Highlights Effective vascular grafts with diameters less than 4 mm remain unavailable on the market for cardiovascular surgery applications. Biodegradable grafts featuring prolonged resorption and regenerative potential are considered a viable alternative. The comprehensiveness of risk assessment for such grafts in preclinical trials is contingent upon the selected animal model. Abstract There is still no effective vascular prosthesis with a diameter of less than 4 mm on the market of products for the needs of cardiovascular surgery. A biodegradable vascular prosthesis with prolonged resorption and regenerative capacity may be an alternative. The completeness of determining the risks of failure of biodegradable prostheses of small-diameter vessels subjected to preclinical tests directly depends on the animal model chosen for such tests. This literature review presents the main trends in recent years in the selection of animal models for preclinical testing of biodegradable vascular prostheses of small diameter and evaluates the effectiveness of tests in the context of species-specific features of the most popular small and large animal models.

Highlights A promising area of tissue engineering is the creation of materials for the repair of damaged myocardium. The key advantage of a polyvinyl alcohol (PVA) – based material is the ability to change its properties to meet the requirements of biocompatibility, mechanical characteristics, and others. Aim. To create cryogels based on polyvinyl alcohol and to study their structural, physico-mechanical, wetting properties and electrical conductivity. Methods . PVA cryogels in 0.9% NaCl and PVA in deionized water were prepared using 1, 3, or 5 freeze-thaw cycles. The surface morphology of the cryogels was studied by scanning electron microscopy (SEM). The strength and elastic-deformative properties of the materials were determined using a universal testing machine (Zwick/Roell, Germany). The hydrophilicity of the cryogels’ surface was assessed by measuring the contact angle using the ImageJ software (National Institutes of Health, USA). Electrical conductivity was measured by the four-point probe method using a multimeter (EXCEL, China). Statistical analysis was performed using GraphPad Prism 8.0 software (GraphPad Software, USA). A p-value < 0.05 was considered statistically significant. Results. A comprehensive analysis of SEM images and contact angle measurements of PVA hydrogels showed that using 0.9% NaCl and 1–3 freeze-thaw cycles create a highly porous, hydrophilic structure with thin pore walls. PVA_NaCl cryogels outperformed samples prepared with deionized water in terms of strength and elastic modulus. The highest mechanical properties were observed for PVA_NaCl after 3 cycles (strength 0.82 (0.742; 0.849) MPa, elongation 347.4 (307.6; 351.8) %, Young’s modulus 0.097 (0.092; 0.105) MPa). The electrical conductivity of PVA_NaCl reached 0.531 cm/s after 1 cycle but decreased with more cycles; PVA_H2O samples showed no conductivity. Conclusion. PVA_NaCl cryogels with 0.9% NaCl exhibit good physico-mechanical and electrical properties close to those of myocardium. The results indicate the promise of PVA_NaCl cryogels with 1–3 freeze-thaw cycles as materials for myocardial tissue engineering.

Highlights Sequential extracorporeal therapy is a multi-organ support strategy for the treatment of critical illnesses that pathogenetically addresses the underlying cause of organ failure. This article reports a rare case of sequential extracorporeal therapy, which significantly prolonged the life of a patient with severe multiple organ failure after orthotopic heart transplantation. Abstract This article describes a clinical case of a 52-year-old man with ischemic cardiomyopathy, chronic left ventricular aneurysm, multiple myocardial cicatricial changes, diabetes mellitus and postcholecystectomy syndrome, who underwent orthotopic heart transplantation. After surgery he had developed sepsis and septic shock due to nosocomial pneumonia, pancreatic necrosis, acute renal and liver failure. Postoperative period was complicated by a crisis of rejection of the donor heart and pulmonary embolism. We used therapeutic plasma exchange, prolonged renal replacement therapy with the use of CytoSorb, Jafron and Toraymyxin sorption columns, as well as extracorporeal membrane oxygenation in the treatment process. As a result of progression of multiple organ failure, the patient died, but thanks to targeted use of extracorporeal technologies it was possible to prolonge the patient's life for 42 days. Consistent use of various methods of extracorporeal therapy has demonstrated its effectiveness, but further studies are needed to standardize their use in the aim to determine the target group of patients and select the optimal technology.

