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Aim.To study the effect of ACE inhibitors (ACEI) in heart recipients on the prognosis and myocardial remodeling.Materials and methods.Three hundred and eighty-six patients who received orthotopic heart transplantation (HT) were consequently enrolled to the study from February 2009 to November 2016.Results.Thirty days after the HT, ACEIs were assigned to 141 recipients. Arterial hypertension was diagnosed in all cardiac recipients who received ACEI and among 48 patients (19.5%) from non-ACEI group. Patients receiving ACEI had significantly better event-free survival than control group (p = 0.045) during the follow-up for 1361,6 ± 36,9 days. Left ventricle (LV) end-diastolic dimension did not change over the time in both groups, whereas LV posterior wall thickness in non-ACEI group significantly increased from 1.35 ± 0.03 cm to 1,23 ± 0.05 cm (p < 0.05).Conclusion.Cardiac recipients who received ACE inhibitors had better survival and less transplant left ventricle progression, that could reflect beneficial effects of renin-aldosterone-angiotensin system inhibition after heart transplantation.

Aim.Purpose of study was evaluated of early outcomes of HT performed from donors with LVEF Materials and methods.The study included 18 (14 men and 4 women, age 29 to 59 (42.9 ± 2.7) years) recipients who received cardiac allograft from donors with LVEF Results.Heart donors (13 men and 5 women, 22 to 57 (39.1 ± 3) years) were the traumatic (n = 3) and non-traumatic (n = 15) brain damage. Maximal inotropic support was norepinephrine 433 ± 46.2 ng/kg /min (n = 14) and dopamine 5.6 ± 2.5 μg/kg/min (n = 4). Laboratory parameters of the heart donor blood: Hb 11.5 ± 0.7 g/l, total protein 72 ± 14 g/l, Na+ 139 ± 3 mmol/l, troponin I 0.3 ± 0.2 ng/ml, CK-MB 98 ± 18 U/l. ECG of the donor’s heart: LVEDV 134 ± 9 ml, LVEF 22–39 (35.3 ± 4.3)%, diffuse LV hypokinesis (n = 10), regional dyskinesis (n = 8). Ischemic time was 151 ± 27 min. 16 (88.9%) had acceptable cardiac allograft function. Primary graft failure treated by MCS (VAECMO (n = 2)) was in 2 (11.1%). ICU stay was 7.7 ± 1.2 days. All recipients were discharged at home.Conclusions.Own experience demonstrates the satisfactory results of HT from donors with LVEF

Aim: to evaluate clinical effi ciency of percutaneous coronary interventions (PCI) at potential recipients of heart with the chronic ischemic heart failure (CHF).Materials and methods. In this retrospective study results of treatment at 76 patients with CHF NYHA III and 36 patients with CHF NYHA IV by scheduled PCI are presented. Duration of observation was from 6 to 160 months. The age of patients at the time of intervention was 61,7 ± 0,62 years (from 33 to 76). 108 male and 4 female. Defi ned life expectancy and echocardiography parameters of the left ventricle (LV) of heart. Results.20 patients were died, 16 of them from cardiovascular events. 18 patients during this period undergo orthotopic heart transplantation (HT). The endovascular revascularization leads to LV volumes reduction, increase of ejection fraction and decrease of pulmonary artery pressure. Progress CHF is followed by negative dynamics of these characteristics and need of HT performance. In 74% of cases the effect of myocardial revascularization allows to provide increase in life expectancy of potential recipients of heart with the chronic ischemic heart failure. Conclusion.Performance of PCI at patients with the chronic ischemic heart failure can delay heart transplantation or become its alternative.

Hypertension is a common syndrome in adult and pediatric cardiac transplant recipients affecting the great majority of patients. Elevated blood pressure is a major potentially modifiable risk factor associated with cardiac graft failure, vasculopathy, arrhythmias, stroke, renal failure and premature death. This review discusses the magnitude of the problem, its distinct mechanisms, and certain issues of prevention and treatment of post-transplant hypertension.