выполнено плановое КШ в условиях ИК. Всем пациентам, помимо стандартного клинического обследования, проводили нейрофизиологическое тестирование за 3-5 дней до операции, на 7-14-е сутки и через год после КШ. Наличие стойкой ПОКД диагностировали у пациентов при наличии 20% снижения когнитивных показателей через 1 год после операции по сравнению с дооперационными 20% нейропсихологических тестов. Для выявления факторов, предположительно влияющих на риск развития стойкой ПОКД, применяли регрессионный анализ в виде бинарной логистической регрессии. Результаты. Установлено, что при наличии у пациентов исходно высокого когнитивного статуса, развитии ПОКД в раннем послеоперационном периоде КШ, выполненного в условиях ИК, низкой степени соблюдения схемы назначенного лечения и прогрессировании стенозов сонных артерий (СА) через 1 год после операции можно с высокой долей вероятности (85%) прогнозировать развитие стойкой ПОКД. Заключение. Полученные результаты свидетельствуют о многофакторном происхождении стойкой ПОКД, в ее развитии значительную роль играет не только предоперационное состояние когнитивного статуса, но и факторы послеоперационного периода, такие как степень соблюдения схемы назначенного лечения, ранняя ПОКД и прогрессирование стенозов СА.

OBJECTIVE. The study investigated the role of stenosis of brachiocephalic arteries in development of postoperative complications in patients, who underwent the coronary bypass grafting (CABG) and operations concerning heart valve pathology in conditions of extracorporeal circulation. There were observed such complications as stroke (n = 4) and hypoxic ischemic encephalopathy with delirium in postoperative period. MATERIAL AND METHODS. The research was carried out in 21 patients on the base of Center of сardiosurgery and interventional cardiology of St. Petersburg Multifield Center. All the patients were male aged 64±6,9 years. RESULTS. The study showed that risk of cerebral complications, especially hypoxic ischemic encephalopathy with delirium, could increase in case of bilateral carotid stenosis combined with hemodynamically insignificant unilateral vertebral artery stenosis. The significant hemodynamic branchiocephalic arterial stenosis caused chronic and acute clinical signs of cerebrovascular insufficiency in anamnesis. CONCLUSIONS. The high risk of development of severe cerebral complications was associated with hemodynamically significant bilateral carotid stenosis accompanied by hemodynamically significant uni- and bilateral stenosis or one-sided occlusion of cerebral artery. Management of treatment should take into account risk factors of cardiosurgical patients.

The literature review presents an analysis of publications describing the use of a glucose%insulin mixture as a cardioprotective agent in acute myocardial infarction and in cardiac surgeries with extracorporeal circulation (ECC). It summarizes historical aspects of implementation of the glucose%insulin therapy in cardiology and car% diac surgery. Possible mechanisms of action of the glucose-insulin-potassium mixture in acute ischemia and myocardial infarction were analyzed (normalization of electrical processes on the cardiomyocyte membrane, replenishment of metabolic substrates and increased production rate of adenosine triphosphoric acid due to glycolysis, decreased intensity of non%esterified fatty acid oxidation, decreased apoptosis, etc.). It discusses results of clinical studies evaluating prescription of the mixture for acute myocardial infarction, including data from metaanalyses. It demonstrated that the role and the clinical efficacy of the preventive and therapeutic measure under consideration in acute myocardial infarction are still the subject of discussion and require further research. It also analyzed modern concepts explaining the cardioprotective effects of insulin and glucose during surgeries with ECC (decreased insulin resistance, activation of anaplerosis, stimulation of intracellular signaling pathways maintaining the viability of cells, reduction of the severity of systemic inflammatory response, immunomodulating effect, etc.). Review discusses results of clinical studies including data from randomized clinical trials and metaanalyses performed over the last 5 years that demonstrated the absence of the effect of the glucose%insulin therapy on the hospital mortality. Various studies demonstrated its positive effects including decreased incidence of peri% operative myocardial infarctions and intensity of inotropic support, increased values of postoperative cardiac index, decreased duration of postoperative mechanical ventilation and ICU stay, etc. Review concludes that the interest to the therapeutic and preventive use of the glucose%-nsulin mixture in both emergency cardiology and cardiac surgery has been revived recently.

The results of experimental and clinical studies strongly suggest that remote ischemic preconditioning (RIP) has no neuroprotective effect during cardiac surgery performed under extracorporeal circulation. Remote preconditioning (RP) has no neuroprotective effect in hemorrhagic stroke. A randomized multicenter study is needed to evaluate the efficiency RIP in patients with ischemic stroke. RP reduces the severity of ischemia/reperfusion kidney injury during transplantation. RIP has been established to prevent contrast-induced nephropathy. There is a need for a multicenter trial to evaluate the efficiency of RIP in patients with abdominal aortic aneurysm repair. Analysis of the presented data indicates that RIP fails to prevent cardiorenal syndrome in infants and children during cardiac surgery. The data available in the literature on the capacity of RIP to provide nephroprotective effect in patients after coronary artery bypass surgery are discordant and indicative of the advisability of a multicenter study.Результаты экспериментальных и клинических исследований убедительно свидетельствуют, что дистантное ишемическое прекондиционирование (ДИП) не оказывает нейропротекторного эффекта при кардиохирургических вмешательствах, выполняемых в условиях искусственного кровообращения. Дистантное прекондиционирование (ДК) не оказывает нейропротекторного эффекта при геморрагическом инсульте. Необходимо проведение рандомизированного многоцентрового исследования для оценки эффективности ДИП у пациентов с ишемическим инсультом. ДК снижает выраженность ишемического и реперфузионного повреждения почки при трансплантации. Установлено, что ДИП предупреждает появление нефропатии, индуцированной контрастным веществом. Необходимо многоцентровое исследование для оценки эффективности ДИП у пациентов с протезированием аневризмы брюшной аорты. Анализ представленных данных свидетельствует, что ДИП не предупреждает возникновение кардиоренального синдрома у новорожденных и детей при выполнении кардиохирургических вмешательств. Данные литературы о способности ДИП оказывать нефропротекторный эффект у пациентов с коронарным шунтированием носят противоречивый характер и свидетельствуют о целесообразности проведения многоцентрового исследования.

