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Background: The aim of the study was to analyze the mid-term outcomes of the frozen elephant trunk (FET) procedure for chronic aortic dissection (СAD)., Methods: From March 2012 to December 2022, 123 FET procedures were performed in patients with acute and chronic aortic dissection as well as aortic aneurysm. Fifty-five patients with chronic aortic dissection (CAD) were eligible for study. CAD patients were divided into 2 groups: type A (n=32), type B (n=26). Pre-, intra- and postoperative data were collected retrospectively from electronic patient records, with median follow-up period of 21.5 months (range, 1-96)., Results: The overall 30-day mortality in CAD patients was 10.3%. The overall survival rate for the entire cohort was 66.5±7.9%, for type A and type B patients was 77.6±8.1% and 53±1.3%, respectively (P = 0.229). Distal stent-graft-induced new entry developed in 2 (3.4%) patients. Freedom from composite outcome (death or/and distal aortic re-intervention) for the entire cohort was 56.8±9.8%, and for type A and type B patients was 66.5±1.2% and 44.8±1.4%, respectively (P = 0.181). The incidence of stroke was 1.7%. Two (3.4%) patients had signs of SCI. Respiratory failure occurred in 14 (23.1%) patients. The rate of dialysis was 15.5% (n=9). The chest re-exploration for bleeding rate was 5.2% (n=3)., Conclusions: Early and late outcomes (death or/and distal aortic re-intervention) after the FET in CAD are tolerable without difference between type A and type B., (Copyright © 2025. Published by Elsevier Inc.)

Background: To date a number of papers analysing outcomes of the frozen elephant trunk (FET) in acute aortic dissection has been published. However, there are limited comparative studies on long-term outcomes of FET in acute and chronic aortic dissection. The objective of the study was to analyze the long-term outcomes after FET procedure for aortic dissection (AD)., Methods: Between March 2012 and December 2022, a total of 123 FET had been performed for thoracic aortic disease. Patients with aortic dissection (n = 97) were divided into 2 groups: acute (n = 32, 33%) and chronic aortic dissection (n = 65, 67%). Pre-, intra- and postoperative data were retrospectively collected from electronic patient's records, including follow-up data of the analyzed patients., Results: The incidence of stroke was 3.1%. The delirium rate was up to 9.3% in both groups with a prevalence in chronic aortic dissection (CAD) group without significant differences (P = 0.494). Paraplegia was diagnosed only in CAD patients (n = 2). Respiratory failure and the rate of renal replacement therapy were similar in the studied groups. Re-sternotomy was required in one (3.1%) patient with acute AD and 5 (7.7%) patients with chronic AD (P = 0.416). Overall 30-day mortality in the entire cohort, acute and chronic AD was 13 (13.4%), 7 (21.9%) and 6 (9.2%), respectively (P = 0.097). The overall survival rate at 60 months for the entire cohort, acute and chronic AD was 64.1 ± 5.9%, 62.3 ± 9.1%, 66.5 ± 7%, respectively (P = 0.265). Freedom from unintended distal aortic re-intervention at 60 months for the entire cohort of patients, acute and chronic AD was 74.2 ± 1.5%, 100%, 65.3 ± 2%, respectively (P = 0.355)., Conclusions: Our experience showed acceptable long-term outcomes after the FET procedure including mortality and re-intervention rate in patients with aortic dissection regardless of acuity of the dissection., Trial Registration: The study has been registered in Australian and New Zealand Clinical Trial Registry (ACTRN 12618001329257) on August 7, 2018., (© 2024. The Author(s).)

Myocardial revascularization has been known to not affect the prognosis in some patients. Coronary artery bypass graft (CABG) failure may develop one year after CABG surgery. This is accompanied by a high risk of developing myocardial infarction after complete myocardial revascularization in obstructive coronary artery disease (CAD) due to microvascular dysfunction. The study of microvascular dysfunction using intraoperative stress tests with adenosine triphosphate (ATP) allows for the assessment of the coronary bypass flow reserve (CBFR) and the risk of graft failure one year after surgery. The study included 79 CAD patients (238 grafts) who underwent dynamic single-photon emission computed tomography (SPECT) before CABG and dynamic transit time flow measurement (TTFM) during CABG at rest and at stress. The CBFR was calculated by the ratio of the mean graft flow (MGF) at stress to the MGF at rest. A multivariate regression model showed that the MGF at rest ( p = 0.043), the MGF at stress ( p = 0.026) and the CBFR ( p = 0.0001) were significant independent predictors of graft failure. As a result of ROC analysis, the threshold CBFR < 1.67 units correlated with graft failure more closely (sensitivity 82%, specificity 90%) The CBFR is a significant independent predictor of graft failure for up to 16 months.

Background: Inhaled nitric oxide (iNO) showed to improve oxygenation at low doses by reducing intrapulmonary shunt and to display antiviral properties at high doses. To assess the safety and potential benefits, we designed an exploratory clinical trial comparing low-dose with intermittent high-dose iNO to only intermittent high-dose iNO in hypoxemic COVID-19 patients., Methods: In this single-center interventional non-inferiority randomized trial (ClinicalTrials.gov, NCT04476992), twenty oxygen-dependent COVID-19 patients were randomly assigned to the high-dose (200 ppm for 30 min) + continuous low-dose (20 ppm) iNO group (iNO 200/20 ) or the high-dose iNO group (iNO 200 ). Methemoglobinemia (MetHb) assessed 48 h after iNO initiation was the primary endpoint. Reverse-transcription polymerase chain reaction for SARS-CoV-2, inflammatory markers during hospitalization, and heart ultrasounds during the iNO 200 treatments were evaluated., Results: MetHb difference between iNO groups remained within the non-inferiority limit of 3 %, indicating comparable treatments despite being statistically different (p-value<0.01). Both groups presented similar SpO 2 /FiO 2 ratio at 48 h (iNO 200 vs. iNO 200/20  341[334-356] vs. 359 [331-380], respectively, p-value = 0.436). Both groups showed the same time to SARS-CoV-2 negativization, hospital length of stay, and recovery time. iNO-treated patients showed quicker SARS-CoV-2 negativization compared to a similar group of non-iNO patients (HR 2.57, 95%CI 1.04-6.33). During the 228 treatments, iNO 200 and iNO 200/20 groups were comparable for safety, hemodynamic stability, and respiratory function improvement., Conclusions: iNO 200/20 and iNO 200 are equally safe in non-intubated patients with COVID-19-induced respiratory failure with regards to MetHb and NO 2 . Larger studies should investigate whether iNO 200/20 leads to better outcomes compared to non-iNO treated patients., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Nonsyndromic sporadic thoracic aortic aneurysm (nssTAA) is characterized by diverse genetic variants that may vary in different populations. Our aim was to identify clinically relevant variants in genes implicated in hereditary aneurysms in Russian patients with nssTAA. Forty-one patients with nssTAA without dissection were analyzed. Using massive parallel sequencing, we searched for variants in exons of 53 known disease-causing genes. Patients were found to have no (likely) pathogenic variants in the genes of hereditary TAA. Six variants of uncertain significance (VUSs) were identified in four (9.8%) patients. Three VUSs [ FBN1 c.7841C>T (p.Ala2614Val), COL3A1 c.2498A>T (p.Lys833Ile), and MYH11 c.4993C>T (p.Arg1665Cys)] are located in genes with "definitive" disease association (ClinGen). The remaining variants are in "potentially diagnostic" genes or genes with experimental evidence of disease association [ NOTCH1 c.964G>A (p.Val322Met), COL4A5 c.953C>G (p.Pro318Arg), and PLOD3 c.833G>A (p.Gly278Asp)]. Russian patients with nssTAA without dissection examined in this study have ≥1 VUSs in six known genes of hereditary TAA ( FBN1 , COL3A1 , MYH11 , NOTCH1 , COL4A5 , or PLOD3 ). Experimental studies expanded genetic testing, and clinical examination of patients and first/second-degree relatives may shift VUSs to the pathogenic (benign) category or to a new class of rare "predisposing" low-penetrance variants causing the pathology if combined with other risk factors.

