Source: https://medi.ru/rkj/15373/
Timestamp: 2019-04-26 05:45:14+00:00

Document:
Aim. To assess results of Meshalkin National Research Medical Center and Tomsk National Research Medical Center in surgical treatment of DeBakey type I aortic dissection using hybrid technologies (“frozen elephant trunk”) compared with classical standard interventions.
Material and methods. The study included patients operated on successively in the 2002-2010 timeframe with a diagnosis of acute and subacute DeBakey type I aortic dissection. A retrospective observational comparison of the surgical treatment results of patients (two groups) was performed: using standard surgical approaches (beveled anastomosis or aortic arch replacement using multi-branched prosthesis) and frozen elephant trunk (FET) intervention. The groups included 70 and 31 patients, respectively. Mortality and morbidity were evaluated in the postoperative period, the frequency of aorto-related events - during the observation period.
Results. Mortality and the frequency of complications between the groups in the early and late postoperative periods did not differ. Aorto-related events of the groups in the long-term period differed statistically significantly in favor of hybrid interventions (p=0,005).
Conclusion. The hybrid technology of thoracic aorta reconstruction using “frozen elephant trunk” type allows to make one-step reconstruction of the aorta during its multilevel lesion. Observation of patients in the long-term period allows us to announce of a longtime, stable result of surgical treatment in the absence of additional perioperative risks.
Key words: aorta, frozen elephant trunk, dissection, surgery.
Funding. The study was supported by the grant of the Russian Science Foundation 17-75-30009.
ResearchID. The study is registered on clinicaltrials.gov. Unique Protocol ID: CASTLE NRICP NCT03349164.
3The Institute of Computational Mathematics and Mathematical Geophysics of RAS, Novosibirsk, Russia.
Chernyavsky A. M. ORCID: 0000-0001-9818-8678, Lyashenko M. M. ORCID: 0000-0001-8675-8303, Syrota D. A. ORCID: 0000-0002-9940-3541, Khvan D. S. ORCID: 0000-0002-5925-2275, Kozlov B. N. ORCID: 0000-0002-0217-7737, Panfilov D. S. ORCID: 0000-0002-0217-7737, Lukinov V. L. ORCID: 0000-0002-3411-508Х.
Kamenskaya O. V., Klinkova A. S., Loginova I. Yu., Chernyavsky A. M., Lomivorotov V. V., Karaskov A. M.
Aim. To assess the impact of clinical and intraoperative factors on the dynamics of quality of life (QOL) after aortic prosthetics in patients with chronic dissection of ascending aorta and aortic arch.
Material and methods. The study included 56 patients (mean age 50 years) with chronic DeBakey type I aortic dissection. With the help of the SF-36 questionnaire, QOL was examined before and later (12 months) after aortic prosthetics. The method of multivariate linear regression analysis was used to evaluate factors that influence the dynamics of various parameters of QOL in the late postoperative period.
Results. Before the operation, patients scored from 52 points and below almost in all parameters of the questionnaire, which indicates a very low initial level of QOL. In the long-term period after aortic prosthetics, a statistically significant improvement in the following physical and psycho-emotional indicators was noted: role functioning (p=0,004); bodily pain (p=0,0001); vitality (p=0,009); social role functioning (p=0,002); emotional role functioning (p=0,009); physical health (p=0,02); mental health (p=0,03). At the same time, there was no positive change in the initial low parameters of general health and psychiatric health perceptions. According to multivariate regression analysis, the dynamics of QOL parameters in the long-term period after surgical treatment of the dissection of ascending aorta and aortic arch are affected by both intraoperative conditions (cerebral protection method) and the early postoperative period (neurological complications, cardiopulmonary failure, atrial fibrillation). Indicators such as gender, age, body weight, comorbidity, type of prosthesis of the ascending aorta, time spent in the intensive care unit, duration of artificial pulmonary ventilation do not have a significant effect on QOL in the long-term postoperative period.
Conclusion. Clinical and intraoperative factors that adversely affect the dynamics of various indicators of QOL in long-term periods after prosthetics of the ascending aorta and aortic arch were: cerebral protection in conditions of deep hypothermia and craniocerebral hypothermia against the background of systemic circulatory arrest; development of neurological complications, as well as atrial fibrillation and cardiopulmonary failure in the early postoperative period.
Key words: quality of life, aortic prosthetics, postoperative complications.
Funding. This study was supported by the grant of the Russian National Fund (17-75-30009).
Meshalkin National Research Medical Center of RAS, Novosibirsk, Russia.
Kamenskaya O. V. ORCID: 0000-0001-8488-0858, Klinkova A. S. ORCID: 0000-0003-2845-930X, Loginova I. Yu. ORCID: 0000-0002-3219-0107, Chernyavsky A. M. ORCID: 0000-0001-9818-8678, Lomivorotov V. V. ORCID: 0000-0001-8591-6461, Karaskov A. M. ORCID: 0000-0001-8900-8524.
Aim. To assess the results of transcatheter aortic valve implantation (TAVI) in comparison with open surgery for aortic stenosis in patients over 75 years old.
Material and methods. We analyzed the results of 33 operations of aortic valve replacement in patients with aortic stenosis performed in the Moscow Municipal Clinical Hospital No. 15 in the period from June 2012 to September 2017. The first group included 21 TAVI operations. In 15 patients TAVI was performed through the femoral artery, 6 - transthoracic through the cardiac apex. All patients with transcatheter intervention were implanted with SAPIEN valves. In the postoperative period all patients showed a decrease in the systolic pressure gradient on the valve to 9,8±4,06 mm Hg. Aortic valve area after the operation has increased on average from 0,72±0,1 cm2 to 1,9±0,3 cm2. For comparison, a control group of 12 patients who underwent aortic valve replacement under cardiopulmonary bypass was formed. All patients had a high operative risk. Euroscore II 6,3±4,9, STS 5,2±3,4.