A search for low molecular weight biomarkers to objectively evaluate the efficiency of extracorporeal detoxification methods is extremely relevant. For this purpose, the investigation is to verify whether metabolites, the production of which from aromatic amino acids in the human body can be of microbial ori gin, may be used. Objective: to evaluate the efficiency of extracorporeal detoxification methods on the serum level of phenyl carboxylic acids in patients with sepsis associated renal failure. Subjects and methods. Ten patients with acute or chronic (end stage) renal failure that had developed in the presence of severe sepsis, infective and toxic shock, long term extracorporeal circulation, postresuscitation disease, etc. were prospectively examined and treated. All the patients underwent extracorporeal detoxification; the choice of its technique was determined from their past medical history and intoxication patterns. The investigators eval uated organ dysfunctions using the Sequential Organ Failure Assessment (SOFA) scale, estimated body tempera ture, leukocyte count, and leukocyte index of intoxication, and assessed the results of a procalcitonin test. Hemodiafiltration was done as extrarenally indicated to ameliorate a systemic inflammatory response in septic shock, by applying an EMiC 2 superhigh permeability dialyzer. Low flux Diacap LO PS dialyzers were employed for hemodialysis. Blood samples were taken to estimate changes in the serum concentrations of phenylcarboxylic acid, benzoic acid, 3 phenylpropionic acid, phenyllactic acid, para hydroxyphenylacetic acid (p HPAA), and para hydroxyphenyllactic acid (p HPLA) directly before and immediately after extracorporeal detoxification. Results. The severity of organ dysfunctions by SOFA score was 10—22 (mean 16 scores); 10 day mortality rates were 40%. In all the patients, the baseline serum levels of some phenylcarboxylic acids were considerably above normal. After hemodiafiltration, the serum concentrations of p HPAA and p HPLA decreased (by an aver age of 1.7 and 1.85 fold, respectively). Conclusion. In sepsis associated renal failure, the clearance rate of microbial aromatic acid metabolites (p HPAA and p HPLA) is promising potential biomarker to evaluate the efficiency of extracorporeal detoxification methods.

Aim. To study the ability of hospital-associated strains isolated from the biological substrates of patients oper- ated on under extracorporeal circulation, to form bio fi lms on the surface of medical materials and products. Materials and methods. The formation of bio fi lms of strains of Staphylococcus aureus , Serratia liquefaciens , Klebsiella pneumoniae , Pseudomonas aeruginosa and Acinetobacter spp . isolated from the biological substrates of patients operated on under extracorporeal circulation, on different surfaces (politetraftorotilen, medical poly- ethylene, Polyoxybutirate-to-valerate, silicone, polyvinyl chloride), was studied by a modi fi ed method for the surface of the medical materials and products. Results. The in fl uence of the material nature, as well as hydrophi- lization of the surface, on the ability of hospital-associated strains, isolated from the biological substrates of pa- tients operated on under extracorporeal circulation, to form bio fi lms is studied. It is shown that that certain strains exhibit an increased tendency to bio fi lm formation on more hydrophobic surfaces, e. g., Acinetobacter spp. At the same time the activity of Staphylococcus aureus on silicon surface (hydrophobic surface) is minimal. Other strains almost equally form bio fi lms on hydrophilic and hydrophobic surfaces e.g. Serratia liquefaciens . It was also shown that the surface hydrophilization of PEG to 50% for all the studied strains leads to dramatic reduc- tion of bio fi lm formation. Conclusion. The tendency to form bio fi lms of a particular hospital-associated strain is individual and depends on the nature of the medical material and physical-chemical characteristics of its surface. Hydrophilization of the surface of the medical material is accompanied by a lowered risk of bio fi lm formation.

Objective: to study the prognostic value and correlations of hemodynamic parameters during operations under extracorporeal circulation (EC), as well as the possibilities of mathematically predicting the time that takes to recover the normal function of the heart operated on. Subjects and methods: Ninety-three patients (88 males and 5 females) who had undergone myocardial revascularization under EC were examined. The standard intraoperative monitoring involved pulmonary arterial catheterization and transesophageal echocardiography (TEEcho-CG) The duration of postopertative inotropic therapy was recorded. Multiple linear regression analysis was used to comparatively assess the prognostic value of hemodynamic parameters. Results: At the end of surgery, left ventricular ejection fraction, pulmonary artery wedge pressure, and cardiac index were established to be significant predictors of the duration of using cardiotonics. The analysis permitted the prognostic value of the established hemodynamic predictors to be depicted as a linear regression equation. It was shown to be clinically applied. Conclusion. The study revealed the significant intraoperative hemodynamic predictors of recovery of the function of the myocardium after its revascularization under EC. The proposed procedure for interpreting the data obtained, by using a Swan-Ganz catheter and TEEcho-CG, predicts the duration of required sympathomimetic therapy and hence the time of recovery of normal function of the heart operated on.

The paper presents the results of use of the combined antihypoxant Cytoflavin during operations under extracorporeal circulation. Twenty-nine patients operated on for rheumatic mitral valvular disease were examined. The examinations have shown that the use of Cytoflavin positively affects the restoration of cardiovascular performance and improved tissue oxygen transport in the postperfusion period.