Background and Aims: Cardiopulmonary bypass (CPB) and circulatory arrest (CA) can induce intestinal injury and consequently lead to multiple organ dysfunction. Nitric oxide (NO) has protective effects, but its effect on the intestine has not been studied. The study aimed to investigate intestinal injury variables and prove the intestinal protective effects of exogenous nitric oxide when modelling CPB and CA in an experiment., Methods: The study was performed on sheep ( n = 24). There were four groups: CPB, CPB + NO, CPB + CA and CPB + CA + NO. Sheep in NO groups received intraoperative inhalation of NO at a dose of 80 ppm. Groups without NO underwent CPB and CA without NO delivery. Defaecation rate, dynamics of intestinal fatty acid binding protein (i-FABP), coefficient of microviscosity and polarity in the areas of lipid-lipid and protein-lipid interactions of erythrocyte membranes were assessed. One hour after CPB, the intestinal tissue was collected and assessed for tissue concentrations of adenosine triphosphate (ATP) and lactate., Results: The defaecation rate after CPB was higher in the CPB + NO group than in the CPB group. The concentration of i-FABP after CPB was lower in the CPB + NO and CPB + CA + NO groups than in the CPB and CPB + CA groups. Erythrocyte deformability before and after CPB revealed no significant dynamics in groups with NO. The ATP concentration 1 h after CPB was higher in the CPB + NO group than in the CPB group. The morphological picture in groups with NO was better., Conclusion: When modelling CPB and CA, NO had a positive effect on the functional and structural state of the intestine and also maintained erythrocyte deformability., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Anaesthesia.)

This study aims to determine the effectiveness of administering 80 ppm nitric oxide in reducing kidney injury, mitochondrial dysfunction and regulated cell death in kidneys during experimental perfusion. Twenty-four sheep were randomized into four groups: two groups received 80 ppm NO conditioning with 90 min of cardiopulmonary bypass (CPB + NO) or 90 min of CPB and hypothermic circulatory arrest (CPB + CA + NO), while two groups received sham protocols (CPB and CPB + CA). Kidney injury was assessed using laboratory (neutrophil gelatinase-associated lipocalin, an acute kidney injury biomarker) and morphological methods (morphometric histological changes in kidney biopsy specimens). A kidney biopsy was performed 60 min after weaning from mechanical perfusion. NO did not increase the concentrations of inhaled NO 2 and methemoglobin significantly. The NO-conditioning groups showed less severe kidney injury and mitochondrial dysfunction, with statistical significance in the CPB + NO group and reduced tumor necrosis factor-α expression as a trigger of apoptosis and necroptosis in renal tissue in the CPB + CA + NO group compared to the CPB + CA group. The severity of mitochondrial dysfunction in renal tissue was insignificantly lower in the NO-conditioning groups. We conclude that NO administration is safe and effective at reducing kidney injury, mitochondrial dysfunction and regulated cell death in kidneys during experimental CPB.

Atherosclerosis and aneurysm of the aorta are relatively common pathological conditions that remain asymptomatic for a long period of time and have life-threatening and disabling complications. DNA methylation profiling in several regions (a dilated area, a nondilated area, and an atherosclerotic plaque) of the ascending aorta was carried out in patients with aortic aneurysm. DNA methylation was analyzed by reduced representation bisulfite sequencing (RRBS). Differences in methylation level between dilated and normal aortic tissues were detected for two CpG sites of the NR2F1-AS1 gene (|Δβ| > 0.2 and FDR < 0.05). In total, 586/480 differentially methylated CpG sites (DMSs) were identified by comparing atherosclerotic plaque samples with dilated/normal aortic tissues; 323/234 of the DMSs were hypermethylated and 263/246 were hypomethylated in atherosclerotic plaques. Most DMSs were in introns and intergenic regions; 88.2% of the DMSs were in the binding sites of transcription factors, among which ZNf263, ZFP148, PATZ1, NRF1, TCF12, and EGR1 play a role in the pathogenesis of atherosclerosis of various arteries and ELK1, ETS1, and KLF15 play a role in aortic aneurysms. Sixteen DMSs were found in the regions of the genes CMIP, RPH3AL, XRCC1, GATA5, EXD3, KCNC2, HIVEP3, ADCY9, CDCP2, FOLR1, WT1, MGMT, GAS2, CA1, PRSS16, and ANK3, whose protein products are involved in both aortic dissection and atherosclerosis in various arterial circulation regions. The protein products of the genes are involved in a wide range of biological processes, including mesenchyme development (GO:0060485; FOLR1, WT1, GATA5, HIVEP3, and KCNC2) and positive regulation of DNA metabolic processes (GO:0051054; MGMT, WT1, and XRCC1).

Performing cardiac surgery under cardiopulmonary bypass (CPB) and circulatory arrest (CA) provokes the development of complications caused by tissue metabolism, microcirculatory disorders, and endogenous nitric oxide (NO) deficiency. This study aimed to investigate the potential mechanisms for systemic organoprotective effects of exogenous NO during CPB and CA based on the assessment of dynamic changes in glycocalyx degradation markers, deformation properties of erythrocytes, and tissue metabolism in the experiment. A single-center prospective randomized controlled study was conducted on sheep, n = 24, comprising four groups of six in each. In two groups, NO was delivered at a dose of 80 ppm during CPB ("CPB + NO" group) or CPB and CA ("CPB + CA + NO"). In the "CPB" and "CPB + CA" groups, NO supply was not carried out. NO therapy prevented the deterioration of erythrocyte deformability. It was associated with improved tissue metabolism, lower lactate levels, and higher ATP levels in myocardial and lung tissues. The degree of glycocalyx degradation and endothelial dysfunction, assessed by the concentration of heparan sulfate proteoglycan and asymmetric dimethylarginine, did not change when exogenous NO was supplied. Intraoperative delivery of NO provides systemic organoprotection, which results in reducing the damaging effects of CPB on erythrocyte deformability and maintaining normal functioning of tissue metabolism.

Background: It remains difficult to understand the association between the local mechanical properties of ascending thoracic aorta aneurysm (asTAA), its tissue, and its cellular and molecular changes. The purpose of our study was to investigate the relationship between biomechanical properties, histopathological findings, and tissue biomarkers of asTAA., Methods: Intraoperative asTAA samples from 30 patients were studied. All samples were examined histologically and underwent a tensile test. We determined the tensile strength (σ в , MPa), the strain (ε, mm/mm˟%), and the area under the strength-strain curve (S) along with the concentrations of tissue matrix metalloproteinases (MMP-1 et al.) and their inhibitors, their interleukins (IL) -6 -10, and their tumor necrosis factor (TNF) -α., Results: It was found that 43.3 % of asTAA patients had atherosclerosis, 3.3 % had aortitis, and 53.3 % of patients had connective tissue dysplasia. Differences in the studied parameters between these subgroups were not found. Age correlated with ε (r = -0.49) and S (r = -0.54). ε was also associated with media fibrosis degree (r = -0.5), collagen/elastin ratio (r = -0.61), and IL-10 (r = 0.52). IL-10 correlated with collagen/elastin ratio (r = -0.58), TNF-α (r = 0.77), and MMP-1 (r = 0.71)., Conclusion: Tissue IL-10 has a protective effect on the elastic structures of the aortic wall and is positively associated with the activity of MMP-1 and pro-inflammatory cytokines. IL-6 is associated with media fibrosis degree, and negatively affects strength-strain parameters of asTAA samples., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Svetlana Sazonova reports financial support was provided by 10.13039/501100006769Russian Science Foundation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

This article describes a clinical case of successful repeated coronary bypass grafting 18 years after the initial surgery in a patient with non-ST-elevation acute coronary syndrome.