Results. There were no cases of death in the TAVI group. These patients had the following postoperative complications: 3 patients (13,6%) - complete atrioventricular block, which required permanent pacemaker implantation; it was a significantly more frequent complication of transcatheter interventions. Less frequently in the postoperative period patients had severe acute cardiovascular failure (p=0,001), acute renal failure (p=0,05), paroxysmal atrial fibrillation (p=0,001). The volume of intraoperative blood loss was significantly less in the TAVI group: 147,6±84,4 ml and 666,7±322,9 ml (p=0,05). Mortality in the surgical group was 33% (4 patients). In the surgical group in 2 cases the cause of death was multiple organ failure, in two cases - acute cardiovascular failure. Patients from this group patients had the following postoperative complications: bleeding requiring a resternotomy - 2 (16,7%), pneumonia - 1 (8,3%), heart failure in the postoperative period, requiring prolonged cardiotonic support - 9 (75%), one patient underwent mechanical hemodynamic support, renal failure requiring renal replacement therapy in one patient. Conclusion.
Conclusion. Even though surgical aortic valve replacement is the “gold standard” for treating patients with aortic stenosis, the results of operations in the older age group is not sufficient due to the high frequency of postoperative complications. TAVI, proposed by Cribier A, et al. in 2002, gives better results in patients over 75 age group due to the lower incidence of complications in the postoperative period, less intraoperative blood loss. We suppose that it is an alternative for patients of the older age group and high operative risk.
Key words: aortic valve, aortic stenosis, transcatheter implantation, operative risk.
2N. I. Pirogov Russian National Research Medical University, Moscow, Russia.
Bayandin N. L. ORCID: 0000-0002-9199-5669, Krotovsky A. G. ORCID: 0000-0002-3837-1726, Vasilyev K. N. ORCID: 0000-0002-3652-7707, Moiseev A. A. ResearcherID: U-7134-2018, ORCID: 0000-0003-2431-4429, Setyn T. V. ORCID: 0000-0001-8703-8471.
Tarasov R. S., Shushpannikov P. A., Ganyukov V. I., Sizova I. N.
Aim. To analyze the results and features of early cardiac remodeling (CR) in children of preschool and school age after endovascular correction of atrial septal defect (ASD).
Material and methods. A prospective study included 27 children with secondary ASD who underwent endovascular correction for one year (from the beginning of 2017 to the beginning of 2018). The patients were divided into two groups. The first (n=12) - children of preschool age (<8 years old), mean age 4,5 [3;6], and the second (n=15) - school age (8-18 years old), mean age 12 [9;14]. The following indicants were assessed during hospitalization: the success of the intervention, hospital complications, functional data characterizing CR according to echocardiography before and after the correction of the defect.
Results. It was shown that all children successfully completed endovascular closure of ASD. Complications were not identified. We find several statistically significant changes in echocardiogram data before and after the intervention. In the preschool age group, the size of the right ventricle (RV) decreased from 1,66 to 1,45 cm (p=0,028), the right atrium (RA) decreased from 3,58 to 3,1 cm (p=0,003), and the longitudinal size of RV decreased from 3 to 2 cm (p=0,032) and basal size of RV - from 5,98 to 4,4 cm (p=0,005), the volume of RA decreased from 25,7 to 20,7 ml (p=0,005). In the group of school age, the size of the RV changed from 2,08 to 1,8 cm (p=0,038), the size of the RA - from 3,72 to 2,71 cm (p=0,007), the RV area in diastole - from 12,4 to 10,6 mm2. The gradient has changed from 2 to 1,54 mm Hg (p=0,043), the frontal size of the tricuspid valve (TV) decreased from 2,7 to 2,48 cm (p=0,010). The basal size of RV decreased from 3 to 2,6 cm (p=0,015), the median size - from 2,73 to 2,37 cm (p=0,017) and the longitudinal size - from 5,97 to 5,45 cm (p=0,007). No significant differences in CR among the groups were found.
Conclusion. We made conclusion about the efficacy and safety of endovascular correction of ASD, which has a positive effect on early HR in children, both in early and in old age.
Key words: congenital heart defects, atrial septal defect, cardiac remodeling, endovascular correction.
Tarasov R. S. ORCID: 0000-0003-3882-709X, Shushpannikov P. A. ORCID: 0000-0002-6886-2526, Ganyukov V. I. ORCID: 0000-0002-9704-7678, Sizova I. N. ORCID: 0000-0001-8076-8746.
Aim. To evaluate the frequency and identify predictors of long-term fatal cardiovascular events (CVE) after planned percutaneous coronary interventions (PCI).
Material and methods. We conducted a retrospective study that included 150 patients who underwent planned endovascular intervention on the coronary arteries. Outcomes of interventions were assessed 6 years after the PCI, by analyzing medical records and telephone interviews. The primary endpoint of the study was cardiovascular-related death.