Objective. To compare the efficacy of antisecretory agents used to prevent early postoperative mucosal erosive and ulcerative lesions of the upper gastrointestinal tract (GIT) in patients undergone cardiac surgery under extracorporeal circulation (EC). The study was performed by stratification randomization. Sixty-three adult patients with acquired cardiac diseases who had undergone operations on the heart under EC were clinically and endoscopically examined. To prevent acute proximal GIT ulcerations in the early postoperative period, all the patients were given antisecretory agents: ^-histamine receptor blockers or proton pump inhibitors (PPI). A drug was chosen by the blind method (envelope one). One group (n=31) took ^-histamine receptor blockers, the other (n=32) received PPI (omeprazole). To examine the upper GIT mucosa and to determine gastric acid-producing function, esophagogastroduodenoscopy with parietal pH-metry and chromoscopy were performed on postoperative days 5 and 9. Analysis of the findings revealed acute erosive and ulcerative lesions in 12.7% of all the examinees only in the ^-blocker group. Suppressed hydrochloric acid was significantly pronounced in the PPI group, as evidenced by chromoscopy. In the H2-blocker and PPI groups, the mean gastric pH value was 2.4±1.0 and 5.5±06 (F=224 and 259, respectively; p=0.0001).

The purpose of the study was to examine the time course of changes in the cellular composition of bronchoalveolar lavage (BAL) fluid to assess the possibilities of using the values of an endopulmonary cytogram (EPC) for the prediction of the development of infectious pulmonary complications and death in victims with severe concomitant injury. Sixty-three victims divided into 2 groups by the injury severity scale (ISS) (Beaker et al., 1974) were examined. For BAL sampling, a BF-XT40 endoscope (Olympus, Japan) was applied to bronchofibroscopy. To study BAL, the authors used the routine cyto-logical techniques and compared the latter’s results with those of EPC. The data were statistically processed, by employing the Statistica 6.0 programs; p Kozlov I. A., Poptsov V. N. Combined Therapy with Nitric Oxide and Surfactant-BL for Acute Respiratory Distress Syndrome After Operations Using Extracorporeal Circulation ….15 Abstract Выбрать Показать< /> The present study was undertaken to comparatively evaluate the efficacy of inhalational nitric oxide alone and in combination with surfactant-BL in the complex therapy for acute respiratory distress syndrome (ARDS) after surgery under extracorporeal circulation (EC). The study included 53 patients aged 21 to 76 years. It has revealed that in ARDS that complicates operations under EC, the use of surfactant-BL during therapy with inhalational nitric oxide enhances the latter’s effects on arterial oxygenation, accelerates the regression of pulmonary oxygenizing dysfunction, and reduces the duration of artificial ventilation and the length of stay in an intensive care unit.

Приведено клиническое наблюдение, когда превентивное подключение вспомогательного искусственного кровообращения (ИК) позволило выполнить полную эндоваскулярную реваскуляризацию пациенту с инфарктом миокарда, многососудистым анатомически сложным поражением коронарных артерий и резко сниженной фракцией выброса левого желудочка., We present report of successful full revascularization of heart during additional adjuvant extracorporeal revascularization (EcR) in case of difficult anatomy of anatomically difficult, multivessel lesions of coronary arteries and reduced ejection fraction (EF) of left ventricular (LV)., Журнал “Диагностическая и интервенционная радиология”, Выпуск 2 2015, Pages 79-84

The present study was undertaken to analyze the efficacy of inhaled nitric oxide (iNO) in the prevention and treatment of intraoperative gas-exchange disorders during operations on the ascending aorta with hypothermal circulatory arrest. The study included 22 patients aged 16—67 years. It revealed that the use of iNO substantially improved arterial oxygenation at surgery with hypothermal circulatory arrest. The preliminary findings suggest that the preventive use of iNO during extracorporeal circulation improves the clinical course of patients after surgery with hypothermal circulatory arrest.

Objective: to evaluate the safety of using 7.2% NaCl/6% hydroxyethyl starch 200/0.5 solution to develop acute renal injury (ARI) in patients after aortocoronary bypass surgery (ACBS) under extracorporeal circulation (EC). Subjects and methods. This was a single-center prospective, randomized, single-blind clinical trial. The patients singly received either 7.2% NaCl/6% hydroxyethyl starch 200/0.5 solution (a NC/HES group, n=20) or 0.9% NaCl (a control group, n=20) in a dose of 4 ml/kg for 30 min after induction of anesthesia. The primary endpoint was the rate of ARI diagnosed according to the recommendations of the International Organization KRIGO (Kidney Disease: Improving Global Outcomes). The secondary endpoints were serum cystatin C (sCys С), and urinary neutrophil gelatinase-associated lipocalin (uNGAL). Results. The rate of ARI was comparable in both patient groups. Thus, ARI was found in 4 (20%) patients in the NC/HES group and in 6 (30%) cases in the control group (p=0.72). During the first two postoperative days, the peak concentration of creatinine was significantly lower in the NC/HES group (101 (range 94—107) ^l/l) than in the control one (117 (range 100—127) ^l/l) (p=0.02). That of sCys C was substantially lower in the NC/HES group (0.83 (range 0.73—0.89) mg/l) than in the control one (1.02 (range 0.88—1.15) mg/l) (p=0.001). The patients of the NC/HES group had comparable peak of uNGAL concentrations (33 (range 5—38) ng/ml) versus the controls (30 (range 21—50) ng/ml). Conclusion. The use of NC/HES does not cause any increase in the rate of ARI, increased renal injury, or a more significant decrease in glomerular filtration in patients after ACBS under EC. Key words: hypertonic solution, hydroxyethyl starch, acute renal injury, aortocoronary bypass surgery.

