Artificial Circulation Research Articles

Rare Case of Surgical Treatment of a Giant Aortic Arch False Aneurysm

The authors present a clinical case of a 44-year-old male patient with a chronic giant aortic arch pseudoaneurysm with a diameter of 136 × 72 mm. The open resection of false aneurysm was accomplished without artificial circulation. Repair was performed with temporary ascending-to-descending and brachiocephalic bypass without cardiopulmonary bypass.

Досвід впровадження операцій зі штучним кровообігом на базі відділення судинної хірургії обласної лікарні

Досвід впровадження операцій зі штучним кровообігом на базі відділення судинної хірургії обласної лікарні

Risk factors of adverse outcomes of various interventions when treating patients with concomitant lesions of the coronary bed and carotid arteries in 30-day follow-up

Aim. The study looks at clinical and instrumental factors associated with adverse outcomes in the hospital and long-term follow-up when using various surgical strategies for treatment of patients with multifocal atherosclerosis.Methods. From 2011 to 2015, three hundred ninety-one patients with combined hemodynamically significant atherosclerotic lesion of the coronary bed and internal carotid arteries were included in this study in a continuous sampling mode. A detailed analysis of the prognostic significance of a wide range of clinical-instrumental, anatomical-angiographic and perioperative factors was performed.Results. Against the background of patients’ initially severe comorbid condition, the most significant hospital risk factors were III–IV functional class angina and stroke in the anamnesis. It is important to note a high risk of complications, with bleeding reaching three points or higher on the Bleeding Academic Research Consortium (BARC) scale during simultaneous coronary artery bypass graft surgery and carotid endarterectomy. At the same time, EuroSCORE II value not higher than 2% and the duration of artificial circulation 74 minutes or less turned out to be protective factors. Conclusion. The study is not randomized and requires further research on the algorithms for choosing the optimal option of revascularization in this group of patients. The results obtained can form the basis for further research aimed at developing optimal surgical protocols for patients with multifocal atherosclerosis.Received 2 August 2017. Revised 16 October 2017. Accepted 25 October 2017.Funding: The research was done with support of the grant (No. 12090ГУ/2017) awarded by the Fund for Facilitation of Innovations within the framework of the “Umnik-2016” project (Kemerovo).Conflict of interest: Authors declare no conflict of interest.Author contributionsConception and study design: R.S. TarasovData collection and analysis: A.A. Golovin, N.N. Burkov, M.G. ZinetsDrafting the article: A.N. KazantsevCritical revision of the article: S.V. Ivanov, A.I. AnoufrievFinal approval of the version to be published: R.S. Tarasov, A.N. Kazantsev, S.V. Ivanov, A.A. Golovin, N.N. Burkov, A.I. Anoufriev, M.G. Zinets, L.S. Barbarash

Features of surgical treatment of ischemic heart disease in patients with the expressed dysfunction left ventricular

Objective: to study the effect of intraluminal coronary shunts to immediate results of surgical treatment of ischemic heart disease in patients at high surgical risk with a reduced fraction of left ventricular ejection. Materials and methods: a retrospective analysis of case histories of 96 patients with coronary heart disease and decreased ejection fraction of the left ventricle who underwent surgery coronary artery bypass grafting. The patients were divided into 2 groups: the study group included 47 patients operated in the parallel artificial blood circulation, which when performing the distal anastomoses used temporary intracoronary shunts; the control group comprised 49 patients, also operated in the parallel artificial blood, but when performing distal anastomoses did not use intracoronary shunts. Monitoring of patients was performed until 12 months after surgery. Results: both groups of patients were matched for clinical and demographic indicators. In the analysis of intraoperative and postoperative period revealed the difference in the incidence of cardiac arrhythmias, other parameters were comparable. Conclusions: thus, in patients with reduced ejection fraction left ventricular intracoronary shunts is advisable to use for reasons and not in all cases, operations myocardial revascularization in the parallel artificial circulation.

Mini-extracorporeal circulation technology, conventional bypass and prime displacement in isolated coronary and aortic valve surgery: a propensity-matched in-hospital and survival analysis.