Results. Fatal CVE were recorded in 10,6% of patients. A statistically significant relationship was found between the development of fatal CVE in the long-term period after planned PCI and the presence of initial chronic obstructive pulmonary disease in patients (OR=12,3; CI (3,6-41,5); р<0,001), atrial fibrillation (OR=5,1; CI (1,6-16,3); p=0,003), diabetes mellitus (OR=3,2; CI (1,1-9,8); p=0,032), acute cerebrovascular accident (OR=8,6; CI (2,0-36,4); p=0,001); any clinical complications of interventions (OR=3,1; CI (1,1-9,0); p=0,028), taking of antiarrhythmic drugs (OR=5,9; CI (1,3-27,4); p=0,012), statins taking at the time of PCI (OR=0,3; CI (0,1-0,8); p=0,013). According to the results of the ROC-analysis, the most significant predictor of fatal CVE in the long-term period was erythrocyte sedimentation rate more than 14,5 mm/h (AUC=0,677; CI (0,507-0,835); p=0,027). According to 6-year observation, Kaplan-Meier curves showed a significant effect of multifocal atherosclerosis, acute periprocedural kidney injury and heart rhythm disorders recorded during PCI, on the incidence of long-term fatal CVE.
Conclusion. A statistically significant relationship between the development of fatal CVE in the long-term period after planned PCI and the presence of initial comorbid pathology in patients (chronic obstructive pulmonary disease, atrial fibrillation, diabetes mellitus, multifocal atherosclerosis, acute cerebrovascular accident), erythrocyte sedimentation rate more than 14,5 mm/h, concomitant drug therapy at the time of the intervention (taking of antiarrhythmic drugs, statins). Significant predictors of adverse long-term outcome after planned endovascular myocardial revascularization were clinical complications of PCI, recorded during the hospital period, especially acute periprocedural kidney injury and heart rhythm disorders.
Key words: : cardiovascular mortality, percutaneous coronary interventions, coronary heart disease.
Vershinina E. O. ORCID: 0000-0002-2665-9108, Repin A. N. ORCID: 0000-0001-7123-0645.
Loginova I. Yu., Kamenskaya O. V., Prokhorikhin A. A., Tarkova A. R., Kretov E. I., Lomivorotov V. V., Karaskov A. M.
Aim. To assess the results of a one-year follow-up after transcatheter aortic valve implantation (TAVI) in patients with intermediate surgical risk with severe aortic stenosis.
Material and methods. The study included 42 patients with hemodynamically significant aortic stenosis and intermediate surgical risk. We assess the incidence of prosthesis-associated complications, one-year survival, clinical and hemodynamic characteristics, as well as the dynamics of the quality of life and social adaptation in the early postoperative period and one year after the intervention.
Results. In patients with intermediate surgical risk prosthesis-associated complications were not registered in the early postoperative period and one year after TAVI, the survival rate was 97,6% and 88%, respectively. The hemodynamic effect of the operation according to the results of echocardiography persisted a year after the intervention with the positive dynamics of the myocardial contractile function. The quality of life a year after the TAVI increased on the scale of the physical health of the SF-36 questionnaire from 25 (22;29) to 42 (28;46) points (p=0,031), on the mental health from 42 (33;50) up to 53 (48;57) points (p=0,025). The level of social adaptation has increased significantly; score of the Holmes and Rahe scale decreased from 250 (198;300) to 200 (180;220) (p=0,027).
Conclusion. The hemodynamic efficacy of TAVI in patients with intermediate surgical risk with severe aortic stenosis is associated with a significant improvement of life quality and the level of social adaptation one year after the endovascular correction of valve defect.
Key words: transcatheter aortic valve implantation, aortic valve disease, surgical risk, quality of life, social adaptation.
Funding. This work was supported by the Russian Science Foundation (17-75-30009).
Conflicts of Interest: The source of financing did not participate in the development of the study design, the collection and analysis of the material, as well as in publishing of the results.
E. N. Meshalkin National Medical Research Center of the Ministry of Health, Novosibirsk, Russia.
Loginova I. Yu. ORCID: 0000-0002-3219-0107, Kamenskaya O. V. ORCID: 0000-0001-8488-0858, Prokhorikhin A. A. ORCID: 0000-0002-3247-8290, Tarkova A. R. ORCID: 0000-0002-4291-6047, Kretov E. I. ORCID: 0000-0002-7109-9074, Lomivorotov V. V. ORCID: 0000-0001-8591-6461, Karaskov A. M. ORCID: 0000-0001-8900-8524.
Bogachev-Prokofiev A. V., Sharifulin R. M., Zubarev D. D., Karaskov A. M.
Aim. Transcatheter aortic valve replacement in patients with high and extremely high risk has become a routine procedure in many cardiac surgery clinics. Until recently, there were no transcatheter prostheses produced within Russia. This article analyzes the results of applying the first domestic transcatheter aortic valve prosthesis MedLab-KT.
Material and methods. In the period from June 2018 to October 2018, 7 operations of transcatheter aortic valve replacement were made using the MedLab-KT prosthesis. In all cases, implantation was performed by transapical access.
Results. We noted one death. In all cases, paraprosthetic regurgitation was not registrated or was not significant. There are no cases of dislocation of the prosthesis. There were no complications associated with access. In one case, implantation was complicated by myocardial infarction.
Conclusion. The first experience of implantation demonstrated the efficacy and safety of using the MedLab-LT prosthesis for transcatheter aortic valve replacement. The analysis of long-term results is required.
Key words: aortic valve, aortic stenosis, transcatheter aortic valve replacement, transapical access.
Funding. This work was supported by the Russian Science Foundation (16-15-10315).
Bogachev-Prokofiev A. V. ORCID: 0000-0003-4625-4631, Sharifulin R. M. 0000-0002-8832-2447, Zubarev D. D. ORCID: 0000-0001-7961-3149, Karaskov A. M. ORCID: 0000-0001-8900-8524.