Objective: to provide a rationale for the efficiency of sevoflurane-induced cardiac preconditioning (CPC), by assessing the pattern of recovery of heart rate and by estimating troponin I levels and changes in NT-proBNP concentrations in patients undergoing aortocoronary bypass surgery (ACBS) under extracorporeal circulation (EC). Subjects and methods. Sixty patients aged 60.6±8 years (M±&) were examined after elective ACBS using EC and divided into two groups of 30 patients each: 1) inhalation induction and maintenance of anesthesia (IIMA) with sevoflurane and fentanyl, with CPC being simulated; 2) total intravenous anesthesia (TIA) with propofol and fentanyl. Inhalation induction of sevoflurane anesthesia was performed in the IIMA group. Ten minutes before aortic ligation, the dose of the anesthetic was increased up to 2 MAC for CPC. Inhaled anesthetics were not used in the TIA group. The authors assessed the pattern of cardiac performance recovery and estimated the level of NT-proBNP 24 and 48 hours after tracheal intubation and that of troponin I following 24 hours of the intubation. Results. Defibrillation was required in one patient from the TIA group who developed ventricular fibrillation. The baseline levels of NT-proBNP were comparable in both groups. Following 24 hours, its level was more than thrice higher in the TIA group than that in the IIMA one (p

Objective: to reveal risk factors for postoperative neurological complications (PONC) during surgery under extracorporeal circulation (EC). Subjects and methods. Five hundred and forty-eight patients were operated on under EC. Multimodality monitoring was performed in all the patients. Pre-, intra-, and postoperative data were analyzed. Results. Two patient groups were identified. These were 1) 59 patients with PONC and 2) 489 patients without PONC. The patients with PONC were older than those without PONC (61.95±1.15 and 59±0.4 years) and had a smaller body surface area (1.87±0.02 and 1.97±0.01 m2); in the PONC group, there were more women (37.3±6.4 and 22.1±1.9%). In Group 1, comorbidity was a significantly more common indication for surgery (33.9±6.22 and 9.2±1.29%). In this group, cerebral oxygenation (CO) was significantly lower (64±1.41 and 69.9±0.38%). In the preoperative period, there were group differences in hemoglobin (Hb), total protein, creatinine, and urea (135±2.03; 142±0.71 g/l, 73±0.93; 74.9±0.3 mmol/l, 104.7±3.3; 96.3±1.06 mmol/l, 7.5±0.4; 6.5±0.1 mmol/l, respectively). The PONC group more frequently exhibited more than 50% internal carotid artery (ICA) stenosis (28.8±5.95; 15.3± 1.63%; р

The paper analyzes the results of the investigations made at the V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical Sciences, on the pathophysiology and applied aspects of cardiac performance and the anesthetic maintenance of cardiac operations. The main tasks presented to its investigators were to improve electric cardiac defibrillation and cardioversion, to elaborate the optimal infusiotransfusion therapy tactics during cardiac surgery, to optimize intraoperative myocardial protection, to maintain lung functions under extracorporeal circulation, to search for the most effective and safe schemes of general and epidural anesthesia in cardiosurgical patients, and to substantiate algorithms for their postoperative activation. The findings could solve the problem of treating circulatory disorders in the practice of critical care medicine on a new plane. At the same time new areas of a further scientific search have been identified.

Objective : to study the time course of changes in brain natriuretic peptide (BNP) levels in patients with coronary heart disease, who undergo myocardial revascularization under extracorporeal circulation and to assess a relationship of the level of the biomarker to the clinical data in the early postoperative period. Subjects and methods. Fifty-two patients aged 62.2±1.1 years with a left ventricular ejection fraction (LVEF) of 51.1±1.4% were examined. The concentration of BNP was determined by immunofluorescence assay (Triage Meter Plus, Biosite Diagnostics, USA) before (BNP 1 ) and at the end (BNP 2 ) of surgery, in the morning of the first (BNP 3 ) and second (BNP 4 ) postoperative days. Central hemodynamics was invasively monitored using Swan-Ganz-type catheters. Results . The values of the biomarker were normal (51.6±3.5 pg/ml) in most cases. In the other patients, the level of the peptide was increased up to 165.8±16.1 pg/ml. The relationship between preoperative LVEF and BNP 1 was moderate ( r =-0.54; p

Objective: to analyze the efficiency of hemofiltration (HF) in the stage of extracorporeal circulation (EC) during cardiac surgery in order to prevent acute renal function lowering and the development of acute renal failure (ARF). Materials and methods. The risk of postoperative ARF requiring renal replacement therapy (RRT) was preoperatively assessed by the summed Cleveland risk score and percentage (2005). HF during EC was used in patients at high risk for ARF. The procedure was performed, by combining 2 extracorporeal circuits: EC and a Diapact®CRRT apparatus. With evolving ARF, Stage 3 after Risk, Injury, Failure, Loss of Kidney Function, End-stage Renal Disease (RIFLE), 2004, and Acute Kidney Injury Network (AKIN), 2007, continuous venovenous hemofiltration (CVVHF) and continuous high-flow hemodialysis (CHFHD) were done in the dialysate recirculation mode after surgery under EC. The Mann-Whitney non-parametric test was used to estimate the significance of intergroup differences. The results are presented: median (lower quartile; upper quartile), the differences considered to be significant atpResults. HF during EC; 6 patients were aged 65.5 (range 57—70) years with chronic kidney disease, preoperative glomerular filtration rate (GFR) was 50 (range 41.5—65) ml/min/1.73 m2 using the Cockroft-Gault formula. The maximum GFR decrease by 2.9 (range 0.7—7) ml/min/1.73 m2 was seen after EC. A control group comprised 12 patients aged 73 (range 63—75) years. There was a postoperative GFR reduction by 17 (range 13.7—22) ml/min/1.73 m2. One patient from the control group developed ARF and multiple organ dysfunction, which required CVVHF and CHFHD. Conclusion. The use of intraoperative HF in patients at high risk for renal function lowering is likely to prevent a considerable GFR reduction and ARF after surgery under EC.

