Features of Surgical Treatment of Malignant Tumors of the Heart and Ways to Improve Immediate Results

To date, the issues of surgical treatment of malignant cardiac tumors (MCT) remain relevant and are of particular interest to cardiac surgeons. Hospital mortality of this group of patients is extremely high (20–30%). Finding ways to reduce early postoperative mortality remains an extremely important task of oncocardiac surgery. The aim. To analyze the causes of early postoperative mortality based on the data of many years of experience in the surgical treatment of MCT and to propose methods for the prevention of early postoperative complications with the improvement of the immediate results of operations. Materials and methods. From 1970 to 01.01.2021, National Amosov Institute of Cardiovascular Surgery has provided surgical treatment of 67 patients with malignant tumors of the heart which amounted to 7.1% of the total number of observed patients with cardiac tumors (949). Of the 67 patients with MCT, 57 (84.9%) were operated using artificial circulation, three operations (4.6%) were emergency. Hospital mortality was 19.4% (13 patients). Results. Microscopic examination of the removed tumors revealed the presence of necrosis zones, their mechanical damage leads to significant intoxication of the patient. To prevent tumor intoxication (cause of postoperative mortality) in the operative and postoperative periods, new methods of combating such a factor of hospital mortality were used, which helped to improve the results of treatment of MCT. Hospital mortality reduced from 33.3% (1970–2001) to 5.5% (last 10 years), as a result of use these measures. Conclusions. Destruction of the tumor during surgery with artificial circulation leads to the entry of a significant number of tumor cells and toxins into the bloodstream, causing tumor intoxication. Improvement of the immediate results of surgical treatment of MCT depends on their timely diagnosis, which allows for adequate surgery with radical removal of the tumor and the use of detoxification measures, significantly reducing surgical mortality.

Mechanisms of glycolysis and bioenergy state of cells at the stages of cardiosurgical interventions in patients with hypoxic — ischemic impairments of the brain

Objective — to study the features of bioenergetic provision of oxidative homeostasis (OH) in patients with hypoxic‑ischemic brain lesions (HIBL) before and after cardiac surgery (CS) using artificial circulation (AC). Methods and subjects. Clinical and biochemical studies were performed in 38 patients, including 14 with ischemic stroke, 15 with encephalopathy, and 9 with severe cognitive dysfunction. Results. Analysis of metabolic indicators of glycolysis activity and energy homeostasis of cells before and after CS revealed the patterns of changes in the disorganization of glycolysis mechanisms, intensification of anaerobic mechanisms while limiting the energy supply of cells. The obtained data confirm the formation of specific postoperative metabolic provision of bioenergy in patients with CS, which should be considered as one of the triggers of HIBL and individualization of antioxidant cerebroprotection in the preoperative period, taking into account the state of bioenergetic metabolism of cells and the dominant mechanisms of glycolysis. Conclusions. Preoperative antioxidant cerebroprotection as a means of prevention of hypoxic‑ischemic brain lesions during cardiac surgery using artificial circulation should be based on the determination of bioenergetic and metabolic reserves, the depletion of which by antioxidant drugs suppression should not be considered, as activation of anaerobic glycolysis at simultaneous metabolic suppression of mitochondrial bioenergetics is a factor of formation or aggravation of ischemic lesions of brain.

Impact of anemia on outcomes in on-pump coronary artery bypass surgery patients

Aim To study the contribution of preoperative anemia to the prognosis of adverse clinical events (mortality, complications, transfusion) in patients with ischemic heart disease (IHD) after myocardial revascularization in the conditions of artificial circulation.Material and methods This retrospective cohort study included 1 133 patients with IHD who had undergone isolated myocardial revascularization in the conditions of artificial circulation in 2019. The primary endpoints were mortality and a composite endpoint that included, in addition to mortality, cases of acute coronary syndrome, heart, respiratory and renal failure, neurological deficit, and infectious complications. The secondary endpoints were duration of artificial ventilation of more than 12 h, duration of stay in the resuscitation and intensive care unit (RICU) of more than one day, and duration of postoperative inpatient treatment of more than 7 days. Results Preoperative anemia was found in 196 (17.3 %) patients. The anemia was not associated with mortality but increased the risk of the composite endpoint, prolonged artificial ventilation, stay in RICU for more than one day, and red blood cell transfusion. Despite the absence of a relationship between red blood cell transfusion and mortality, the use of transfusion was associated with increased risks of the composite endpoint and prolonged stay in the RICU and hospital.Conclusion Preoperative anemia is a risk factor for adverse outcomes of myocardial revascularization in the conditions of artificial circulation. Timely treatment of preoperative anemia may improve outcomes of the treatment.