Aim. To study the communicative characteristics of the attending physician, assessed by the patient, and analyze their connection with adherence to the treatment of patients with coronary artery disease (CAD) undergoing coronary artery bypass graft (CABG).
Material and methods. The study included 366 patients - men aged 41 to 77 years old (mean age 59,9±6,9 years) with a stable form of CAD. The patients included in the study were examined 5-7 days before the CABG and 6 months after it. The clinical condition of the patient, the presence of cardiovascular risk factors and the therapy taken before and within 6 months after were assessed. Before being discharged from the clinic, A. А. Leontiev communication card was used to determine the model of communicative interaction.
Results. The higher the patient assessed the communicative competence of the doctor according to the several parameters (“benevolence”, “encouragement of initiative”, “openness”, “activity” and “flexibility”), the higher his adherence to treatment was. Patients who gave a low rating to the attending physician by the communicative parameters (“openness”, “flexibility” and “interest” in communication), had the lowest adherence to treatment.
Conclusion. The adherence to treatment of CAD patients is influenced by such communicative characteristics of the attending physician as “benevolence”, “encouragement of initiative”, “openness”, “activity” and “flexibility” qualify as democratic style of communication between a doctor and a patient.
Key words: adherence to treatment, coronary artery disease, coronary artery bypass graft.
2Kemerovo State University, Kemerovo, Russia.
Pomeshkina S. A. ORCID: 0000-0003-3333-216X, Solodukhin A. V. ORCID: 0000-0001-8046-5470, Bezzubova A. A. ORCID: 0000-0002-7411-7346, Yanitsky M. S. ORCID: 0000-0003-3049-8594, Barbarash O. L. ORCID: 0000-0002-4642-3610.
Aim. Implantable cardioverter-defibrillator (ICD) implantation technique optimization in patients with coronary artery disease (CAD) in order to reduce fluoroscopy time and total radiation dose to staff.
Material and methods. Patients with CAD and indications for the ICD implantation were examined. Patients were divided into two groups. In first group before ICD implantation, patients underwent cardiac 99mTc-methoxy-isobutyl-isonitrile scintigraphy for right ventricle wall perfusion disorders assessment. In this group defibrillating lead was implanted to the septal position, if the perfusion disorders were in the apical segments, and to the apical position, if perfusion disorders were in the septal segment. In second group lead was implanted using conventional approach. Fluoroscopy duration and radiation dose were compared.
Results. There were 58 patients (male-52, female-6, age-64,5±8,5 years) enrolled. The first group consisted of 27 (46,5%) patients. For 13 (48,1%) patient ICD was implanted for primary, and 14 (51,9%) one for secondary sudden cardiac death (SCD) prevention. In 14 (51,9%) cases in this group defibrillating lead was implanted to the apical and in 13 (48,1%) - to the septal position. The 2-nd group consisted of 31 (53,5%) patients. For 13 (41,9%) patient ICD was implanted for primary, and 18 (58,1%) one for secondary SCD prevention. In 15 (48,3%) cases in this group defibrillating lead was implanted to the apical and in 16 (51,7%) - to the septal position. There were significant differences between groups in terms of fluoroscopy duration - 85,5±28,1 and 131,6±53,5 sec (р=0,0001) and radiation dose - 0,14±0,07 and 0,21±0,08 (p=0,0004) mSv, respectively.
Conclusion. Assessment of right ventricular perfusion before ICD implantation reduce fluoroscopy time and total radiation exposure to staff.
Key words: cardioverter-defibrillator, fluoroscopy time, radiation exposure to staff, 99mTc-methoxy-isobutyl-isonitrile, defibrillating lead.
2Pathological Physiology Department, International School of Medicine, Bishkek, Kyrgyzstan.
Atabekov T. A. ORCID: 0000-0003-2645-4142, Batalov R. E. ORCID: 0000-0003-1415-3932, Krivolapov S. N. ORCID: 0000-0001-8121-8287, Khlynin M. S. ORCID: 0000-0002-9885-5204, Sazonova S. I. ORCID: 0000-0003-2799-3260, Shvartsman A. D. ORCID: 0000-0003-4313-0975, Suranova G. Zh. ORCID: 0000-0002-9458-4873, Popov S. V. ORCID: 0000-0002-9050-4493.
Aim. To assess the efficiency of guideline for the prevention of hemorrhagic complications in the early postoperative period.
Material and methods. In the period from 2008 to 2017, 166 patients with pathology of the thoracic aorta were operated. The patients were divided into 2 comparable groups: group 1 - patients with reconstructed aortic arch of the type “Hemiarch” (group “hemiarch”, n=90), group 2 - patients with fully reconstructed aortic arch (group “arch”, n=76). All operations were performed with artificial blood circulation, circulatory arrest with moderate hypothermia (25-28° C) and unilateral antegrade cerebral perfusion through the brachiocephalic trunk.
Results. The reconstructions of the thoracic aorta in patients of the “hemiarch” group were accompanied by significantly less period of artificial blood circulation (p=0,027), cardiac arrest period (p=0,012), duration of circulatory arrest (p=0,019), and duration of antegrade brain perfusion (p=0,021). The volume of discharge through the drainage was 350 [192;506] ml and 400 [250;723] ml in the “hemiarch” and “arch” groups, respectively (p=0,29). Patients of the “arch” group more often required transfusion of packed red cells (p=0,003), fresh frozen plasma (p=0,0006), platelet concentrate (p=0,002) in comparison with patients of the “hemiarch” group. At the same time, the frequency of bleeding requiring reoperation was comparable in both groups (5,6% versus 5,3%, p=0,969). The 30-day mortality also had no statistically significant differences in patients of the “hemiarch” and “arch” groups (3,3% versus 9,2%, p=0,119).