Objective: to study the informative value of a dramatic increase in the preoperative blood level of the inactive moiety of the precursor of N-terminal pro-type B natriuretic peptide (NT-proBNP) in cardiac surgical patients with hypercreatininemia. Subjects and materials. Twenty-one patients with a preoperative NT-proBNP level of 1000 pg/ml or more, who underwent myocardial revascularization under extracorporeal circulation (ECC), were examined. The patients were divided into groups with normal (up to 120 ^mol/l) (Group 1; n=11) and elevated (Group 2; n=10) creatinine concentrations. The values of circulation were processed after skin incision and at the end of surgery. The clinical features of a perioperative period were analyzed. Results. Creatininemia was 103±3.3 and 183±12.9 ^mol/l in Groups 1 and 2, respectively (p0.05). There were no intergroup differences in intraoperative circulatory parameters. The intensity of sympatomimetic therapy after ECC was equal in the identified patient groups and there were either no differences (p>0.05) in the frequency of intra-aortic balloon counterpulsation (18.2 and 10.0%), the length of mechanical ventilation (15±1.5 and 18.7±2.3 hours) and intensive care unit stay (1.8±0.5 and 2.0±0.7 days) in survivors, and inpatient mortality (23.7 and 20.0%) that proved to be substantially higher than the EuroSCORE-predicted one. Regression analysis showed that in the entire group of operated patients, the level of NT-proBNP turned out to be a more significant predictor of inpatient mortality (p=0.012) than EuroSCORE-predicted one (p = 0.04). The similar regularity was characteristic for patients with hypercreatininemia. In the patients with hypercholesterolemia, the EuroSCORE-predicted mortality completely lost its significance (p=0.61) in predicting actual mortality rates. In this group, NT-proBNP showed a predicting trend. Conclusion. The blood NT-proBNP concentration of 1000 pg/ml or more preserves its significance as a high operative risk factor in the presence of myocardial revascularization under ECC in patients with the blood creatinine level of 140—270 ^mol/l. Key words: N-terminal pro-type B natriuretic peptide (NT-proBNP), myocardial revascularization, extracorporeal circulation, hypercreatininemia.

Objective: to study the efficacy of inhaled nitric oxide used intraoperatively to prevent lung oxygenating dysfunction in patients with coronary heart disease after myocardial revascularization under extracorporeal circulation (EC). Subjects and methods. Thirty-two patients aged 55.0±2.0 years were examined. The inclusion criteria were the standard course of surgical intervention (the absence of hemorrhage, acute cardiovascular insufficiency, perioperative myocardial infarction, etc.), a pulmonary artery wedge pressure of less than 15 – mm Hg throughout the study, and the baseline arterial partial oxygen tension/inspired mixture oxygen fraction (PaO2/FiO2) ratio of at least 350 mm Hg. There was a control group (n=21; Group 1) that used no special measures to prevent and/or to correct lung oxygenating dysfunction and Group 2 (n=11) that received inhaled nitric oxide. Ihe administration of inhaled nitric oxide at a concentration of 10 ppm was initiated after water anesthesia, stopped during EC, and resumed in the postperfusion period. Results. At the end, PaO2/FiO2 and intrapulmonary shunt fraction did not differ between the groups (p>0.05). Before EC, the patients receiving inhaled nitric oxide had a lower intrapulmonary blood shunting (8.9±0.7 and 11.7±1.0%; p

Objective: to evaluate the efficiency of high thoracic epidural anesthesia (EA) and analgesia during aortocoronary bypass surgery (ACBS) without extracorporeal circulation (EC). Subjects and methods. The study enrolled 93 patients who had undergone ACBS without EC. The patients were randomized to three groups: 1) 30 controls who had balanced endotracheal anesthesia with propofol and fentanyl and postoperative intravenous analgesia with fentanyl; 2) 30 patients who received epidural infusion with combined endotracheal and epidural (0.75% ropivacaine, 10—12 ml, and fentanyl, 2—3 ^g/kg) anesthesia and postoperative infusion of 0.2% ropivacaine and fentanyl, 2 ^g/ml, into the epidural space at a rate of 3—10 ml/hr; 3) 30 patients who had epidural infusion with autoanalgesia in which autoanalgesia with ropivacaine and fentanyl were additionally used during their epidural infusion after ACBS. Results. The less severe degrees of arterial hypertension and myocardial depression were observed in the EA groups during ACBS (p

Objective: to study the clinical efficiency of introducing an algorithm for organ-protective intensive care. Materials and methods. 3278 case histories of patients admitted to the clinic in 2000—2009 for surgical treatment (under extracorporeal circulation) for coronary heart disease (CHD) and acquired heart defects (AHD) were retrospectively analyzed. Throughout the analyzed period, the patients operated on for CHD and AHD were 2068 (63.1%) and 1210 (36.9%), respectively; the postoperative incidence of multiple organ dysfunction (MOD) among all the patients was 11.8% (378 patients); mortality in MOD was 3.75% (n=123) of the operated patients (included into the study) or 32.5% of all the patients with MOD. Conclusion. The incidence of MOD is in proportion to the number of surgical interventions and depends on their specific features (recurrence, baseline severity, comorbidity, or multifocal atherosclerosis). Preventive intensive therapy for MOD reduced mortality and altered its syndromic pattern towards a preponderance of pyoseptic complications. Key words: cardiosurgery, extracorporeal circulation, multiple organ dysfunction.