Highlights 81 unique proteins were identified in the native heart valves affected by rheumatic heart disease. The identified unique proteins are involved in the organization of extracellular matrix and collagen fibrils, cell adhesion, the regulation of osteoblast differentiation, cell migration, and endothelial cell proliferation. When compared with native heart valves affected by calcific aortic valve disease, 24 upregulated and 9 downregulated proteins were identified in native heart valves explanted from patients with rheumatic heart disease. Aim. To identify key proteins and signaling pathways involved in the pathogenesis of rheumatic heart disease (RHD). Methods. Using high-performance liquid chromatography-mass spectrometry, we performed label-free proteomic profiling of native heart valves explanted from RHD patients (n = 3). Native heart valves affected by calcific aortic valve disease (CAVD) (n = 5) were used as a comparison group. Results. 81 unique proteins involved in the organization of extracellular matrix and collagen fibrils, cell adhesion, the regulation of osteoblast differentiation, cell migration, and endothelial cell proliferation were identified in native heart valves obtained from RHD patients. Furthermore, when compared with native heart valves affected by CAVD, 33 differentially expressed proteins were identified in native heart valves affected by RHD (24 upregulated and 9 downregulated). Conclusion. Proteomic profiling of native heart valves explanted from RHD patients revealed unique and differentially expressed proteins and signaling pathways involved in the development of this pathological condition relative to heart valves affected by CAVD. The obtained pilot data contribute to our understanding of the fundamental mechanisms underlying the RHD pathogenesis and can also be used to search for targeted molecular therapies for the correction of this pathology.

Highlights It has been demonstrated for the first time that multitasking cognitive training reduced the density of low-frequency current sources in the frontal and temporal regions of the brain involved in encoding memories and regulating general brain activity in patients after coronary artery bypass surgery. Aim. To study the topological features of brain activity assessed using the standardized low-resolution brain electromagnetic tomography (sLORETA) method in patients with multitasking cognitive training after coronary artery bypass grafting (CABG). Methods. A prospective study enrolled 100 patients admitted to the hospital for CABG, aged 45 to 75 years. All the patients were randomly assigned to a group with multitask cognitive training (MCT) or a comparison group without training (n = 50). The MCT protocol included a postural task performed simultaneously with cognitive tasks involving mental arithmetic, verbal fluency, and the unusual use of a common object. The MCT course was conducted daily, starting 3–4 days after CABG, and lasted 5–7 days. Standardized low-resolution brain electromagnetic tomography (sLORETA) was used to localize current density sources to assess the topography of changes in brain electrical activity. Results. It was found that there was a decrease in the frontotemporal density of current sources at frequencies of 3–5 and 5–7 Hz after MCT during the early postoperative period CABG, compared to preoperative values (t > 3.43; p < 0.003 and t > 3.53; p < 0.007). Between-group differences were observed in the mediobasal regions of the brain; patients after MCT had a lower density of activity sources in the 3–5 Hz range compared to the group without training (t > -3.48; p < 0.04). Conclusion. The MCT helped to reduce low-frequency activity in patients after coronary artery bypass grafting (CABG). Topographic features were associated with the frontotemporal and medial basal regions of the brain, which are involved in memory encoding and regulating general brain activity. These findings emphasize the significance of investigating neural mechanisms underlying the effectiveness of multitasking interventions in cognitive rehabilitation. The data obtained can be utilized to develop and conduct future research aimed at enhancing cognitive rehabilitation programs.