Conclusion. The frequency of hemorrhagic complications requiring reoperation in patients with a fully or partially reconstructed aortic arch does not have significant differences when using the guideline for preventing of hemorrhagic complications, which makes it possible to provide acceptable frequency of bleeding episodes and reoperations in the early postoperative period.
Key words: aortic arch, hemorrhagic complications, aortic aneurysm, aortic dissection.
3Tomsk State University of Control Systems and Radioelectronics, Tomsk, Russia.
Panfilov D. C. ORCID: 0000-0003-2201-350X, Kozlov B. N. ORCID: 0000-0002-0217-7737, Zatolokin V. V. ORCID: 0000-0003-3952-9983, Ponomarenko I. V. ORCID: 0000-0003-2494-0104, Khodashinsky I. A. ORCID: 0000-0002-9355-7638, Shipulin V. M. ORCID: 0000-0003-1956-0692.
Aim. To study a bone mineral density (BMD) in recipients with calcium degeneration and preserved morphofunctional state of heart valve bioprotheses (BP).
Material and methods. The experimental groups included the patients with structural dysfunctions of BP associated with the calcification of the xenomaterial, confirmed by light and electron microscopy data (group I, n=22) and the patients with normal functional state of the implanted valves according to the results of echocardiographic tests (group II, n=48). BMD was assessed by dual energy absorptiometry in the absolute count of mineralized bone and indicators of T-test.
Results. When interpreting the T-test of a femoral neck the severity of osteopenic syndrome prevailed in patients with calcium degeneration of BP (-1,83 [-2,66; -1,25] in group I vs -1,47 [-2,51; -0,86] in group II, р=0,055). At that the mean values of this indicator in patients with the development of calcium-associated BP dysfunctions in the first four years after a surgical correction of the defects reached the diagnostic criteria of the osteoporosis (-2,73 [-3,40; -2,09] vs -1,67 [-2,92; -0,42], р>0,05). According to the result of absorptiometry of the lumbar spine the worst Т-score indicators were also recorded in recipients with the calcification of BP within the first four years of follow-up (-1,75 [-1,83; -1,43] vs -0,81 [-0,96; -0,66] in patients without the signs of calcification, р=0,021). The state of BMD reflects the physiological and pathological processes of calcium redistribution in organism. The existence of the pathogenetic parallels between the activity of bone resorption processes and calcification of the elements of cardiovascular system allows to consider the osteopenia and pathological mineralization of the soft tissues within the framework of a single continuum. The results of the presented work in their turn testify to the determining significance of the severity of osteopenic syndrome manifestations in the development of the “early” calcium degeneration of BP.
Conclusion. Extension of the concepts of the mechanisms and processes which form the pathogenetic basis of mineralization will allow to determine the effective strategies for managing the risk of calcium-associated BP dysfunctions.
Key words: heart valve bioprotheses, calcification, dysfunctions, osteopenia.
2Regional Clinical Hospital for War Veterans, Kemerovo, Russia.
Rutkovskaya N. V. ORCID: 0000-0002-8829-0481, Stasev A. N. ORCID: 0000-0003-1341-204X, Kondyukova N. V. ORCID: 0000-0002-3416-1860, Kuzmina O. K. ORCID: 0000-0002-0154-323X, Fanaskov V. B. ORCID: 0000-0002-0714-1100, Barbarash L. P. ORCID: 0000-0001-6981-9661.
Podzolkov V. I., Pisarev M. V., Zateyshchikova D. A.
Renin-angiotensin-aldosterone axis activation is an important mechanism of hypertension and its cardiovascular and renal complications. Angiotensin receptor blockers are considered among the first-choice antihypertensive drugs in Russia, European countries, and the USA. In addition to antihypertensive action, these drugs positively influence several components of the cardiovascular continuum and can be used for individualized management of high cardiovascular risk patients. The paper discusses the benefits of angiotensin receptor blockers use in patients with cardiovascular comorbidities. The paper includes a clinical case scenario revealing antihypertensive efficacy of telmisartan as an initial agent in a patient with high risk of cardiovascular events.
Key words: arterial hypertension, cardiovascular risk, angiotensin receptor blockers, telmisartan, cardiovascular continuum.
Podzolkov V. I. ORCID: 0000-0002-0758-5609, Pisarev M. V. ORCID: 0000-0002-9647-1012, Zateyshchikova D. A. ORCID: 0000-0002-8075-8094.
Konradi A. O., Ratova L. G., Emelyanov I. V., Nedoshivin A. O.
Arterial hypertension (AH) is the most common non-infectious disease in the world and in Russia, associated with high cardiovascular morbidity and mortality. In August 2018, new guidelines for the diagnosis and treatment of patients with arterial hypertension were presented at the European Congress of Cardiology. The article discusses the role of the sympathetic nervous system in the pathogenesis of hypertension and the current importance of beta-blockers in the treatment of hypertension.
Key words: arterial hypertension, beta-blockers, 2018 ESC/ESH Guidelines for the management of arterial hypertension.
Almazov National Medical Research Center of RAS, St. Petersburg, Russia.
Konradi A. O. ORCID: 0000-0001-8169-7812, Ratova L. G. ORCID: 0000-0002-3109-034X, Emelyanov I. V. ORCID: 0000-0002-3176-0606, Nedoshivin A. O. ORCID: 0000-0001-8892-6411.
Nedogoda S. V., Sabanov A. V.