Objective: to comparatively analyze nutritional support with breast milk, standard adapted and semielementary formulas. Subjects and methods. Three groups of patients aged 3 months to 1 year who had undergone cardiac surgery under extracorporeal circulation were retrospectively studied. The criteria for enteral feeding efficiency were biochemical parameters on postoperative days 1, 2, and 5, weight accretion rates by day 10, rates of flatulence, tubal expulsion or regurgitation, and stools. Results. In Group 2, unlike Group 3, there was no adequate correction of metabolic disturbances by day 5, not only a reduction in the level of total protein and albumin, but also later recovery of hemoglobin and urea levels. Conclusion. Breast milk is not the infant food of choice in the early postoperative period.

Objective: to reveal possible causes of postoperative multiple organ dysfunction syndrome (MODS) in patients after surgery under extracorporeal circulation (EC), by measuring the level and balance of pro- and anti-inflammatory cytokines. Subjects and methods. The investigation enrolled 162 patients who had undergone operations on the heart and thoracic aorta. The levels of interleukins (IL)-6, IL-8, and IL-10 were determined by ELISA. Results. At surgery under EC, MODS was encountered in 5.7%, mortality was 55.6%. The principal causes of MODS were prolonged EC concurrent with bleeding (23%), massive hemorrhage (16%), perioperative myocardial infarction and cardiogenic shock (15%), prolonged EC (12%), acute lung injury (12%), disseminated intravascular coagulation (10%), allergic and anaphylactic reactions (9%), and intravascular hemolysis (6%). The levels of pro- and anti-inflammatory cytokines were substantially increased in all the patients after surgery under EC irrespective of the presence of MODS in the postoperative period. The patients with MODS displayed pro- and anti-inflammatory cytokine imbalance due to a preponderance of the proinflammatory activity of a systemic response. During massive hemorrhage (more than 20 ml/kg), the patients with MODS exhibited a reduction in the two pools of cytokines. In the absence of MODS, there was a parallel increase in both pro- and anti-inflammatory cytokines. The magnitude of a change in the level of cytokines is related to the volume of blood loss. During prolonged EC (more than 170 min), the patients with MODS had a higher pro- and anti-inflammatory cytokine ratio due to the elevated levels of both pools, but the elevation of anti-inflammatory cytokines was more pronounced. In the patients without MODS, the values of both groups of interleukins were sigmficantly unchanged with longer duration of EC. Key words: multiple organ dysfunction syndrome, systemic inflammatory reaction, interleukins 6, 8, 10, extracorporeal circulation, operations on the heart and thoracic aorta.

Objective: to reveal the predictors of clinically significant deterioration of cardiac pump function resulting from alveolar opening maneuver (AOM) (mobilization) made early after extracorporeal circulation during standard cardiosurgery. Subjects and methods. Hemodynamic, clinical, and laboratory parameters were analyzed in 20 cardiosurgical patients who had undergone AOM in the early postperfusion period. The study inclusion criteria were a PaO2/FiO2 ratio of less than 350 mm Hg, a cardiac index (CI) of more than 2.5 l/min/m2, a dosage of dopamine and/or dobutamine of not more than 10 ^g/kg/min, and standard AOM performance (Pmax, 30—35 cm H2O; end-expiratory pressure (PEEP), 13—15 cm H2O). Regression analysis was used to identify the predictors of a clinically significant reduction in CI (less than 2.5 l/min/m2). Results. Before and after AOM, CI was 3.1±0.1 and 2.9±0.1 l/min/m2, respectively (p>0.05); however, CI was less than 2.5 l/min/m2 (2.16±0.09 l/min/m2) in 25% of cases. After AOM, CI values were significantly related to those recorded prior to a respiratory procedure (p=0.039), total peripheral vascular resistance index (TPVRI) (p=0.00039), and intrapulmonary blood shunt fraction (Qs/Qt) (p=0.041). There were no relationships to other recorded and estimated hemodynamic parameters (p>0.1). – After AOM, CI values were unrelated (p>0.1) to the duration of extracorporeal circulation, the period of myocardial ischemia, and the used dosages of inotropic agents. The predictor of a clinically significant CI reduction after AOM was the only index TPVRI (p=0.00025) recorded before a respiratory procedure. Following AOM, the probability of a significant CI reduction substantially increased (the approximation coefficient R2=0.75) at TPVRI values of 2000 din^sec^cm-5^m2 or more. Conclusion. After AOM performed in the early period after extracorporeal circulation, CI values are related to the baseline level of CI, TPVRI, and Qs/Qt; however, after this procedure only the value of TPVRI is a reliable predictor of clinically significantly depressed cardiac pump function. The risk of persistent car-diodepression is highest at TPVRI values of 2000 din^sec^cm-5^m2 or more. AOM should be carried out early after extra-corporeal circulation in cardiosurgical patients, by making an invasive monitoring that makes it possible to maximally correctly evaluate central hemodynamics, including CI and TPVRI. Key words: alveolar opening maneuver (mobilization), lung recruitment, recruiting maneuver in cardiosurgical patients, central hemodynamics during lung recruitment, cardiodepression during lung recruitment.