Aim: To evaluate manifestations of systemic inflammatory response (SIR) and the effect of the colchicine therapy on SIR severity in patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) with extracorporeal circulation (EC)., Material and Methods: This study included 100 patients aged 62+6.3 years with stable IHD and multivessel coronary atherosclerosis scheduled for CABG with EC. Patients of group 1 (n=50) were administered with a single dose of colchicine (Colchicum-Dispert) 500 µg 4 hours before surgery followed by 500 µg twice a day for 10 days after surgery. Patients of group 2 (n=50) received a standard treatment, including nonsteroid anti-inflammatory drugs after surgery. Severity of the inflammatory response was evaluated by measuring blood cytokines., Results: In the postoperative period, patient of group 1 showed a tendency toward a lower incidence of pleurisy and heart rhythm disorders in the form of paroxysmal atrial fibrillation (AF) (p=0.18). Levels of the anti-inflammatory cytokines, interleukin-10 (IL-10) and interleukin-6 (IL-6), were significantly increased in both groups at 6 hours after surgery (p&lt;0.05); at the same time, in group 1, IL-10 remained increased also at 10 days after surgery (р=0.0002). No significant time-related changes in the proinflammatory cytokines, tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β), were observed. At 3 days post-CABG, there were significant increases in tissue inhibitors of matrix metalloprotease 1 (TIMP-1) (р&lt;0.0001) and matrix metalloproteinase 9 (MMP-9) (р&lt;0.001); at the same time, patients of group 1 had lower MMP-9 concentrations than patients of group 2 (p&lt;0.05). At 10 days of postoperative period, these values were comparable with the background values. Increases in neopterin compared to preoperative values were found in both groups on days 3 and 10 after surgery (р &lt;0.0001)., Conclusion: CABG with EC is associated with the activation of SIR. The colchicine therapy at a dose of 500 µg 4 hours prior to surgery and 500 µg twice a day for 10 days after surgery reduces manifestations of SIR, which is clinically evident as a tendency to reduced incidence of pleurisy and arrhythmias, and does not result in the development of serious complications. The dynamics of matrix metalloproteinases indicates that the colchicine treatment is promising for decreasing the risk of CHF progression and myocardial remodeling in patients with IHD.

Among cardio-surgical patients, the prevalence of iron deficiency conditions reaches 70 %, and anemia is detected in less than 50% cases. Meanwhile, both anemia and latent iron deficiency are risk factors for adverse outcomes in cardio-surgical patients. These conditions are associated with a high frequency and greater volume of blood transfusions as well as with a longer stay in the hospital. Timely diagnosis and correction of iron deficiency, regardless of the presence of anemia, are mandatory at the stage of preoperative preparation. The use of oral iron medicines is limited by their low efficacy in this category of patients and a high risk of adverse events. Intravenous iron medicines have a high potential for correcting iron deficiency, and their efficacy and safety have been previously demonstrated. Administration of ferric carboxymaltose has proved beneficial in studies on iron deficiency correction in cardiological and cardio-surgical patients. In these patients, ferric carboxymaltose improved the dynamics of ferritin and hemoglobin, reduced the risk of blood transfusion, and decreased the duration of stay in the hospital. Preoperative intravenous administration of ferric carboxymaltose to cardio-surgical patients can improve clinical outcomes and the cost effectiveness of cardiac surgery.

The status of DNA methylation in the human genome changes during the pathogenesis of common diseases and acts as a predictor of life expectancy. Therefore, it is of interest to investigate the methylation level of regulatory regions of genes responsible for general biological processes that are potentially significant for the development of age-associated diseases. Among them there are genes encoding proteins of DNA repair system, which are characterized by pleiotropic effects. Here, results of the targeted methylation analysis of two regions of the human genome (the promoter of the MLH1 gene and the enhancer near the ATM gene) in different tissues of patients with carotid atherosclerosis are present. Analysis of the methylation profiles of studied genes in various tissues of the same individuals demonstrated marked differences between leukocytes and tissues of the vascular wall. Differences in methylation levels between normal and atherosclerotic tissues of the carotid arteries were revealed only for two studied CpG sites (chr11:108089866 and chr11:108090020, GRCh37/hg19 assembly) in the ATM gene. Based on this, we can assume the involvement of ATM in the development of atherosclerosis. "Overload" of the studied regions with transcription factor binding sites (according to ReMapp2022 data) indicate that the tissue-specific nature of methylation of the regulatory regions of the MLH1 and ATM may be associated with expression levels of these genes in a particular tissue. It has been shown that inter-individual differences in the methylation levels of CpG sites are associated with sufficiently distant nucleotide substitutions.

Aim      To evaluate quality of life (QoL), general survival, and development of complications in patents one year after surgical aortic valve (AV) replacement with a MedInzh-BIO xenopericardial carcass prosthesis.Material and methods  Degenerative AV disease is one of the most common cardiovascular diseases that gives place only to ischemic heart disease. Surgical correction of the AV defect should be aimed not only at hemodynamic outcomes but also at improvement of QoL. This study included 91 patients (48 women and 43 men), who were implanted with a MedInzh-BIO biological xenopericardial prosthesis in aortic position from January 2017 through March 2020. Mean age of patients was 69.96±4.4 years. QoL was evaluated with a standard SF-36 questionnaire. Also, survival and complications were analyzed one year after surgery.Results Data analysis before and one year after surgery showed a significant improvement of QoL. Postoperative one-year survival was 95.4 %, and major valve-associated complications were absent in 94.5% of cases. During one year, four patients died after 1, 6, 8, and 10 months of follow-up, respectively.Conclusion      The improvement of QoL following the AV replacement with a novel xenopericardial carcass prosthesis with the "easy change" system indicates the clinical and functional effectiveness of the used method. The results of the study demonstrated improvements of both the physical health component and the subjective emotional assessment. Postoperative one-year survival was 95.4 %, and major valve-associated complications were absent in 94.5% of cases.

miRNAs are vital molecules of gene expression. They are involved in the pathogenesis of various common diseases, including atherosclerosis, its risk factors, and its complications. A detailed characterization of the spectrum of functionally significant polymorphisms of miRNA genes in patients with advanced carotid atherosclerosis is an important research task. We analyzed miRNA expression and exome sequencing data of carotid atherosclerotic plaques of male patients (n = 8, 66-71 years of age, 67-90% degree of carotid artery stenosis). For further study and analysis of the association between the rs2910164 polymorphism of the MIR146A gene and advanced carotid atherosclerosis, we recruited 112 patients and 72 relatively healthy Slavic residents of Western Siberia. A total of 321 and 97 single nucleotide variants (SNVs) were detected in the nucleotide sequences of pre- and mature miRNAs in carotid atherosclerotic plaques. These variants were located in 206 and 76 miRNA genes, respectively. Integration of the data of exome sequencing and miRNA expression revealed 24 SNVs of 18 miRNA genes that were processed to mature form in carotid atherosclerotic plaques. SNVs with the greatest potential functional significance for miRNA expression predicted in silico were rs2910164:C>G (MIR146A), rs2682818:A>C (MIR618), rs3746444:A>G (MIR499A), rs776722712:C>T (MIR186), rs199822597:G>A (MIR363). The expression of miR-618 was lower in carotid atherosclerotic plaques of patients with the AC rs2682818 genotype of the MIR618 gene compared with the CC genotype (log2FC = 4.8; p = 0.012). We also found an association of rs2910164:C (MIR146A) with the risk of advanced carotid atherosclerosis (OR = 2.35; 95% CI: 1.43-3.85; p = 0.001). Integrative analysis of polymorphisms in miRNA genes and miRNA expression is informative for identifying functionally significant polymorphisms in miRNA genes. The rs2682818:A>C (MIR618) is a candidate for regulating miRNA expression in carotid atherosclerotic plaques. The rs2910164:C (MIR146A) is associated with the risk of advanced carotid atherosclerosis.