Aim. To evaluate the features of pharmacotherapy in achieving different levels of target blood pressure (BP) in patients with arterial hypertension (AH) with the absence or presence of comorbid diseases in real outpatient practice.
Material and methods. At the open multicenter observational study, outpatient physicians filled original patient questionnaires, which reflected the demographic data of patients, the presence of comorbid diseases and conditions prescribed antihypertensive drugs and achieved during treatment with their use levels of systolic (SBP) and diastolic (DBP) blood pressure (BP), body mass index (BMI), creatinine and blood glucose levels, as well as information about smoking. The obtained data were stratified into groups depending by the level of blood pressure achieved in patients during the therapy, as well as depending on the existing comorbid diseases. Estimated rate of prescription of antihypertensive agents, the number of components of therapy, the number assigned to tableted dosage forms (tablets). We also evaluated the frequency assignments of fixed combinations (FC).
Results. The study included data from 2073 patients. They were divided into six groups according to the level of BP achieved. The groups were comparable by demographic and anthropometric characteristics, as well as in gender representation. In patients of the first group on the background of therapy were achieved the lowest values of blood pressure - 120-129/<80 mm Hg. art. They were less likely than other groups to detect comorbid diseases, less frequently prescribed thiazide/thiazide-like diuretics (TD), and FC were prescribed in 33,8%. In patients of the second group the blood pressure level was 130-139/<80 mm Hg. art., the duration of hypertension was the smallest, they were most often prescribed angiotensin II receptor blockers (ARBS) and so on, and the share of FC was the maximum among the compared groups - 42,3%. In the third group, the blood pressure level was 120-139/80-89 mm Hg. St. These patients are most often prescribed angiotensin converting enzyme inhibitors (ACEi), but rarely angiotensin receptors blockers (ARB), frequency assignments of FC - 37,8%. The level of blood pressure in patients of the fourth group who did not achieved the target value of SBP (≥140 mm Hg), in the fifth group - the target value of DBP (>90 mm Hg), and in the sixth group - the target values of SBP (>140/>90 mm Hg. art.). Their share in the total sample was 19,9%, 4,1%, and 41,2%, respectively. Patients from these groups were more likely to have comorbid diseases, they were more often prescribed four or more components of therapy. BP level <130/<80 mm Hg in patients with type 2 diabetes mellitus (DM 2) was achieved in 4,2%, in patients with coronary heart disease (CHD) in 8,3%. In these groups, a high frequency of beta-blockers (BB) was noted. Patients with chronic kidney disease (CKD) had blood pressure levels of 130-139/<80 mm Hg was 7,9%. Among patients with stroke/transient ischemic attack (TIA) blood pressure 120-129/<80 mm Hg was achieved in 2%. In the general sample of patients, one component of antihypertensive therapy was prescribed in 5,8%, two - in 48,3%, three - in 34,7%, four or more - in 11,2%.
Conclusion. Target blood pressure <140/90 mm Hg was achieved at 34,8%, and the level of blood pressure <130/80 mm Hg - only at 11,5% of patients. In these patients, comorbid diseases were less often observed, from hypotensive drugs, ACEI, BB or TD were most often used, the predominant appointment of twocomponent antihypertensive therapy was noted, which was most often presented in the form of two tablets. In patients with comorbid diseases revealed a very low proportion of achieving the target level of blood pressure: with DM 2 - 4,2%, with CKD - 7,9%, with IHD - 8,3%, with stroke/TIA - 2%. Among the patients of the whole sample, two- and three-component antihypertensive therapy was most often prescribed (48,3% and 34,7%, respectively). A greater number of antihypertensive components were prescribed to patients with several comorbid diseases, and, consequently, with a more severe course of hypertension.
Key words: arterial hypertension, target blood pressure, comorbid diseases, antihypertensive therapy, fixed combinations of drugs.
Funding. The publication of the article is supported by Servier, which had not a bearing on the results of the study and the authors’ own opinion.
Acknowledgements. Arkhipov M. V., Volodina E. N., Galin P. Yu., Gapon L. I., Grekhova L. V., Gultyaeva E. P., Davidovich I. M., Demchuk T. I., Ezhov A. V., Efremushkina A. A., Zbyshevskaya E. V., Zvartau N. E., Zlodeyev K. V., Znamenskaya I. A., Kovalenko T. G., Koval A. P., Korennova O. Yu., Kuzmin V. P., Kulibaba E. V., Lapshina S. A., Lebedev S. V., Libov I. A., Merezhanova A. A., Minushkina L. O., Nevzorova V. A., Odintsova S. N., Osipova O. A., Popova M. A., Ryukhina I. Yu., Ryabikhin E. A., Sergienko I. V., Sokolov I. M., Tavluyeva E. V., Tolpygina S. N., Troshina A. A., Trunina T. P., Trufanova N. L., Fendrikova A. V., Frolova E. V., Khairutdinova G. I., Khokhlov R. A., Khramtsova N. A., Tsareva V. M., Shaposhnik I. I., Shafranskaya R. P.
Volgograd State Medical University of the Ministry of Health, Volgograd, Russia.
Nedogoda S. V. ORCID: 0000-0001-5981-1754, Sabanov A. V. ORCID: 0000-0003-4170-1332.
Aim. Evaluate the one-year results and clinical outcomes of a multi-center randomized clinical trial FRIDOM1.
Material and methods. The study FRIDOM1 was conducted in 11 clinical centers of the Russian Federation in the period 2014-2016. The study included 382 patients with acute ST-elevated myocardial infarction (STEMI), who were randomly divided into the Fortelyzin® and Metalyse®. Thrombolysis was accompanied by anticoagulant and dual antiplatelet therapy followed by percutaneous coronary intervention (PCI). One-year patient status, all-cause mortality, including cardiovascular diseases (CVD), hospitalization, and one-year survival were assessed by telephone contact.