Objective: to study the impact of increased inactive (N-terminal) pro-B-type natriuretic peptide (NT-proBNP) levels in cardiosurgical patients with coronary heart disease without drastically reducing left ventricular contractility on intraoperative central hemodynamics and the specific features of therapeutic measures for its stabilization. Subjects and methods. The inclusion criteria were elective surgery, age less than 70 years, a left ventricular ejection fraction of at least 30%, and no surgical complications. Sixty-one patients aged 54.6±1.2 years with a left ventricular ejection fraction of 51. 5 ± 1. 6 %. Before surgery, NT-proBNP was determined by electrochemiluminiscence («Elescys®proBNP»). Invasive hemodynamic monitoring was made with Swan-Ganz catheters. Results. The level of NT-proBNP was 13.2—3232 pg/ml. When the preperfusion values of the biomarker was more than 350 pg/ml, the magnitude of a peptide concentration increase affected that of an elevation of pulmonary artery wedge pressure (r=0.52; p=0.002) and that of a decrease in left ventricular pump coefficient (r=-0.44; p=0.01). At the end of operations, this patient group, as compared with the others, had a lower left ventricular pump coefficient (2.9±0.2 and 3.9±0.3 g/mm Hg/m2; p

Objective: to make a complex analysis of the efficacy of xenon as the major agent in maintaining anesthesia during early activation of patients operated on under extracorporeal circulation for coronary heart disease. Subjects and methods. Forty-two patients aged 59±3 years were examined. A total of 3±0.2 coronary arteries were shunted. General anesthesia was induced and maintained by propofol and fentanyl under extracorporeal circulation. Anesthesia was maintained by xenon inhalation in the preperfusion and postperfusion periods. General anesthesia was combined with high (Th3—Th4) epidural anesthesia in 10 cases. Results. During xenon inhalation, the central hemodynamic parameters were maximally steady-state both before and after extracorporeal circulation. The coronary perfusion conditions estimated from the coronary perfusion gradients were stable. The study of the conditions for coronary perfusion and the values of myocardial demand showed the persistence of their balance (r=0.55—0.83; p

Objective: to establish a relationship between the influence of extracorporeal circulation (EC) factors — its duration, mean blood pressure, and the magnitude of cerebral dysfunction. Subjects and methods. Thirty patients who had undergone above 120-min EC with surface (34—33°C) hypothermia of the body due to cardiosurgical intervention were examined by neurological and neuropsychological methods as described by A. R. Luriya. Results. Acute global brain ischemia (AGBI), as a consequence of negative EC factors, was shown to have impact on cerebral, specifically, higher psychic functions. There was a heterogeneous susceptibility of cerebral structures to AGBI, particularly the structures of the left hemisphere and cerebellum. Conclusion. The duration of perfusion is a determinant in the development of AGBI when extracorporeal circulation is applied. Arterial hypotensive episodes and critically low mean blood pressure are an important concomitant. Key words: extracorporeal (artificial) circulation, higher psychic functions, neurology, neuropsychology, neurodynamics, acute global brain ischemia.

Objective: to justify a comprehensive approach to preventing and correcting pulmonary oxygenizing dysfunction requiring prolonged artificial ventilation in patients operated on under extracorporeal circulation for coronary heart disease. Subjects and methods. One hundred and twenty-three patients aged 55±0.6 years were examined. The study excluded patients with a complicated course of operations (perioperative myocardial infarction, acute cardiovascular insufficiency, hemorrhage, and long extracorporeal circulation). Stimulating spirometry was initiated 2 days before surgery. An alveolar opening maneuver was performed using a continuous dynamic thoracopulmonary compliance monitoring. The parameters of lung oxygenizing function and biomechanics were analyzed. Results. In 78% of the patients, preoperative inspiratory lung capacity was 5—30% lower than the age-related normal values. After extracorporeal circulation, pulmonary oxygenizing dysfunction was diagnosed in 40.9% of cases; at the same time PaO2/FiO2 was associated with an intrapulmonary shunt fraction (Qs/St) (r=-0.53; p=0.002) and Qs/Qt was related to static thoracopulmonary compliance (Cst) (r=-0.39; p=0.03). Preoperative stimulating spirometry provided a considerable increase in intraoperative PaO2/FiO2 values (p

Objective: to show that patients’ accelerated activation in the use of combined anesthesia with sevoflurane and fentanyl reduces the incidence of pulmonary complications in young age children after surgery under extracorporeal circulation. Subjects and methods. A randomized controlled study covering 127 patients aged 10 months to 3 years was performed. The study included the patients who had undergone surgery for congenital heart diseases. The patients were found to have atrial and ventricular septal defects and arteriovenous communication. The patients were divided into groups in the operating suite just before anesthesia. After standard premedication-preinduction, a child was taken to the operating room. Group 1 patients were given intubation anesthesia with a combination of the inhalation anesthetic halothane and intravenously infused fentanyl. In Group 2 (a study group), anesthesia was made via continuous fentanyl infusion and sevoflurane inhalation. The authors studied the duration of artificial ventilation, postanesthesia sleep, and antibacterial therapy, the frequency of antibiotic switching, as well as sudden sputum mobilization episodes, the duration and intensity of inotropic support, the rapidity of gastrointestinal passage recovery, and the length of intensive care unit stay. Results. Analysis of the findings showed that in Group 2 (a study group), the time of emergence from anesthesia was significantly shorter than that in Group 1 (a control group). The time of postoperative mechanical ventilation was shorter than that in the group of patients receiving the inhalation anesthetic sevoflurane. Anesthesia with the latter reduced the intraoperative dose of fentanyl when clinically adequate anesthesia was applied. There were no differences in the protocol of inotropic agents immediately after surgery, but the patients receiving sevoflurane as an inhalation component needed no inotropic agents 3 hours after surgery while in the controls the infusion of inotropic agents lasted as long as 6 hours postoperatively. After extubation, the number of sputum mobilization cases requiring additional medical measures substantially reduced in children given the inhalation anesthetic sevoflurane. There was a more need for antibiotic substitution due to the presumed clinical inefficiency of the conventional antibiotic prophylaxis, adopted by the protocol in the cardiology center, in the control group. Additional efforts for tracheobronchial tree sanitation broke a schedule of the children’s feeding and rehabilitation in the intensive care unit. In the study group, intestinal performance normalized more promptly. Conclusion. Early spontaneous breathing and extubation make it possible to activate and rehabilitate a child as soon as possible, to reduce a risk for respiratory complications and treatment costs in the postoperative period, which provides an economic gain.