DIAGNOSTICS AND INTENSIVE CARE OF HEART FAILURE IN PATIENTS WHO UNDERWENT CORONARY ARTERY BYPASS GRAFT SURGERY WITH ARTIFICIAL CIRCULATION

Introduction. Coronary heart disease, the complexity of the surgery conducted, inflammatory reaction to extracorporeal circulation and the need for perioperative anticoagulation influence perioperative state of hemodynamics during the surgical revascularization of a myocardium in patients with coronary heart disease. The aim. To improve the results of treatment of cardiac surgery patients with heart failure who underwent surgery, namely, coronary artery bypass grafting using extracorporeal circulation by improving methods of diagnosing heart failure. Materials and methods. 100 cardiac surgery patients with coronary heart disease were operated on at State Institution of Science “Research and Practical Center of Preventive and Clinical Medicine” State Administrative Department. In all the cases, coronary artery bypass grafting was performed using artificial circulation. In patients of group 1 (40 patients) in the postoperative period, the correction of hemodynamic disorders was performed according to the standard protocol. In group 2 (60 patients) - a differentiated approach to the correction of hemodynamic disorders was used. Results. It was found that in group 2 for stabilization of hemodynamics, oxygen status, microcirculation, smaller doses of sympathomimetics and shorter duration of their use, P <0.05 than in 1 were applied. Conclusions. The results of the studies indicate the possibility of using the method of phasography, in particular, the analysis of symmetry of the T wave, as a marker of ischemic changes in the myocardium in cardiac patients who underwent coronary artery bypass grafting using artificial circulation. The obtained data show that the developed algorithm of perioperative management of cardiac surgery patients with heart failure makes it possible to significantly accelerate the rehabilitation of cardiac surgery patients, increase patient comfort and reduce the length of their hospitalization. The possibility of using phasography for monitoring of myocardial condition in patients undergoing coronary artery bypass surgery has been investigated.

Ultrastructural characteristics of erythrocytes and their relationship with oxygen transport in patients with ischemic heart disease after coronary artery bypass grafting with artificial circulation

Aim. Evaluation of nanostructural and micromechanical characteristics of erythrocytes and their relationship with the parameters of oxygen transport in patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) under artificial circulation (AC).Materials and methods. The study involved 30 men with IHD aged 53 to 67 years with a median of 63 years, who underwent planned CABG with AC at the clinic of the Far Eastern Federal University. Blood sampling from patients was carried out before the AC and one day after it from a venous catheter located in the right atrium. Erythrocytes were scanned using a Bioscope Catalyst atomic force microscope (AFM) (Bruker, USA) in combination with an Axiovert 200 inverted microscope (Zeiss, Germany). The micromechanical properties of cell membranes were investigated with the PFQNM-LC-A-CAL cantilevers. The following were recorded: the diameter of erythrocytes, the height of their side, area, volume, membrane rigidity, strength of its adhesion, Young's modulus, elastic deformation. To assess oxygen transport, the oxygen delivery index (DO2I), consumption (VO2I), and extraction ratio (O2ER) were calculated.Results. In one day after CABG, a decrease in DO2I, VO2I, and O2ER was recorded by 14%, 33%, and 16%, respectively, which indicated a limitation in the gas transport function of the blood. Analysis of the AFM characteristics of erythrocytes showed an increase in their area by 35%, in diameter by 6%, in volume by 19%, and the height of the side by 5 times. At the same time, multidirectional changes in the micromechanical properties of erythrocyte membranes were noted: Young's modulus and stiffness decreased by 3.2 and 2 times, respectively; the adhesion force increased by 2.7 times, and the elastic deformation – by 2.2 times. Correlation analysis showed the presence of reliable relationships between indicators of oxygen transport and biomechanical parameters of erythrocyte membranes.Conclusion. A comprehensive analysis of the nanostructural parameters of erythrocytes and oxygen transport expands the understanding of the pathophysiological mechanisms of postperfusion disorders in patients with coronary artery disease after CABG under conditions of cardiopulmonary bypass.