We analyzed the associations of the mechanical strength of dilated ascending aorta wall (intraoperative samples from 30 patients with non-syndromic aneurysms) with tissue MMPs and the cytokine system. Some samples were stretched to break on an Instron 3343 testing machine and the tensile strength was calculated; others were homogenized and the concentrations of MMP-1, MMP-2, MMP-7, their inhibitors (TIMP-1 and TIMP-2), and pro- and anti-inflammatory cytokines were determined by ELISA. Direct correlations between aortic tensile strength and concentrations of IL-10 (r=0.46), TNFα (r=0.60), and vessel diameter (r=0.67) and an inverse correlation with patient's age (r=-0.59) were revealed. Compensatory mechanisms supporting the strength of the ascending aortic aneurysm are possible. No associations of MMP-1, MMP-7, TIMP-1, and TIMP-2 with tensile strength and aortic diameter were found., (© 2023. Springer Science+Business Media, LLC, part of Springer Nature.)

The aim of the study is to analyze predictors of lethality, false lumen thrombosis, enlargement of aortic diameter, and frequency of aorta-related events in the early and remote postoperative periods for various types of proximal aortic dissection surgery using the logistic regression method., Materials and Methods: A retrospective observational comparison of the results of surgical treatment of 213 patients with the diagnosis of "DeBakey type I aortic dissection" has been carried out. The participants were divided into three groups: group 1 underwent classic aortic arch reconstruction using hemiarch technique or total reconstruction of the aortic arch with a multiple-branch prosthesis (n=121); group 2 was subjected to the hemiarch technique and implantation of bare-metal (uncoated) stents (n=55); in group 3, the "frozen elephant trunk" correction technique was used (n=37). The diagnosis of all patients included into the study was preoperatively confirmed by ultrasound and tomographic examination. Predictors of negative events have been identified by building the models of logistic regressions., Results: The multivariate model of logistic regression has revealed multiplicative significant predictors of lethality: postoperative neurological complications increased the probability of lethality by 3.39 (1.24-9.18) times and presence of a patent false lumen by 4.17 (1.49-13.68) times.Among the predictors of aorta-related events, the most important were connective tissue diseases (the probability increased by 6.68 (2.98-15.62) times), presence of partial thrombosis of the false lumen (the probability of event development increased by 2.39 (1.07-5.44) times), and aortic valve repair (the probability aorta-event occurrence increased by 2.84 (1.13-7.17) times).Hybrid prosthesis implantation appeared to be the most significant predictor of false lumen thrombosis increasing its probability by 4.19 (1.90-9.44) times among aortic repair methods, while a bare-metal stent implantation in contrast reduced the likelihood of false lumen thrombosis by 0.17 (0.03-0.62) times. Eventually, the type of repair had not any significant impact on the aorta-related events and lethality in the long-term period., Competing Interests: Conflicts of interest. The authors have no conflicts of interest to declare.

The aim of the study is to evaluate the efficacy of various types of hybrid technology in compare to the classical repair of the aortic arch of type I aortic dissection treatment in the in-hospital period., Materials and Methods: A retrospective observational study has been conducted, the results of surgical treatment of 213 patients with DeBakey type I aortic dissection operated on within the period from 2001 to 2017 were compared. Patients were divided into three groups: in group 1, patients undergone a hemiarch type of aortic repair or the total arch replacement (n=121); in group 2, a hemiarch aortic reconstruction and implantation of bare metal stent was performed (n=55); in group 3, a frozen elephant trunk technique was used (n=37). Taking into consideration the retrospective character of the investigation and nonequivalence of the groups by separate characteristics, they were equalized to improve the reliability of the results using the PSM (propensity score matching) pseudorandomization method. As a result, three groups of comparison were formed which were equalized by the PSM method and called PSM 1, 2, and 3. The mortality and complication rate in the in-hospital period, as well as the frequency of false lumen thrombosis development depending on the treatment method, have been analyzed., Results: The mortality rate in the PSM 1 group was 15 patients: group 1 (standard technique) - 10 patients (9%), group 2 (uncoated stents) - 5 patients (11%). A significant difference was found in the number of major bleedings (group 1 - 8%, group 2 - 21%, p=0.031) and cases of bowel ischemia (group 1 - 1%, group 2 - 9%, p=0.028). Complete false lumen thrombosis of the thoracic aorta was observed significantly more often in group 1 than in group 2 (22% vs 5%, p=0.015).In the examined group PSM 2, hospital mortality rate was 4 patients: group 1 - 3 patients (12%), group 3 - 1 patient (3%). No differences between the groups were found in the number of complications. In group 3, complete false lumen thrombosis of the thoracic aorta was observed in 59% of cases, whereas in group 1 it was found only in 4% of patients (p<0.001).In comparison group PSM 3, the mortality was 8 patients: group 2 - 5 patients (11%), group 3 - 3 patients (9%). The number of neurological complications differed significantly: in group 2 - 27%, in group 3 - 6% (p=0.019). Besides, 3% of cases of complete false lumen thrombosis were found in group 2, while there appeared 55% (p<0.001) of such patients in group 3., Conclusion: The comparative analysis showed that the use of bare metal stents and hybrid prostheses demonstrated a comparable low level of in-hospital mortality compared to the standard surgical technique of aortic arch reconstruction. At the same time, the use of the bare metal stents is associated with a higher rate of perioperative complications (bleeding, postoperative bowel ischemia, neurological complications) compared to the standard treatment and repair of the aortic dissection using hybrid prostheses. Complete thrombosis of the false lumen occurred significantly less commonly in case of using bare metal stents than with standard treatment and hybrid prostheses., Competing Interests: Conflicts of interest. The authors have no conflicts of interest to declare.

Ascending thoracic aortic aneurysm is a life-threatening disease, which is difficult to detect prior to the occurrence of a catastrophe. Epidemiology patterns of ascending thoracic aortic dilations/aneurysms remain understudied, whereas the risk assessment of it may be improved. The electronic databases PubMed/Medline 1966-2022, Web of Science 1975-2022, Scopus 1975-2022, and RSCI 1994-2022 were searched. The current guidelines recommend a purely aortic diameter-based assessment of the thoracic aortic aneurysm risk, but over 80% of the ascending aorta dissections occur at a size that is lower than the recommended threshold of 55 mm. Moreover, a 55 mm diameter criterion could exclude a vast majority (up to 99%) of the patients from preventive surgery. The authors review several visualization-based and alternative approaches which are proposed to better predict the risk of dissection in patients with borderline dilated thoracic aorta. The imaging-based assessments of the biomechanical aortic properties, the Young's elastic modulus, the Windkessel function, compliance, distensibility, wall shear stress, pulse wave velocity, and some other parameters have been proposed to improve the risk assessment in patients with ascending thoracic aortic aneurysm. While the authors do not argue for shifting the diameter threshold to the left, they emphasize the need for more personalized solutions that integrate the imaging data with the patient's genotypes and phenotypes in this heterogeneous pathology.

Background: The clinical significance of the false lumen (FL) thrombosis after the thoracic aortic surgery consists in the correlation with aortic remodeling. The aim of the study was to analyze the incidence of the FL thrombosis of the thoracoabdominal aorta after the frozen elephant trunk (FET) procedure in acute and chronic aortic dissection., Methods: A total of 57 consecutive patients with type A and B aortic dissection (AD) underwent the FET procedure between March 2012 and December 2020 were included in a retrospective study. All of the patients were divided in two groups: acute (N.=18) and chronic (N.=39) AD. Early and 2-year outcomes were evaluated in both groups. Computed tomography scans were obtained along the entire aorta for the aortic status assessment., Results: There were no statistically significant differences in early mortality and postoperative outcomes in both groups. The 2-year survival rate in acute and chronic AD was 74.7±10% vs. 71.4±7% (P=0.573), respectively. In the follow-up, the FL thrombosis rate, changes of the true lumen and total aortic diameters did not differ significantly between the analyzed groups of patients. The freedom from negative aortic remodeling was 62.2±26% in acute AD versus 76.2±11% in chronic AD (P=0.853). One (5.6%) and 4 (10.3%) distal aortic reinterventions were performed in acute and chronic AD, respectively., Conclusions: False lumen thrombosis rate after the FET procedure did not differ significantly in acute and chronic AD.