Highlights Testing of prototypes of small-diameter polymer vascular prostheses was conducted in accordance with the requirements of State Standards. The polymer vascular prostheses PCL/PU/GFmix/ Ilo/Hep demonstrated high resistance to mechanical and hydrodynamic impacts, confirming their potential for long-term use. Background. Testing of vascular prostheses in accordance with State Standards is critically important to ensure their safety, efficacy, and quality, which directly impacts patient health. Aim. To test prototypes of polymer vascular grafts for structural and mechanical properties in accordance with state standards. Methods. Tubular vascular grafts were fabricated using emulsion electrospinning from a solution of polycaprolactone and polyurethane with a complex of pro-angiogenic factors in chloroform. A hydrogel coating containing iloprost and heparin was formed on the inner surface of the graft. The surface structure, planimetric porosity, water leakage pressure, and mechanical properties of the grafts were evaluated before and after multiple needle punctures. Statistical analysis was performed using GraphPad Prism 8. Results. The polymer vascular graft was an elastic tube with a length of 8.0–10.0 cm. Scanning electron microscopy (SEM) revealed that the graft wall had a homogeneous structure without delamination. Both the external and internal surfaces exhibited a network of randomly oriented fibers forming interconnected pores. The relative planimetric porosity of the external side was 59.07 (51.23; 72.80) %, and that of the internal side was 63.43 (58.56; 63.76) %. The water leakage pressure was 240.0 (80.0; 300.0) mmHg. The tensile strength of the vascular grafts was 0.042 (0.041; 0.044) kN in the longitudinal direction and 0.068 (0.038; 0.073) kN/mm in the circumferential direction. After 8, 16, and 24 punctures with a 16G needle, the strength of the grafts decreased by 27.9, 30.88 and 47.06%, respectively (p > 0.05). The suture retention strength of the graft wall ranged from 0.70 (0.593; 0.99) g to 1.370 (0.84; 1.688) g, with no statistically significant differences between the central, upper, and lower sections of the graft (p > 0.05). No suture cut-through was observed. Conclusion. Polymer vascular grafts with growth factors, modified to form a drug-eluting coating on the inner surface, demonstrated high resistance to physical external impacts such as large-diameter needle punctures and hydrodynamic pressure, suggesting potential success for long-term use.

Highlights To date, there is no single principle for postoperative physical rehabilitation of patients who have undergone surgical correction of acquired valvular heart disease. Patients participating in our comprehensive postoperative rehabilitation program, which included treadmill physical training during the early inpatient stage and outpatient training using remote rehabilitation technologies, were characterized by a higher level of exercise tolerance, lower NT-proBNP levels, higher adherence to physical training during the year after surgery compared to patients undergoing a standard postoperative rehabilitation program (dosed walking and therapeutic exercises). The obtained data actualize the necessity of using physical rehabilitation in patients with VHD at the early inpatient stage as a safe and effective tool for improving surgical outcomes. The use of remote rehabilitation technologies with monitoring of cardiac parameters and physical activity is a safe, effective and comfortable method of outpatient rehabilitation for patients with VHD. Aim. To evaluate the efficacy and safety of a comprehensive postoperative rehabilitation program that includes physical training during the first inpatient period and outpatient rehabilitation using remote technologies one year after correction of acquired valvular heart disease (VHD). Methods . The study included 40 patients who underwent successful cardiac surgical correction of acquired VHD with cardiopulmonary bypass. Exercise testing (CPET) was performed one week after intervention while patient received stable standard therapy of heart failure during uncomplicated postoperative period. Two groups of patients were formed: 1) control group with standard postoperative rehabilitation including measures of physical rehabilitation, such as gymnastics and graded walking (n = 23). 2) main group with standard postoperative rehabilitation (graded walking, gymnastics) and early physical training with daily treadmill walking starting from the 8th day after surgery lasting 14 days (n = 17). In main group the physical rehabilitation was continued on outpatient period using remote technologies. During the outpatient phase, patients were recommended to work with a mobile application for four months according to individually selected programs of physical rehabilitation. Safety of training was controlled by assessing cardiovascular system response to physical load using fitness bracelet during the daytime and self-performed six-channel electrocardiography (ECG) using ECG dongle before and after training at home. At the time of installation of the application until discharge from hospital, also as in dynamics 4 months and 1 year after, standard clinical-instrumental examination, CPET, transthoracic echocardiography, and assessment of serum levels of myocardial strain markers (NT-proBNP, sST2) were conducted. Results : Patients participating in the developed complex rehabilitation program involving treadmill training during the inpatient stage and outpatient training using remote technologies demonstrated higher tolerance to physical activity, lower values of NT-proBNP level, and greater adherence to physical exercises over the one year compared to those undergoing standard postoperative rehabilitation. Conclusion. The obtained data highlight the necessity of applying physical rehabilitation in patients with VHD at the early inpatient stage as a safe and effective tool for improving surgical outcomes. Using remote rehabilitation technologies with monitoring of cardiac function parameters and physical activity is a safe, efficient, and comfortable method for outpatient rehabilitation in pts with VHD.

Highlights This analytical review aims to examine the features of the epidemic process of healthcare-associated infections in cardiac surgery. Based on the data described, risk-oriented technologies are considered an effective system for preventing infectious adverse events. Abstract The review is dedicated to a comprehensive analysis of the epidemic process of healthcare-associated infections in cardiac surgery. Despite the rapid development of high-tech and minimally invasive methods for treating circulatory system diseases, the problem of infectious complications after heart surgery remains extremely acute. Cardiac surgery patients present in severe condition, and the surgeries themselves carry a high risk of complications, characterized by significant prevalence, mortality, and colossal economic damage. The main forms of healthcare-associated infections, their pathogens, as well as risk factors and modern prevention approaches are described in detail. Priority is given to risk-oriented technologies as the most effective system for preventing adverse events in cardiac surgery.