Results. The one-year patient status was determined in 186 out of 191 (97,4%) in the Fortelyzin® group and in 185 out of 191 (96,9%) patients in the Metalyse® group. One-year all-cause mortality was 5,9% and 6,5% in the Fortelyzin® and Metalyse® groups, respectively (p=0,83; OR 0,91; 95% CI - 0,42-1,98). One-year mortality from CVD in the Fortelyzin® group is 5,4%, in the Metalyse® group - 6,5% (p=0,67; OR 0,83; 95% CI - 0,37-1,83). All-cause mortality between 30 days and 1 year in the Fortelyzin® group was in 2,2% of patients, CVD - in 1,6%, in the group of Metalise® mortality was in 2,7% of patients (all - CVD). One-year survival was 94,1% and 93,5% in the Fortelyzin® and Metalyse® groups, respectively.
Conclusion. The one-year results of the FRIDOM1 study showed the efficacy and safety of a single bolus administration of Fortelyzin® as part of a pharmaco-invasive strategy for treating patients with STEMI, as well as clinical outcomes that are comparable with Metalyse®, including high survival rates and low CVD mortality.
Key words: ST-elevated myocardial infarction, Fortelyzin®, Metalyse®, pharmacoinvasive strategy, one-year results.
Conflicts of Interest: Markov V. A., Vyshlov E. V., Makarov E. L., Klein G. V. received sponsorship fees for research from Beringer Ingelheim, SupraGen and lecturer fees from AstraZeneca, Beringer Ingelheim, Bayer, Sanofi, SupraGen. Aksentyev S. B. Received sponsorship research fees from Sanofi, Cardiology Research Center, SupraGen, and lecturer fees from AstraZeneca, Bayer, SupraGen. Duplyakov D. V, Platonov D. Yu., Rabinovich R. M. received sponsorship fees for research from Pfizer, SupraGen and lecturer fees from Beringer Ingelheim, Bayer, Sanofi, SupraGen. Konstantinov S. L., Kulibaba E. V. received lecturer fees from AstraZeneca, Beringer Ingelheim, SupraGen. Baranov E. A., Kritskaya O. V., Ponomarev E. A., Yunevich D. S. received sponsorship fees for research from SupraGen. Talibov O. B. received fees for consulting on the design and statistical processing of research results from Beringer Ingelheim, SupraGen. Gerasimets E. A. is a medical advisor of SupraGen.
14The Peoples’ Friendship University of Russia, Moscow, Russia.
Markov V. A. ORCID: 0000-0002-5959-2771, Dupliakov D. V. ORCID: 0000-0002-6453-2976, Konstantinov S. L. ORCID: 0000-0001-8876-0343, Klein G. V. ORCID: 0000-0002-9042-7969, Aksentev S. B. ORCID: 0000-0002-0507-520X, Platonov D. Yu. ORCID: 0000-0003-0635-3571, Vyshlov E. V. ORCID: 0000-0002-3699-4807, Ponomarev E. A. ORCID: 0000-0001-8391-6193, Rabinovich R. M. ORCID: 0000-0002-1562-6212, Makarov E. L. ORCID: 0000-0002-7435-2653, Kulibaba E. V. ORCID: 0000-0001-9094-8716, Yunevich D. S. ORCID: 0000-0002- 4306-1925, Kritskaia O. V. ORCID: 0000-0002-9334-5678, Baranov E. A. ORCID: 0000-0002-9127-6365, Talibov O. B. ORCID: 0000-0001-6381-2450, Gerasimets E. A. ORCID: 0000-0002-2409-0472.
The article presents data about the prevalence and expected prognosis for arterial hypertension. Emphasis is placed on the selection of antihypertensive therapy in elderly patients. The features concerning the positive effect of the calcium channelblocking agent - amlodipine, thiazid-like diuretic - indapamide retard in the form of monotherapy and a combination of the above drugs on the course and prognosis of arterial hypertension in elderly patients are investigated. A clinical example of the use of the fixed dose combination amlodipine + indapamide retard is also introduced.
Key words: arterial hypertension, calcium channel-blocking agent, thiazid-like diuretics, amlodipine, indapamide retard, elderly.
2Interregional Clinical Diagnostic Center, Kazan, Russia.
Galeyeva Z. M. ORCID: 0000-0002-9580-3695, Galyavich A. S. ORCID: 0000-0002-4510-6197, Baleyeva L. V. ORCID: 0000-0002-7974-5894, Safina E. G. ORCID: 0000-0002-4315-3678, Sorokina O. V. ORCID: 0000-0001-5675-7705.
Local progenitor cells are present in all tissues, including the myocardium. Stimulation of these cells can significantly improve the efficiency of the regeneration process. Biodegradation products of Alloplant biomaterials (ABM) are an inhibitor of fibrosis and serve as an inducer of stem cells in various body tissues including smooth and skeletal muscles, as well as connective tissue.
Aim. To determine the cell regenerative potential of progenitorial c-kit and committed GATA-4 cells in ischemic myocardium on the background of ABM application in chronic experiment.
