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Aim. To assess the association between changes in interventricular delay (IVD) and response to cardiac resynchronization therapy (CRT) during 24-month postoperative period in patients with quadripolar left ventricular leads.Material and methods. This retrospective non-randomized study included data from 48 patients with implanted CRT devices with quadripolar left ventricular (LV) leads, examined 3, 6, 12, 24 months after operation. CRT responders were considered patients with a decrease in end-systolic volume (ESV) by more than 10% compared with preoperative. To test the hypothesis about the rationale for choosing the maximum IVD when installing the LV lead, the group of patients was divided into two subgroups as follows: one with the maximum IVD (IVDmax, n=24), the other — without this condition (n=24).Results. A correlation was found between changes in IVD and ESV, as well as ejection fraction (EF) in the period of 6, 12 and 24 months after implantation compared to baseline. In the subgroup with IVDmax, the shortening of IVD in the postoperative period is higher at each considered period compared to the second subgroup, and in general, there is a more pronounced decrease in IVD over 24 months. At the same time, 3, 6, 12 months after surgery, patients with IVDmax show a significantly greater decrease in ESV and, accordingly, a greater increase in EF. Prognostic models of CRT response in the long term after implantation were created. Significant predictors were the initial IVD, changes in IVD in the early postoperative period and IVDmax selection. At the same time, not a single factor, taken separately, made it possible to separate responders and non-responders.Conclusion. A greater shortening of the IVD corresponds to a greater decrease in LV ESV and EDV, as well as a greater increase in EF in the long-term postoperative period. The choice of quadripolar LV lead in accordance with the maximum IVD is accompanied by a decrease in the proportion of non-responders, a more pronounced decrease in electrical ventricular dyssynchrony and an improvement in systolic function.

Aim. To assess the incidence of cerebrovascular events and cognitive status in the long-term period after coronary artery bypass grafting (CABG) in patients with and without preoperative mild cognitive impairment (MCI).Material and methods. This prospective study involved 115 patients aged 45 to 69 years, who were admitted to the hospital for elective on-pump CABG. All patients underwent clinical, laboratory, ultrasound, neuroimaging and neuropsychological examination 3-5 days before and 5-7 years after CABG. Cognitive functioning was assessed using screening neuropsychological scales and neuropsychological testing with an assessment of neurodynamics, attention and short-term memory. Pre-CABG MCI was diagnosed based on the criteria by R. Petersen et al. Therefore, the patients were divided into two groups: with (n=51) and without MCI (n=64).Results. It was found that strokes and dementia during the long-term postoperative period of CABG were observed only in the group of patients with preoperative MCI (7,84%). Five-seven years after CABG, a decrease in cognitive status according to neuropsychological scales was found in all patients (p≤0,05). A decrease in neurodynamics, attention and short-term memory compared to the preoperative level was found in 47,92% of patients with preoperative MCI, without MCI — in 40,63%. Neurodynamic disorders occurred equally frequently in both groups (63,8% and 57,8% of patients, respectively). Memory impairments were more often observed in patients with MCI (55,3%) compared to those without MCI (34,4%) (OR=2,36, 95% CI, 1,09-5,12, p=0,03). According to brain multislice computed tomography in the group with preoperative MCI, the number of patients with cysts and leukoaraiosis 5-7 years after CABG was higher than in those without MCI (p≤0,05).Conclusion. In the long-term (5-7 years) postoperative period of CABG, more than 40% of patients demonstrate a decrease in cognitive status, regardless of preoperative data. At the same time, preoperative MCI is associated with adverse cerebrovascular events and dementia, accompanied by morphological brain abnormalities. Due to the revealed facts, it is necessary to optimize approaches to drug treatment and secondary prevention of cognitive decline after cardiac surgery.

Aim. To determine quantitative criteria for assessing the therapeutic benefits and the most informative time frames after cardiac resynchronization therapy (CRT) to assess its long-term effectiveness (1, 2, 3 years of follow-up) based on retrospective analysis. To assess the CRT effectiveness, parameters of left ventricular (LV) reverse remodeling and signs characterizing the clinical CRT response were considered.Material and methods. This single-center, retrospective, non-randomized study included data from 278 patients with implanted CRT devices. Quantitative criteria for assessing CRT effectiveness were determined using a two-step cluster analysis of patients 1, 2, and 3 years after CRT by LV reverse remodeling parameters.Results. In the dataset with satisfactory division accuracy, after the first year, two clusters were identified, which are conventionally named as “non-responders” and “responders”. Two and three years after therapy, patients were classified into three clusters: “non-responders”, “responders” and “super-responders”. For the obtained clusters, we found cutoff values for LV reverse remodeling parameters, which can be used as criteria for response to therapy.The study identified the most informative time frames for assessing the postoperative CRT effectiveness 1, 2, 3 years after the surgery. At the same time, the clinical response to therapy is manifested earlier in comparison with the reverse LV remodeling.Despite the high divisibility of patients into responders and non-responders, predictive models of CRT effectiveness created using the available data from standard diagnostic protocols for heart failure patients have insufficient accuracy to be used for making decisions on therapy appropriateness. This circumstance indicates the need to receive additional data to improve the forecasting quality.Conclusion. The study revealed a period for assessing the clinical response and changes in LV reverse remodeling after CRT surgery, which is important for the optimal choice of postoperative therapy. It has been shown that in most cases, one year after surgery is sufficient to assess the clinical response, and the process of LV reverse remodeling can last up to two years on average.When assessing the CRT effectiveness by reverse remodeling, along with a change in LV end-systolic volume (ESV), it is necessary to take into account LV end-diastolic volume (EDV) changes. The change in LV ejection fraction showed a significantly lower value among the analyzed parameters in assessing the CRT effectiveness. Based on the cluster classification of patients, a dividing rule was established for responders and non-responders in the first and second years after surgery with an accuracy of 97%: a decrease in LV ESV and EDV by 9% or more compared to preoperative values.

Objective: To evaluate safety of coronary artery bypass surgery using bilateral internal mammary artery and effectiveness of this procedure in long-term postoperative period., Material and Methods: The study involved 129 patients who underwent CABG for the period 2006-2007. There were 2 groups of patients depending on surgical strategy: group 1 (n=61) - double IMA harvesting, group 2 (n=68) - CABG using single IMA. Short-term results were compared using standard statistical methods. Long-term survival was compared using Kaplan-Meyer method., Results: Revascularization index was 3.014±0.76 in the 1st group and 3.1±0.73 in the 2nd group (p>0.05). In-hospital mortality was 0% and 1.47%, respectively (p> 0.05). A 10-year survival was 95.1% and 91.2%, respectively (p>0.05). Freedom from cardiac events (mortality, myocardial infarction, recurrent angina pectoris) was significantly different (95% vs. 81%, p<0.05)., Conclusion: Significantly lower rate of adverse cardiac events in long-term postoperative period in comparison with conventional CABG clearly demonstrates high quality of life after coronary artery bypass surgery using bilateral internal mammary artery for a long time. Therefore, this procedure is preferred in patients with coronary artery disease.