Highlights Atmospheric air pollution is one of the key factors that significantly affect morbidity and mortality rates. The article presents an assessment of the pollution of residential areas and an analysis of the associations of air pollutants with the development of adverse events. Aim. To assess the level of pollution in residential areas and identify associations between airborne air pollutants and adverse events. Methods. Airborne air pollutant levels were analyzed for the period 2009–2020. A total of 2,982 respondents were included in the study to analyze the association between airborne pollutants and the risk of adverse events. Adverse events were assessed as new cases of dyslipidemia, obesity, diabetes, hypertension, myocardial infarction, stroke, arrhythmia, unstable angina, revascularization procedures, decompensation and/or verification of chronic heart failure, hospitalization for cardiac pathology, and death. Results. Airborne air pollution levels are predominantly considered high. The most common contaminants exceeding the maximum permissible concentrations include benzopyrene, nitrogen dioxide, formaldehyde, and suspended solids. Pollutant levels were somewhat lower in rural areas compared to all city districts. Pollution levels were more pronounced in the Zavodskoy and Kirovsky districts, and to a lesser extent in the Leninsky and Tsentralny districts. At the prospective stage, despite the absence of differences in the incidence of heart attack, stroke, arrhythmia, or cardiovascular death, statistically significant differences were observed when combining the above-mentioned cases. A more unfavorable profile was revealed among respondents living in the Leninsky district. Residents of the village and Rudnichny district had a more favorable profile, while the opposite was true in the Zavodskoy and Kirovsky districts. An analysis of latent factors characterizing the combination of pollutants with the greatest impact on health revealed associations between the composition of atmospheric impurities and the development of adverse outcomes in prospective observation. Conclusion. The air quality in the districts of residence was assessed as unfavorable; The content of impurities in atmospheric air is associated with the occurrence of new cases of hypertension, dyslipidemia, diabetes and obesity in previously healthy individuals, as well as with the risk of developing new cases of all cardiovascular events.

Highlights Surface modification of biodegradable anti-adhesion membranes with polyvinyl alcohol improves the physical and mechanical properties and hemocompatibility of the products, but at the same time reduces the rate of biodegradation, which leads to calcification of the membranes during subcutaneous implantation in laboratory animals and requires the elimination of the negative impact. Aim . To evaluate the effect of surface modification with polyvinyl alcohol on the biocompatibility of anti-adhesion biopolymer membranes manufactured by electrospinning. Methods . Membranes were formed from a composition of poly (D, L-lactide-co-glycolide) (50:50) and poly (D, L-lactide-co-glycolide) (85:15), using 1,1,1,3,3,3-hexafluoroisopropanol as a solvent. Dexamethasone was added to impart anti-inflammatory activity. Membranes were formed by electrospinning, after which they were surface modified with a 0.5% aqueous solution of polyvinyl alcohol. Physicomechanical properties, hemocompatibility, biocompatibility, and in vivo degradation were assessed. Results . PVA modification in the dry state was accompanied by an increase in the tensile strength and a two-fold increase in Young's modulus with a comparable elongation at break. Two-minute hydration returned the modulus to its original values. The hemocompatible properties of all sample groups met the safety criterion for hemolysis (≤ 2%). The number of adherent cells in PM/DM/PVA decreased severalfold compared to PM and PM/DM, and the strain index decreased to 1.4 versus 2.33–2.42. After 14 days, PM and PM/DM demonstrated active fiber erosion, while PP/DM/PVA retained a continuous PVA layer and less pronounced surface degradation. By 3 months, PM had completely degraded, PM/DM remained as small fragments surrounded by macrophages, and a calcification contour was visualized for PM/DM/PVA. Conclusion . Modification of the polymer membrane surface with polyvinyl alcohol eliminated residual electrostatic stress and improved the physical, mechanical, and hemocompatibility properties. However, subcutaneous implantation in laboratory animals resulted in calcification of the samples. Therefore, further research is needed to evaluate optimization of the PVA layer to reduce the susceptibility to calcification.