Objective: to optimize the diagnosis of a systemic inflammatory reaction (SIR) after aortocoronary bypass surgery (ACBS) under extracorporeal circulation (EC), by examining the reaction of the peripheral blood lymphocytic plasma membrane to surgery. Subjects and methods. Eighty-three patients with coronary heart disease (CHD) who had undergone ACBS were examined. The lymphocytic plasma membrane was studied before and 1, 2, 3, and 7 days after surgery. Lymphocytes were derived on the ficoll-verografin (Pharmacia Chemical, Uppsala, Sweden) density gradient (p=1.077). The isolated cells were investigated by phase contrast microscopy (900X). Results. The patients with CHD were found to have perioperative peripheral lymphocytic plasma membrane changes (blebbing), the genesis of which was determined by impaired membrane-cytoskeleton interactions. More plasma membrane changes occurred throughout the postoperative period, with their maximum being recorded on day 1, which corresponded to the increase peak in the concentrations of interleukin-6 and tumor necrosis factor-а. Conclusion. The follow-up cell membrane changes appearing as peripheral lymphocytic blebbing reflect the development of SIR during ACBS under EC. In patients with CHD, the lymphocytic plasma membrane blebbing is of varying degrees: from early to terminal. The determination of peripheral lymphocytic blebbing allows one not only to record SIR, but also to assess its time course of changes. Key words: lymphocytic blebbing, systemic inflammatory reaction, aortocoronary bypass surgery, extracorporeal circulation.

Objective: to study the effect of the antioxidant and cardioprotector mexicor on oxidative stress in patients with acute coronary circulatory disorders (ACCD) during perioperative direct myocardial revascularization. Subjects and methods. The study included 33 patients with ACCD who had undergone coronary bypass surgery. Two groups (a study group and a control one) were formed. Prior to surgery, all the patients received the maximum doses of antianginal and antihypertensive drugs. The study group patients additionally took mexicor. All patients were operated on under extracorporeal circulation and moderate hypothermia. Lipid peroxidation (LPO) indices were estimated via measurements of the serum levels of dienic conjugates, malonic dialdehyde, and the degree of serum lipid oxidability. The serum antioxidative system (AOS) was judged from the concentration of а-tocopherol and cerulo-plasmin. The oxidative stress coefficient K, an integral index, was calculated to evaluate LPO-AOS imbalance. Results. High oxidative stress was found to be detectable in patients with ACCD. Mexicor lowers oxidative stress, diminishes LPO-AOS imbalance, improves oxygen balance and cardiac contractility, and reduces the number of life-threatening cardiac arrhythmias. Conclusion. Mexicor diminishes oxidative stress in patients with ACCD in the perioperative period of coronary bypass surgery. Mexicor-induced stabilization of LPO positively affects better oxygen balance and cardiac contractility, thus reducing the number of perioperative complications. Key words: oxidative stress, dienic conjugates, malonic dialdehyde, а-tocopherol, ceruloplasmin, coronary bypass, acute coronary circulatory disorder, hemodynamics.

Objective: to study the safety and clinical and economic efficiency of early activation of children operated on under extracorporeal circulation (EC). Subjects and methods. Sixty-eight children aged 4—14 years (8.6±0.4 years) operated on under EC for congenital heart diseases (CHD) were examined. In accordance with the time of switching to spontaneous respiration and tracheal extubation, 2 groups were identified: 1) those who received postoperative artificial ventilation (AV) for 2.9±0.2 hours (a study group); 2) those who had AV for 8.7±0.7 hours (a control group). Both groups did not differ in age, cardiac diseases, their severity, anthropometric characteristics, EC duration, aortic ligation time, and abnormality pattern. In the study group, anesthesia was maintained with fentanyl (5.3±0.1 ^g/kg/hr), diazepam (0.15±0.01 mg/kg/hr), and inhaled ftorotan or enflurane. Diazepam was discontinued in the postperfusion period. The control group received fentanyl (7.6±0.4 ^Bg/kg/hr), diazepam (0.3±0.02 mg/kg/hr), droperidol (0.4±0.04 mg/kg/hr), and/or sodium oxybutyrate (81±5 mg/kg/hr). Myoplegia was provided by pancuronium or pipecuronium that was continuously infused until EC was completed in Group 1 and intermittently injected until the end of surgery in Group 2. Results. There were no indications for tracheal reintubation in both groups of patients. The early postoperative period was uncomplicated in 97.2% of the children in the study group and in 28.1% in the control group (p

Objective: to study the time course of changes in the respiratory biomechanics, extravascular water of the lung (EVWL) and its oxygenizing function and their relationship at different stages of surgical interventions under extracorporeal circulation (EC). Subjects and methods. 29 patients aged 37 to 72 years were examined during uncomplicated operations under EC. The parameters of artificial ventilation (AV) and lung biomechanics were recorded in real time on a Servo-I monitoring apparatus. PaO2/FiO2, Qs/Qt, and body mass index (BMI) were calculated. The EVWL index (EVWLI) was determined by the transpulmonary thermodilution technique. Studies were conducted at stages: 1) after tracheal intubation and the initiation of AV; 2) before sternotomy; 3) after sternal uniting at the end of surgery. Results. Pressures in the airways and their resistance were statistically significantly unchanged. There were significant reductions in Cdyn and Cst at the end of surgery (Stage 3). The mean values of PaO2/FiO2, Qs/Qt, and EVWLI did not undergo considerable changes. There was a significant correlation between PaO2/FiO2 and Qs/Qt (r=-0.5 to -0.8; p