Conventional cardiopulmonary bypass is the most commonly used means of artificial circulation in cardiac surgery. However, it suffers from the effects of haemodilution and activation of inflammatory/coagulation cascades. Prime displacement (PD) can offset haemodilution and mini-extracorporeal technology (MIECT) can offset both. So far, no study has compared all of these modalities together; hence, we compared the outcomes of these 3 modalities at our institution. This was a retrospective analysis of our cardiac surgical database. A total of 9626 patients underwent conventional bypass (CB), 3125 patients underwent a modification of CB, called PD, and 904 underwent MIECT. A 1:1 propensity-matching algorithm was employed using IBM SPSS 24 to match (i) 813 MIECT patients with 813 CB patients and (ii) 717 MIECT patients with 717 PD patients. The patients included coronary artery bypass grafting and valve surgery. MIECT had significantly (P < 0.05) longer bypass and cross-clamp times compared to CB and PD. MIECT had significantly higher rates of postoperative atrial fibrillation associated with it compared to CB. The mean red cell blood transfusion was significantly lower in the MIECT group compared to the CB group as was the mean platelet transfusion and fresh frozen plasma transfusion. The overall 5-year survival was higher in the MIECT group compared to the CB group (log-rank, P = 0.018). Between the MIECT and the PD groups, we found the incidence of renal failure and gastrointestinal complications to be significantly higher in the PD group compared to the MIECT group. MIECT has short-term advantages over CB and PD. However, due to the retrospective limitations of the study, including calendar time bias, a multicentre randomized controlled trial comparing all 3 modalities will be beneficial for the larger cardiac community.

Совместная динамика синхронизации низкочастотных колебаний в вегетативной регуляции кровообращения и показателей вариабельности ритма сердца у пациентов после операций с искусственным кровообращением в раннем послеоперационном периоде

Совместная динамика синхронизации низкочастотных колебаний в вегетативной регуляции кровообращения и показателей вариабельности ритма сердца у пациентов после операций с искусственным кровообращением в раннем послеоперационном периоде

Cardiopulmonary bypass and circulatory support in Petrovsky Russian Research Center for Surgery

Since initial application of cardiopulmonary bypass (1960) and circulatory support (1977) unique methods of extracorporeal circulation have been developed at Petrovsky Russian Research Center for Surgery. Some of them were introduced for the first time in the country (USSR and then in the Russian Federation). It was possible due to creative team of Boris Vasilyevich Petrovsky, whose potential was aimed at expanding the indications for surgical treatment of cardiac, aortic, liver, lung and kidney diseases under artificial circulation and then circulatory support.

Influence of bicycle ergometric loads on the energy supply system in patients after surgery with an artificial circulation.

Введение. В ряде исследований было выявлено снижение риска повторных госпитализаций на фоне проводимой кардиореабилитации после аортокоронарного шунтирования (АКШ). Физическая кардиореабилитация может стать эффективным средством восстановления адаптационных возможностей организма. Целью тренировочной программы кардиореабилитации после кардиохирургических операций является оптимизация систем энергообеспечения.

History of artificial circulation with biological oxygenation in cardiac surgery in Russia

History of artificial circulation with biological oxygenation in cardiac surgery in Russia

Water artificial circulation for eutrophication control

This work analyzes, from a mathematical point of view, the artificial mixing of water -by means of several pairs collector/injector that set up a circulation pattern in the waterbody -in order to prevent the undesired effects of eutrophication. The environmental problem is formulated as a constrained optimal control problem of partial differential equations, where the state system is related to the velocity of water and to the concentrations of the different species involved in the eutrophication processes, and the cost function to be minimized represents the volume of recirculated water. In the main part of the work, the wellposedness of the problem and the existence of an optimal control is demonstrated. Finally, a complete numerical algorithm for its computation is presented, and some numerical results for a realistic problem are also given.