The Use of Polymeric Materials in Modern Dentistry

The achievements and discoveries of chemical science have firmly established themselves in all branches of humanity. One of the most significant chemistry possibilities is the polymerization and polycondensation of compounds, which, in turn, are methods for producing polymers. Polymers are high molecular weight compounds consisting of many units (monomers) linked by chemical bonds. Unique polymer compounds are the basis of plastics, chemical fibers, rubber, paints, and varnishes, adhesives [8]. Polymers are used for the manufacture of removable prostheses, materials for fillings and inlays, orthodontic appliances, artificial teeth, dental implants, as well as in the creation of artificial heart valves, artificial kidney devices, artificial circulation, artificial heart [6].

TYPES OF CORRECTION OF THE SUPRACARDIAC FORM OF PARTIAL ABNORMAL DRAINAGE OF THE PULMONARY VEINS. WARDEN PROCEDURE

The article describes the types of correction of the supracardial form of abnormal drainage of the pulmonary veins. One of the methods of correcting this defect is the Warden operation, which includes: after sternotomy, connection of artificial circulation, cardioplegia, the superior vena cava is cut off, the proximal end is sutured. Next, a right atriotomy is performed, an anastomosis is formed using an autopericardial patch between the abnormal drainage and the left atrium through the ASD. Then an anastomosis is formed between the auricle of the right atrium and the distal end of the superior vena cava. As a result, blood from the abnormal pulmonary veins begins to drain into the left atrium through the ASD.

Effectiveness of posterior pericardiotomy in preventing cardiac tamponade and effusion pericarditis in the early period after interventions on the thoracic aorta

<p><strong>Background.</strong> Interventions on the thoracic aorta involving prolonged artificial circulation, clamping of the aorta and extensive dissection of the mediastinal structures are associated with a higher incidence of pericardial effusion and cardiac tamponade compared to other interventions. We suggest that routine implementation of posterior pericardiotomy may significantly affect the incidence of postoperative pericardial effusion syndrome and cardiac tamponade after interventions on the thoracic aorta.</p><p><strong>Aim.</strong> Evaluation of the effectiveness of posterior pericardiotomy regarding the development of cardiac tamponade, effusion pericarditis and the postoperative course of patients in the early period after interventions on the thoracic aorta.</p><p><strong>Methods.</strong> We conducted a retro- and prospective study that included 100 patients with thoracic aorta pathologies who were operated on in the cardiac surgery department of clinic from 2017 to 2020. All subjects were divided into two groups: a treatment group of 40 patients who underwent routine posterior pericardiotomy, and a control group of 60 patients without posterior pericardiotomy but with standard installation of postoperative drains. Assessment of the effect of posterior pericardiotomy on pericardial effusion, cardiac tamponade and the early postoperative period was conducted on the basis of transthoracic echocardiography that was performed daily during hospitalisation (the maximum amount of effusion during the observation period was taken as the control point), as well as up to one month after discharge from hospital.</p><p><strong>Results.</strong> The study groups did not differ regarding parameters such as time of artificial circulation (p = 0.39), time of myocardial ischaemia (p = 0.42), length of intensive care unit stay (p = 0.79) and length of hospitalisation (p = 0.21). Evaluation of pericardial effusion of varying severity during hospital follow-up revealed its presence in 15 (37.5%) patients in the PPt group and in 54 (90%) in the control group (p = 0.0001). Early postoperative cardiac tamponade developed in 4 (6.7%) patients in the control group, but was not observed in the PPt group (p = 0.09). At the same time, 5 (8.3%) patients without pericardiotomy required pericardiocentesis; however, this procedure was not performed in the PPt group (p = 0.06). Additionally, we did not find a statistically significant difference between the groups in relation to the frequency of puncture of the left pleural cavity (37.5% in the PPt group versus 43.3% in the control group, p = 0.56). According to the results of control echocardiography after one month, effusion of varying severity was found in 21 (35%) patients in the control group versus 1 (2.5%) in the PPt group (p = 0.0001).</p><p><strong>Conclusion.</strong> Posterior pericardiotomy is an affordable, applicable, safe and effective method for preventing postoperative pericardial effusion and cardiac tamponade after thoracic aortic surgery. This manipulation did not significantly affect the length of hospitalisation or the incidence of postoperative atrial fibrillation in this cohort of patients. Posterior pericardiotomy is not associated with a more frequent need for puncture of the left pleural cavity.</p><p>Received 13 October 2020. Revised 10 December 2020. Accepted 11 December 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