Material and methods. 100 Wistar rats weighing 180-200 g were used, that underwent ligation of coronary artery. In the experimental group (n=50), 600 μl of a physiological solution containing 12 mg of ABM was administered simultaneously with coronary occlusion. General histological studies (hematoxylin and eosin staining, and staining as per Mallory), immunohistochemical (c-kit, GATA-4) and morphometric studies (determination of the index of the scar’s area, counting of stained cells) were carried out. The statistical processing of the results was carried out using the rank methods - single factor dispersion analysis as per Kruskalou-Wallace and the comparison of uncorrelated data by the Mann-Whitney method.
Results. When using ABM during coronary occlusion, myocardium was characterized by a statistically significant (p<0,0001) prevalence of c-kit+/GATA-4+ cells numbers throughout the follow-up period (3-45 days). These cells were localized mainly in the granulation tissue of the peri-cicatricial area, bordering on the preserved cardiac muscle tissue. In the peri-cicatricial area, cardiac cells had a different degree of maturity - from poorly differentiated forms (without clear ultrastructural signs of cardiomyogenic orientation) to young cardiomyocytes. In the presence of ABM, coronary occlusion was characterized by statistically significantly smaller values of the index of the scar’s area (p<0,05.<0,0001).
Conclusion. ABM degradation products are chemoattractants for c-kit cells and promote their differentiation into cardiomyogenic GATA-4 cells, which contributes to more successful myocardium repair.
Key words: myocardium, alloplant biomaterial, stem cells, c-kit/GATA-4.
Funding. The study was conducted within the framework of the state assignment: NIOKR registration number 115040870057 from 08.04.2015.
2Cardiology Research Institute, Tomsk National Research Medical Centre of RAS, Tomsk, Russia.
Chernyavsky M. A., Zherdev N. N., Chernova D. V., Chernov A. V., Kudaev Yu. A., Gusev A. A.
Key words: aortic coarctation, aortic dissection, aortic arch aneurysm, endovascular isolation of aortic aneurysm.
Almazov National Medical Research Center, Saint Petersburg, Russia.
Chernyavsky M. A. ORCID: 0000-0003-1214-0150, Zherdev N. N. ORCID: 0000-0003-2500-2320, Chernova D. V. ORCID: 0000-0001-9470-2609, Chernov A. V. ORCID: 0000-0003-3092-7774, Kudaev Yu. A. ORCID: 0000-0002-2111-0765, Gusev A. A. ORCID: 0000-0002-2417-166X.
Shchukin Yu. V., Sukhorukov V. V., Ryabov A. E., Buklesheva I. M., Germanov V. A., Krugomov A. V., Aydumova O. Yu.
Patient’s history with an implanted pacemaker and a myocardial infarction with a coronary-pulmonary fistula of circumflex artery was analyzed. The article discusses the difficulties of diagnosing this pathology and the possibilities of its curative treatment, as well as the experience of its management in the Clinics of Samara State Medical University.
Key words: interventional cardiology, coronary pulmonary fistula, intravascular occlusion, coronary angiography.
Samara State Medical University of RAS, Samara, Russia.
Shchukin Yu. V. ORCID: 0000-0003-0387-8356, Sukhorukov V. V. ORCID: 0000-0002-1617-3454, Ryabov A. E. ORCID: 0000-0001-8831-276X, Buklesheva I. M. ORCID: 0000-0003-1467-4447, Germanov V. A. ORCID: 0000-0003-4239-5066, Krugomov A. V. ORCID: 0000-0002-1611-9095, Aydumova O. Yu. ORCID: 0000-0001-5673-7958.
Sharifulin R. M., Bogachev-Prokofiev A. V., Zhuravleva I. Yu., Timchenko T. P., Zheleznev S. I., Karaskov A. M.
Mitral insufficiency is one of the most common valvular pathology. In almost half of the patients, standard mitral valve replacement using extracorporeal circulation cannot be used due to the high risk of complications. In recent years, for this category of patients a method for transcatheter mitral valve replacement has been proposed. Now it is known about a few transcatheter prostheses for implantation into the native mitral valve that are at the stage of preclinical or clinical trials. This article analyzes the results of the clinical use of prostheses for transcatheter mitral valve replacement.
Key words: mitral valve, biological prosthesis, transcatheter mitral valve replacement.
Funding. This study was supported by a grant from the Russian Science Foundation (16-15-10315).
Sharifulin R. M. ORCID: 0000-0002-8832-2447, Bogachev-Prokofiev A. V. ORCID: 0000-0003-4625-4631, Zhuravleva I. Yu. ORCID: 0000-0001-7630-8085, Timchenko T. P. ORCID: 0000-0002-1812-2845, Zheleznev S. I. ORCID: 0000-0002-6523-2609, Karaskov A. M. ORCID: 0000-0001-8900-8524.
Kostyunin A. E., Ovcharenko E. A., Klyshnikov K. Yu.
Bioprosthetic valves are often used to replace diseased heart valves. They differ from mechanical valves by optimal hemodynamic parameters and low thrombogenicity. However, although the durability of modern bioprosthetic valves, their design, and implantation procedures are being improved, the replacement of the native valve does not necessarily lead to favorable outcome, because valvular defect is often replaced by “prosthetic valve disease”. Structural valve degeneration is one of the main causes of bioprosthetic valve failure, but its mechanisms have not been studied in detail. This review summarizes and analyzes current data on mechanisms responsible for bioprosthetic valve structural degeneration. These mechanisms include passive degeneration, inflammation, fibrosis and osteogenesis.
Key words: bioprosthetic heart valves, dysfunctions, calcification, structural valve degeneration.
Kostyunin A. E. ORCID: 0000-0001-6099-0315, Ovcharenko E. A. ORCID: 0000-0001-7477-3979, Klyshnikov K. Yu. ORCID: 0000-0003-3211-1250.

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