Objective: Acute kidney injury (AKI) is a serious complication of cardiac surgery with cardiopulmonary bypass (CPB). The aim of this study was to evaluate the effects of nitric oxide (NO) supplementation to the CPB circuit on the development of cardiac surgery-associated AKI., Methods: This prospective randomized controlled study included 96 patients with moderate risk of renal complications who underwent elective cardiac surgery with CPB. The study protocol was registered at ClinicalTrials.gov (identifier NCT03527381). Patients were randomly allocated to either NO supplementation to the CPB bypass circuit (NO treatment group; n = 48) or usual care (control group; n = 48). In the NO treatment group, 40-ppm NO was administered during the entire CPB period. The primary outcome was the incidence of AKI., Results: NO treatment was associated with a significant decrease in AKI incidence (10 cases [20.8%] vs 20 cases [41.6%] in the control group; relative risk, 0.5; 95% confidence interval, 0.26-0.95; P = .023) and a higher median urine output during CPB (2.6 mL/kg/h [interquartile range (IQR), 2.1-5.08 mL/kg/h] vs 1.7 mL/kg/h [IQR, 0.80-2.50 mL/kg/h]; P = .0002). The median urinary neutrophil gelatinase-associated lipocalin level at 4 hours after surgery was significantly lower in the NO treatment group (1.12 ng/mL [IQR, 0.75-5.8 ng/mL] vs 4.62 ng/mL [IQR, 2.02-34.55 ng/mL]; P = .005). In the NO treatment group, concentrations of NO metabolites were significantly increased at 5 minutes postclamping, at 5 minutes after declamping, and at the end of the operation. Concentrations of proinflammatory and anti-inflammatory mediators and free plasma hemoglobin did not differ significantly between the 2 groups., Conclusions: NO administration in patients at moderate risk of renal complications undergoing elective cardiac surgery with CPB was associated with a lower incidence of AKI., (Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

The authors report a 76-year-old female with mega-aorta syndrome that was asymptomatic for a long time. The first symptoms appeared after ascending aorta enlargement up to 81 mm and compression of superior vena cava. The patient underwent frozen elephant trunk procedure. The authors demonstrate the possibilities of assessing the aortic strain by ECG-synchronized CT angiography and 2D transesophageal ultrasound with speckle tracking. Potential role of these methods in determining the type of aortic reconstruction is discussed.

We describe a case report of a 63-year-old man who presented with chronic left-hand weakness and the absence of a pulse in the left arm. Thoracoabdominal computed tomography (CT) revealed an extensive thoracic aortic mural thrombus. Initial anticoagulation therapy did not provide a positive result, so the patient was referred for surgery. Hybrid aortic arch surgery using the frozen elephant trunk technique was performed with excellent early outcomes. A CT performed in the early postoperative period showed that the thrombus was completely excluded from the aortic lumen by the hybrid graft. No thrombus dislodgment was detected. No thrombus recurrence was observed during 19 months of follow-up., Competing Interests: Conflict of Interest The authors declare no conflicts of interest., (International College of Angiology. This article is published by Thieme.)

Understanding the mechanisms underlying the connection between somatic mosaicism and cardiovascular disease is likely essential for the future of personalized medicine. This article is aimed at providing data on somatic mosaicism in human carotid atherosclerosis. An advanced carotid atherosclerotic plaque and white blood cells were collected simultaneously from each patient (eight Slavic males, aged 67 ± 3.8 years [mean ± SD]) to assess the spectrum of germline and somatic genetic variants. Exome sequencing of DNA from the samples was performed with the SureSelect Clinical Research Exome Enrichment Kit (Agilent Technologies) and HiSeq 1500 (Illumina). The dataset contains germline and somatic single-nucleotide variants and small indels identified in the advanced carotid atherosclerotic plaque and white blood cells of each patient. This dataset does not include copy number variants owing to a lack of suitable tools for reliable calculation of copy numbers from exome sequencing data on cancer-unrelated samples. The dataset should help to understand somatic mosaicism in cardiovascular diseases and to identify copy number variants by means of more appropriate newer tools in the future., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s). Published by Elsevier Inc.)

We compared the expression of Са 2+ -ATPase (SERCA2a), calsequestrin (CASQ2), ryanodine receptors (RyR2) proteins and their genes (ATP2A2, CASQ2, and RYR2) in coronary heart disease (CHD) patients with and without comorbid type 2 diabetes mellitus. All studies were performed on the right atrial appendages resected during coronary bypass surgeries. Expression of SERCA2a and RyR2 proteins and their ATP2A2 (p=0.046) and RYR2 genes in comorbid pathology was significantly (p=0.042) higher (by 1.2 and 2 times; p=0.025). The expression of CASQ2 protein and its gene did not differ significantly between the groups (p=0.82 and p=0.066, respectively). It was concluded that the expression of SERCA2a and RyR2 proteins and their genes (but not CASQ2 and its gene) is elevated in CHD associated with type 2 diabetes mellitus. Expression of the studied proteins correlated with the expression of their genes. Increased expression of CASQ2 protein and its gene can probably prevent imbalance of the Ca 2+ -transporting systems in cardiomyocytes and contractile dysfunction of the myocardium, even in CHD associated with type 2 diabetes mellitus., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: The objective of the study was to evaluate early and midterm outcomes after the frozen elephant trunk (FET) procedure with different proximal landing zones in patients with aortic dissection., Methods: Forty-four patients with type A and type B aortic dissection that extended down to the abdominal aorta were enrolled in the study. All of the patients had the FET procedure. The patients were divided in 2 groups according to the level of the proximal landing zone: the zone 2 (Z2) group and zone 3 (Z3) group. Early and midterm outcomes including the false lumen (FL) thrombosis rate were monitored in both groups., Results: The incidence of stroke, delirium and spinal cord ischaemia was 5.9% vs 3.7% (P = 0.533), 5.9% vs 7.4% (P = 0.903) and 5.9% vs 0 (P = 0.533) in the Z2 and Z3 groups, respectively. The 30-day mortality was 9.1% in both groups. The mean distal landing zone was T7.5 (T7; T9) in the Z2 group vs T9 (T8; T10) in the Z3 group (P = 0.668). The 2-year overall survival was 62.2% with no significant difference in the Z2 and Z3 groups (61.6% vs 64.2%; P = 0.940). There were no aortic-related deaths during the follow-up period. Freedom from reintervention at 24 months was 73% and was comparable between Z2 and Z3 (74.1% vs 91.7%; P = 0.123). The rate of early complete FL thrombosis was comparable in the Z2 and Z3 groups. By 24 months of observation in the Z3 group, the rate of complete FL thrombosis was significantly higher (60% vs 77%; P = 0.046)., Conclusions: No statistically significant differences were observed between landing zones 2 and 3 during the FET procedure with regard to early outcomes. Proximalization of the FET was associated with a shorter FL thrombosis in the midterm follow-up period that affected the distal aortic reintervention rate., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: Effective treatment of patients with ischemic cardiomyopathy is one of the most difficult issues in contemporary cardiac surgery. The aim of this study was to evaluate the long-term effectiveness of reconstructive interventions on the left ventricle during chronic heart failure in patients with ischemic cardiomyopathy., Methods: Between March 2013 and December 2017, 178 patients underwent surgical treatment for ischemic cardiomyopathy. Isolated coronary artery bypass grafting was compared with coronary artery bypass grafting with left ventricular reconstruction, using propensity score matching analysis. The primary endpoints of the study were hospital mortality and long-term survival., Results: After propensity score matching, 29 pairs of patients were compared. The 30-day hospital mortality was comparable (6.8% versus 6.8%, p  = 0.952), the average follow-up was 37.4 ± 12.6 months, with no statistically significant difference in mortality from all causes ( p  = 0.352). After coronary artery bypass in combination with left ventricular reconstruction, patients showed a statistically significant decrease in clinical and functional indicators of chronic heart failure compared to those who had coronary artery bypass grafting alone, in terms of peak oxygen consumption (15.3 versus 13.5 mL·kg -1 ·min -1 , p  = 0.043) and N-terminal pro-brain natriuretic peptide concentrations (298.6 versus 461.1 pg·mL -1 , p  = 0.032)., Conclusions: Compared to isolated coronary artery bypass, coronary artery bypass in combination with left ventricular reconstruction for the treatment of ischemic cardiomyopathy leads to a significant decrease in the clinical and functional parameters of chronic heart failure in the long-term postoperative period.