Experience in the Use of Artificial Fibrillation in the Correction of Postinfarction Left Ventricular Aneurysms as the Most Appropriate Alternative to Pharmaco-Cold Protection of the Heart

Coronary heart disease (CHD) is the leading cause of death in the world. In most cases, the disease is complicated by myocardial infarction (MI) followed by the formation of a left ventricular aneurysm (LVA), ruptures of the interventricular septum, ischemic cardiomyopathy, mitral regurgitation and arrhythmias. Postinfarction left ventricu-lar aneurysm is the most common and severe complication of CHD. There are a lot of methods of LVA surgical correc-tion, including Cooley’s linear repair technique, purse-string technique of Jatene and endoventriculoplasty using the Dor technique. Over the last year, 43 left ventricular aneurysm repair surgeries were carried out at the NatioМешковаnal M. M. Amosov Institute of Cardiovascular Surgery. Depending on the comorbidities, age, left ventricular contractility and other factors, plastic correction was performed using artificial fibrillation (n = 24 [55.8%]) or cardioplegic solution (n = 19 [44.2%]) for myocardial protection. Significant difference in the mean duration of the operation, the time the patient was on the artificial circulation, the amount of inotropic support, the time of mechanical ventilation, and the contractile function of the left ventricle (LV) was observed. In group 1, where artificial left ventricular fibrillation was used for myocardial protection, the mean duration of the surgery was 1.9 ± 0.2 h shorter. Accordingly, the patient’s stay on the artificial circulation decreased by 92.2 ± 0.3 minutes. Also, the duration of mechanical ventilation was significantly shorter: 4.6 ± 0.8 hours and 7.3 ± 0.7 hours in groups 1 and 2, respectively. And most importantly, in the group 1 the ejection fraction increased by 2.3 ± 0.45% compared with 1.17 ± 0.43% in the group 2. However, all the other parameters were similar in both groups. This gives reason to consider artificial ven-tricular fibrillation as the most appropriate method of myocardial protection in the future.

Clinical Risk Factors of Thrombosis in Children after Congenial Heart Diseases Management

Background. Development of thrombotic complications in the postoperative period worsens the course of the disease and increases mortality of children operated for congenital heart diseases (CDC). There is limited data on clinical risk factors of thrombosis after CDCs surgical correction in modern literature. In our opinion, there are several promising factors that have not been studied as predictors of thrombosis in children with CDCs. Aim of the study is to analyze possible effect of patient clinical characteristics on development of thrombotic complications in infants after surgical treatment of CDC. Methods. We have studied data of 156 children aged from birth to 11 months 29 days (median age — 5 months) with CDCs operated under artificial circulation. Following indexes were studied in all patients: age, surgical risk according to RACHS-1 (Risk adjustment for congenital heart surgery), anesthesia duration, surgery duration, aortic cross-clamping time, artificial circulation duration, gestation period, body weight and height at the time of surgery. Results. Thrombosis was diagnosed in 44 patients (28.2%) in the postoperative period. Thromboses of various localizations were found during the patients’ examination: cerebral, intracardiac, limbs vessels, etc. It was revealed that thrombosis detection in patients with RACHS-1 >3 has increased in 2.84 times (95% CI: 1.36-5.92), at anesthesia duration >220 minutes — in 2.64 times (95% CI: 1.15-6.05), at surgery duration >150 minutes — in 3.36 times (95% MD: 1.51-7.5), at aortic cross-clamping time >32 minutes – in 3.23 times (95% CI: 1.45-7.32), at artificial circulation duration >70 minutes — in 3.43 times (95% MD: 1.6-7.34), with gestation period less than 39 weeks — in 2.44 times (95% CI: 1.18-5.03), with child’s weight less than 5.000 grams – in 4.3 times (95% CI: 2.02-9.15), with child’s height less than 60 centimeters — in 4.57 times (95% CI: 2.15-9.73), and at the age less than 3 months old — in 2.31 times (95% CI: 1.08-4.92). Conclusion. RACHS-1 >3, anesthesia duration >220 minutes, surgery duration >150 minutes, aortic cross-clamping time >32 minutes, artificial circulation duration >70 minutes, gestation period less than 39 weeks, weight at the time of surgery less than 5000 grams, height at the time of surgery less than 60 centimeters, and age under 3 months increases the risk of thrombotic complications in postoperative period.