Aim      To study time-related changes in bone remodeling markers in patients with ischemic heart disease (IHD) associated with type 2 diabetes mellitus (DM) and disorders of carbohydrate metabolism (CM). Also, a possibility was studied of using these markers for evaluation of breast bone reparative regeneration in early and late postoperative periods following coronary bypass (CB).Materials and methods           This study included 28 patients with IHD and functional class II-III exertional angina after CB. Patients were divided into 2 groups based on the presence (group 1) and absence (group 2) of CM disorders. Contents of osteocalcin (OC), C-terminal telopeptide (CTTP) of type 1 collagen, deoxypyridinoline (DPD), and alkaline phosphatase bone isoenzyme (ALPBI) were measured by enzyme immunoassay on admission (Т1) and at early (Т2) and late (Т3) postoperative stages. Sternal scintigraphy with a radiopharmaceutical (RP) was performed at stage 3 following sternotomy.Results The content of OC and CTTP was reduced in group 1 compared to the values in the group without CM disorders (р&lt;0.005) at stages Т1 and Т2. There were no significant intergroup differences in concentrations of ALPBI and DPD throughout the study. Time-related changes in OC, CTTP, and DPD had some intergroup differences: the increase in biomarkers was observed in group 1 considerably later, at stage Т3 (р&lt;0.005), while in group 2, it was observed at stage T2 after sternotomy. Scintigraphy revealed significant intergroup differences in the intensity of RP accumulation in sternal tissue.Conclusion      The intergroup differences in the content of biomarkers evidenced a disbalance among processes of formation and resorption of bone tissue and delayed remodeling processes in patients with IHD associated with type 2 DM and CM disorders. The study confirmed significance of comprehensive evaluation of time-related changes in markers for bone tissue metabolism and sternal scintigraphy for diagnosis and evaluation of sternal reparative regeneration following sternotomy in patients with IHD associated with type 2 DM and disorders of CM metabolism.

Hydraulic dilatation is used in everyday cardiac surgical practice for assessment of leak-proofness and prevention of spasm of autovenous shunts. The classical technique envisages manual high-pressure solution injection, which exerts a negative effect on venous conduits and is one of the causes of incompetence of shunts in the postoperative period. Limiting pressure during hydraulic dilatation is necessary to minimize morphological changes and preserve functional viability of venous conduits. The purpose of the present study was to develop and assess efficacy of a standardized methodology of controlled hydraulic dilatation of venous conduits. We worked out an original technique of controlled hydraulic dilatation of venous conduits under perfusion pressure of artificial circulation. This was followed by assessing morphological changes and functional viability of venous segments after controlled hydraulic dilatation as compared with veins after conventional uncontrolled hydraulic dilatation and the control intact veins. Uncontrolled hydraulic dilatation was accompanied by endothelial damage (p<0.05), multiple conduit wall tears (p<0.05) according to the findings of light microscopy, leading to a significant decrease in the functional vitality of the venous conduit (a decreased reaction to hyperpotassium solution, phenylephrine, acetylcholine and sodium nitroprusside (p<0.05) according to the findings of biophysical examination. Our original technique of controlled hydraulic dilatation of venous conduits under perfusion pressure of artificial circulation made it possible not only to evaluate leak-proofness of the vessel but also to achieve comparable to the control segments parameters of structural integrity of the venous wall and functional viability of the conduit. Thus, using the developed method of controlled hydraulic dilatation makes it possible to minimize morphofunctional alterations in venous conduits, influencing the function of autovenous shunts.

Aim: The aim of this study was to identify predictors of adverse events after the frozen elephant trunk procedure in the early postoperative period., Patients and Methods: Between March 2012 and March 2020, a total of 273 patients were operated on for aortic pathology. A retrospective analysis aimed at identifying probable predictors was performed on 83 patients who underwent the FET procedure. Uni- and multivariate logistic regression was used to identify predictors of such adverse events as postoperative delirium, respiratory failure, acute kidney injury, and in-hospital mortality., Results: According to the findings of the optimal multivariate regression model, separate reimplantation of the supra-aortic branches was a significant predictor of postoperative delirium (OR 10.41; 95% CI 1.1-35.45; p=0.05); significant risk factors for prolonged respiratory support were the duration of surgery (OR 1.02; 95% CI 1.01-1.03; p<0.001) and postoperative acute renal injury (OR 8.72; 95% CI 1.67-57.38; p=0.014). Independent risk factors for postoperative renal injury turned out to be the true lumen diameter of the descending aorta (OR 1.3; 95% CI 1.1-1.72; p=0.015) and chronic type A aortic dissection (OR 44.07; 95% CI 3.29-2354.8; p=0.014); statistically significant risk factors for in-hospital mortality were multiple organ dysfunction syndrome (OR 14.34; 95% CI 1.69-155.48; p=0.016) and coronary artery stenosis (OR 3.36; 95% CI 1.19-13.26; p=0.042)., Conclusion: Separate reimplantation of the supra-aortic branches, duration of surgery, acute kidney injury, chronic aortic dissection, multiple organ dysfunction syndrome, true lumen diameter of the descending aorta, coronary atherosclerosis and haemoglobin level were statistically significant predictors of adverse events in the early postoperative period.

The aim of this study was to develop and test a technique for scintigraphic examination of the thoracic aorta, which allows for visualizing foci of inflammation., Materials and Methods: The study included 15 patients (median age - 61 [47; 73] years) with aortic dilatation more than 45 mm and thoracic aortic aneurysm who were candidates for surgical treatment. All patients underwent a chest scintigraphy with 99m Tc-pyrophosphate 48 h before surgery to identify foci of inflammation in the aortic wall. The new technique included intravenous administration of 370 MBq of a radiopharmaceutical (RP), registration of scintigrams at 3 and 6 h after injection of RP in a tomographic mode combined with X-ray computed tomography. After the image reconstruction, subtraction of the later scintigrams from the early ones was performed, followed by analysis of the final images. The results of scintigraphy were compared with the histological data obtained from intraoperative samples of resected aorta., Results: According to the results of this novel scintigraphic technique, artifacts from the radioactivity of the vascular blood pool were eliminated and pathological RP uptake was identified in 5 (33.3±1.5%) out of 15 examined patients. The "focus/vessel lumen" ratio averaged at 1.47 [1.30; 1.48]. Histological examination of resected aorta samples confirmed the presence of chronic inflammation in 4 (26.7±1.3%) out of 15 patients. Parameters of diagnostic efficiency were: sensitivity - 100%, specificity - 91%, diagnostic accuracy - 93%., Conclusion: The method of scintigraphic diagnostics of inflammatory processes in the aorta using 99m Tc-pyrophosphate, supplemented by subtraction of the late from the early images, makes it possible to eliminate artifacts from the radioactivity of the aortic blood pool and to reveal the pathological RP accumulation indicating the areas of inflammation in the aortic wall., Competing Interests: Conflicts of interest. The authors declare no conflicts of interest.

We present a case of a 42-year-old male patient with severe supravalvular aortic stenosis associated with aortic and mitral valve stenosis as well as an anomalous origin of the right coronary ostium caused by deletion in the q11.23 region of the human chromosome 7 in a patient with Williams-Beuren syndrome., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

From 5 to 10% of patients presenting with acute coronary syndrome and receiving dual antiplatelet therapy require surgical myocardial revascularization. Dual antiplatelet therapy considerably increases the risk of surgical bleeding. Endoscopic harvesting of the great saphenous vein is a technique that can make it possible to decrease the injury and to minimize blood loss. The study included a total of 32 patients presenting with acute coronary syndrome and undergoing coronary artery bypass grafting. They were subdivided into two groups: Group One (study group) was composed of 17 patients subjected to endoscopic harvesting of the great saphenous vein in the flap. Group Two (comparison group) consisted of 15 patients undergoing an open technique of harvesting of the vein in the flap. During the entire perioperative period, the amount of discharge through drainages from the mediastinum did not differ significantly (958±173 ml for Group One patients and 1005±165 ml for Group Two patients, p=0.47). The amount of discharge from the bed of the great saphenous vein on the lower extremities in Group One patients turned out to be less than in Group Two patients (443±37 ml vs. 570±77 ml, p=0.04). A higher haemoglobin content in the total blood count was observed in the postoperative period in the Study Group patients (90±30 g/l vs. 74±21 g/l, respectively, p=0.03). The necessity to use donor blood preparations in Group One patients turned out to be less (transfusion of erythrocytic mass 0 and 2 (0; 2) doses, p=0.001; fresh frozen plasma 2 (0; 3) and 5 (3; 8) doses, respectively, p=0.0001). The duration of hospital stay amounted to 8±1.1 days in the study group and to 15±4.5 days in the comparison group (p<0.0001). Hence, this approach makes it possible to control blood loss in high-risk patients undergoing coronary artery bypass grafting on the background of dual antiplatelet therapy, to decrease the amount of donor blood, and to reduce the length of hospital stay.

Aim: This study was undertaken to evaluate the efficacy of three-stage measurement of the transit-time flow through coronary bypass grafts with the help of flowmetry for early verification of technical errors during on-pump coronary artery bypass graft surgery., Patients and Methods: We performed an intraoperative analysis of 214 bypass grafts with the help of three-stage flowmetry. The first stage of measuring was performed on-pump with and without the proximal loop test, the second stage of measurement was performed after weaning the patient off the heart-lung machine, and the third stage of measurement was carried out after heparin inactivation prior to chest wound closure., Results: Amongst the 214 transplants regarded as functioning, intraoperative flowmetry revealed insufficient blood flow in 9 (4.2%) cases. Technical surgical errors were confirmed in these shunts during revision thereof. In 6 (2.8%) of the 9 such grafts we detected non-optimal parameters of flowmetry during the first measurement (while the heart was stopped); of these, in 5 (2.3%) cases non-optimal blood flow was verified with the use of the proximal loop test on the target coronary artery and in 1 (0.47%) case without it. In another one (0.47%) of the nine such transplants, inadequate blood flow was revealed during the second measurement, which confirmed technical errors in proximal anastomoses. In a further 2 (0.93%) of the 9 such transplants we observed low parameters of blood flow during the third measurement, which was related to kinking of the shunts due to their excessive length. All surgical errors were corrected immediately at the stage of verification thereof., Conclusion: The strategy of three-stage assessment of flowmetry makes it possible to ensure and confirm adequate functionality of coronary artery bypass grafts at all stages of the operation, thus allowing timely verification and immediate correction of any technical problems with coronary artery bypass grafts.

In this article we present discussion of the current state of the problem of surgical treatment of ischemic cardiomyopathy (ICM). The pathophysiological aspects of left ventricular remodeling in patients with ICM are also covered. A detailed characterization of methods for assessing the myocardial viability is given and their role in patients with ICM is shown. The problem of right ventricular dysfunction in ICM is discussed. Main attention is focused on the methods of surgical treatment of ICM. Limitations of the Surgical Treatment for Ischemic Heart Failure (STICH) study are analyzed. The article is intended for cardiologists, general practitioners and cardiac surgeons.

Objectives: The aim of this study was to evaluate abdominal aortic remodelling after the standard compared with the elongated frozen elephant trunk (FET) technique in patients with aortic dissection., Methods: Twenty-six patients underwent surgery and were randomized into 2 groups. Fifteen patients were treated with the standard FET technique. Eleven patients were treated with the advanced FET technique using an additional thoracic stent graft implanted down to the coeliac artery, within 30 days after the first stent graft implantation. Preoperative and postoperative and 5-year follow-up computed tomography aortic scans were obtained along the stent graft (A), between the distal edge of the graft and the coeliac trunk (B) and at the abdominal aorta (C)., Results: In the standard FET group, positive and stable aortic remodelling occurred in segments A (100%), B (87%) and C (87%). Negative remodelling was found in 2/15 (13%) patients; 1 patient had an endovascular reintervention. In the elongated FET group, positive and stable remodelling were observed in segments A (100%), B (100%) and C (90.9%). Negative remodelling occurred in 1/11 (9.1%) patients. No reintervention was required. Cumulative survival, freedom from negative remodelling and distal aortic reintervention in the standard FET group and the elongated FET group were 72 vs 100% (P = 0.29); 67.5 vs 80% (P = 0.58) and 75 vs 100% (P = 0.61), respectively., Conclusions: The standard FET technique is an adequate measure to induce false lumen thrombosis and improve abdominal aortic remodelling. The elongated FET technique seems to be superior to the standard FET procedure in terms of freedom from aortic remodelling and the distal reintervention rate., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

This case report describes simultaneous approach that enables to replace the ascending aortic aneurysm complicated with atherosclerotic lesions of the descending aorta (the "shaggy aorta" syndrome) using frozen elephant trunk technique.

Objectives: The aim of this pilot study was to elucidate the effects of exogenous nitric oxide (NO) supply to the extracorporeal circulation circuit for cardioprotection against ischemia-reperfusion injury during coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB)., Methods: A total of 60 patients with coronary artery disease scheduled for CABG with CPB were enrolled in a prospective randomized study. Patients were allocated randomly to receive treatment according to standard or modified CPB protocol where 40-ppm NO was added to the CPB circuit during cardiac surgery. The primary endpoint was the measurement of cardiac troponin I (cTnI). The secondary end points consisted in the measurements of creatine kinase-muscle/brain fraction (CK-MB) and vasoactive inotropic score (VIS)., Results: NO delivered into the CPB circuit had a cardioprotective effect. The level of cTnI was significantly lower in NO-treated group compared with the control group 6 hours after surgery: 1.79 ± 0.39 ng/mL versus 2.41 ± 0.55 ng/mL, respectively (P = .001). The CK-MB value was significantly lower in NO-treated group compared with the control group 24 hours after surgery: 47.69 ± 8.08 U/L versus 62.25 ± 9.78 U/L, respectively (P = .001); and the VIS was significantly lower in the NO-treated group 6 hours after the intervention., Conclusions: NO supply to the CPB circuit during CABG exerted a cardioprotective effect and was associated with lower levels of VIS and cardiospecific blood markers cTnI and CK-MB., (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

The study was aimed at analysing the immediate results of various surgical approaches to prosthetic repair of ascending aortic aneurysms. We analysed the data of 113 patients operated on for an ascending aortic aneurysm from 2008 to 2017. All patients were divided into two comparable groups. Group One patients (n=43) underwent prosthetic repair of the ascending portion of the aorta with formation of a distal anastomosis proximal to the level of the brachiocephalic trunk, Group Two patients (n=70) were subjected to reconstruction of the ascending aorta with aortic arch plasty ('hemiarch'). In the early postoperative period in Group One and Group Two patients, the frequency of adverse cardiac events amounted to 3 (7.0%) and 1 (1.5%) cases (p=0.339), with prolonged mechanical ventilation required in 12 (18.6%) and 6 (8.6%) cases and resternotomy required in 8 (18.6%) and 4 (5.7%) cases, respectively. The postoperative 30-day mortality in the group of isolated prosthetic repair of the ascending aorta amounted to 11.6% (5 cases) and in the group of patients with the hemiarch reconstruction to 3.0% (2 cases). No neurological complications were observed. Hemiarch prosthetic repair of the aorta is an effective and safe surgical method of treatment. This approach does not increase the risks for cardiac, neurological, pulmonary, haemorrhagic complications in the immediate postoperative period as compared with prosthetic repair of only the ascending portion of the aorta.

Analysed herein is efficacy of hybrid intervention according to the 'frozen elephant trunk' procedure in the medium-term period of follow-up in patients operated on for aortic dissection. During the period from 2012 to 2018, a total of 44 'frozen elephant trunk' procedures were carried out for Stanford type A and B thoracic aortic dissections. All interventions were performed in conditions of moderate hypothermic circulatory arrest (25-28 °C) with unilateral cerebral perfusion through the brachiocephalic trunk. The mean diameter of the implanted stent grafts amounted to 27.7±2.8 mm (range 24-30 mm). The distal edge of the stent graft was located at the level below the Th9 in more than 65% of cases (range Th7-Th12). The stent grafts were fixed proximally at the levels Z0-Z3, predominantly in the Z3 zone (72.7%). Thirty-day mortality amounted to 6.8%, with in-hospital mortality of 15.9%. Five-year survival in acute and chronic type A aortic dissection (AD) amounted to 100 and 80%, respectively (p=0.175). In acute type B aortic dissection five-year survival amounted to 62.2%, being 25.0% for chronic AD (p=0.057). Freedom from reinterventions for acute and chronic type A aortic dissection amounted to 100 and 66.7%, respectively (p=0.286). Freedom from aortic reinterventions for acute and chronic type B aortic dissection amounted to 100% and 75%, respectively (p=0.123). Reconstructive operations performed according to the 'frozen elephant trunk' technique appear to be effective surgical treatment in patients with thoracic aortic dissection, yielding satisfactory clinical results during a medium-term follow-up period.

Improvement of surgical treatment for ischaemic heart disease is one of the main trends in modern medicine. After the operation of coronary bypass grafting, further functioning of blood flow in the grafts largely depends upon its domination over the native blood flow in the target coronary arteries. Therefore, intraoperative diagnosis of functional competence of coronary bypass grafts by means of flowmetry is currently of special importance. The purpose of this study was flowmetric quantitative assessment of the curves of blood flow through the coronary bypass grafts, depending on the degree of stenosis of the target coronary arteries. A total of 135 patients were examined during our study. We evaluated the curves of blood flow through the bypass grafts from the left internal thoracic artery to the anterior descending artery. The bypass grafts were divided into three groups: the 1st group (n=47) with moderate stenosis of the coronary arteries (from 50 to 75%); the 2nd group (n=42) with a more pronounced lesion of the target vessel (from 75 to 99%), and the 3rd group (n = 46) with occluded coronary arteries (100%). It was revealed that the flow rate (Q, ml/min) in group one was lower (17±3.1) than in group two (33±5.3) and group three (45±3.4). Also, differences were revealed in the resistance index of the grafts: it turned out to be higher in group one (5.2±1.1) and group two (4.5±0.9) as compared with group three (1.8±0.5). However, there was no between-group difference in diastolic filling of the grafts, which amounted to 58±13, 61±10 and 64±9% for groups one, two and three, respectively. By the shape of the curve, we assessed the reverse systolic peak whose presence prevailed in the grafts of group one (15 of 47; 31.9%) and group two (11 of 42; 26.2%) as compared with that in the grafts of group three (5 of 46; 10.8%). The obtained findings confirm higher frequency of the presence of competitive blood flow in the grafts used on non-occluded coronary arteries.

In this study we performed a comparative gene expression analysis of carotid arteries in the area of atherosclerotic plaques and healthy internal mammary arteries of patients with advanced atherosclerosis by using microarray HumanHT-12 BeadChip ("Illumina"). The most down-regulated genes were APOD, FABP4, CIDEC and FOSB, and up-regulated gene was SPP1 (|FC|>64; pFDR<0.05). The majority of differentially expressed genes were down-regulated in advanced atherosclerotic plaques. Unexpectedly, genes involved in immune and inflammatory responses were down-regulated in advanced atherosclerotic plaques to compare with the healthy arteries (arachidonic acid metabolism, cytokine-cytokine receptor interaction, NOD-like receptor signaling pathway, Jak-STAT signaling pathway, TNF signaling pathway). "Cellular response to metal ion" (metallothioneins) and "Extracellular matrix organization" were the most significant Gene ontology terms among the down- and up-regulated genes, respectively.

Objectives: The aim of the study was to access the extended occlusion of the intercostal arteries by a stent graft in the development of postoperative spinal cord injury during aortic arch surgery using the frozen elephant trunk technique., Methods: A total of 37 consecutive patients underwent total aortic arch surgery using the frozen elephant trunk technique between March 2012 and July 2017. The mean age of the patients was 54.7 ± 10.5 years. Type A and Type B aortic dissections were the indications for surgery. Moderate hypothermia and antegrade cerebral perfusion via the innominate artery were utilized. The mean diameter of the implanted stent graft was 27.7 ± 2 mm (range 24-30 mm)., Results: No permanent spinal cord injuries occurred. The distal edge of the stent graft was in the T7-T12 range. Its lower edge was implanted at the T9-T12 level in 25 (67.6%) cases. Preoperatively, the mean number of intercostal arteries was 10 ± 1 on the left side and 10 ± 2 on the right side (P = 0.59). Postoperatively, the mean number of open segmental arteries was 3 ± 2 on the left and 4 ± 1 on the right (P = 0.003)., Conclusions: The frozen elephant trunk procedure is associated with the occlusion of most (two-thirds) of the intercostal arteries. Maintenance of adequate blood flow in the subclavian and iliac arteries is an integral prerequisite for a favourable outcome. The level of the deployment of the distal edge of the stent graft does not play a defining role.

The authors studied the parameters of arterial and venous blood flow in patients presenting with haemodynamically significant atherosclerosis of the carotid arteries before and after carotid endarterectomy, as well as while carrying out functional tests. Comparing the indices of arterial blood flow in the Study Group consisting of 52 patients and the Control Group comprising 15 apparently healthy volunteers at rest prior to the operation revealed statistically significant differences of volumetric parameters of blood flow in the internal carotid artery. The obtained results showed that the breath-holding test was accompanied and followed by increased velocity of blood flow in the middle cerebral artery (MCA) on the side contralateral to stenosis, with the reactivity index (RI) amounting to 0.98±0.20, which statistically significantly differed from the RI in the Control Group patients (1.28±0.13). The forced respiration test demonstrated a decrease in the volumetric indices of blood flow in the MCA on the side of stenosis, as well as an increase of the maximum end-diastolic velocity of blood flow on the side contralateral to stenosis. The test with sublingual administration of nitroglycerin appeared to result in reduced blood flow in the MCA. The supratrochlear test demonstrated decreased velocity of blood flow in the supratrochlear artery. Studying the venous link of cerebral vessels after the operation showed that statistically significant differences were revealed only on the side contralateral to stenosis as compared with the values prior to revascularization. An increase of blood flow in the internal jugular veins after the operation on the side contralateral to the operation was apparently suggestive of an adequate distribution of blood flow through the main vessels of the brain.

The article is a review generalizing foreign and Russian experience and devoted to problems of diagnosis and treatment of iatrogenic false aneurysms of the femoral arteries. Based on the present-day scientific data, advantages and disadvantages of each of the currently existing therapeutic approaches are elucidated. Special attention is paid to the division dedicated to a promising minimally invasive trend in angiology, i. e. puncture obliteration of false aneurysms with the use of thrombin.

Described herein is a clinical case report concerning successful elimination of symptoms of oesophageal compression and the tracheobronchial tree in an adult female patient presenting with an incomplete vascular ring and the right-sided aortic arch with mirror-image branching of vessels.