Lab-scale Evaluation of Spiral Vortex Artificial Circulation

When phosphorus and nitrogen concentrations are high in lakes and reservoirs, enough for algae to grow, algal bloom prevention needs to be approached by circulation of stagnant water. A new circulation technology ‘Spiral vortex artificial circulation’ was developed that transports water to the surface without any hose and also provides sufficient oxygen as the water circulates. Artificial thermal and dissolved oxygen stratification was created in a water tank, and thermometers and DO meters were placed at each layer to evaluate the technology’s efficiency by comparing how fast the stratification broke. Two types of booster were used: a flow booster which promotes thorough mixing and a 12 cm flat round booster that protects the bottom of water column from disturbing, yet circulates the surface. Impeller speed was set at 60 rpm and 180 rpm to compare speed difference thus total of four experiments were conducted. The stratified water was completely mixed in two experiments with flow booster. However when 12 cm flat round booster was used at 60 rpm, even after 100 minutes of operation the stratification was not broken whereas it took 75 minutes at 180 rpm. The same or similar settings can be applied in situ without disturbing the benthic zone; if not, nutrients could be released to water bodies which might lead serious eutrophication. The further technology evaluation is in progress for improving its algal bloom suppression and energy efficiency since all technologies required to be environmentally sustainable.

ВІДДАЛЕНІ РЕЗУЛЬТАТИ ХІРУРГІЧНОЇ КОРЕКЦІЇ НЕДОСТАТНОСТІ МІТРАЛЬНОГО КЛАПАНА ВНАСЛІДОК ПОРУШЕННЯ ЦІЛІСНОСТІ ХОРДАЛЬНО-ПАПІЛЯРНОГО АПАРАТУ

Узагальнений досвід хірургічного лікування 520 пацієнтів, яким здійснено хірургічну корекцію недостатності мітрального клапана (МК) внаслідок порушення цілісності хордально-папілярного апарату. Хворі послідовно оперовані в умовах штучного кровообігу (ШК) за період 2006 - 2015 рр. Пластика МК виконана у 201 пацієнта, протезування МК (ПМК) - у 319. Віддалені результати проаналізовані у 487 (93,8%) пацієнтів у строки спостереження у середньому (6,3 ± 2,6) року.&#x0D; Ключові слова: пластика мітрального клапана; протезування мітрального клапана; хордально-папілярний апарат; віддалені результати.

Myocardial Protection against Ischemic and Reperfusion Injuries (Experimental Study).

The effects of hypoxic, hyperoxic, and hypoxic-hyperoxic preconditioning were examined in the prospective study on narcotized and artificially ventilated rabbits. Under artificial circulation, acute myocardial ischemia was modeled by ligation of anterior descending coronary artery, which was followed by reperfusion. The degree of ventricular arrhythmias was assessed, and the ischemic area was evaluated in percent of the area at risk. Microscopic characterization of the myocardium was employed to assess the cardioprotective effect of hypoxic and/or hyperoxic preconditioning. According to Kruskal-Wallis test, the greatest resistance of the myocardium to ischemic and reperfusion injury was observed after hypoxic-hyperoxic preconditioning (H=42.459; p=0.009). The rabbits subjected to this type of preconditioning demonstrated the least damaged myocardium in comparison with nonconditioned controls.

Effect of Artificial Circulation on the Removal Kinetics of Cyanobacteria in a Hypereutrophic Shallow Lake

AbstractThis study consisted of two parts. First, pre-aeration tests were conducted to assess the space-time variability of water quality in a shallow lake. Chlorophyll-a concentration and cyanobac...

Alternative Way for Organ Donation in Societies With Traditional Beliefs and Well Organized System of Emergency Medical Care

Substantial improvements in neurological and neurosurgical care in Russia in the last years led to imminent but expected decrease in organ donation rate. This trend inflicted the need to actively search for new ways to expand donor pool and resulted into emergence of two priority areas. First is based on the liberalization of brain death diagnostic criteria. Second one highlights the application of methods of artificial circulation. Brain death criteria liberalization will inevitably cause alterations in conventional relationship between doctor and patient. Adoption of artificial circulation approach induces the necessity to constructively rethink its role in saving person’s life or, in case of failure, saving organs of deceased person for transplant. Resuscitation procedure algorithm, death record protocol for a patient with non-beating heart, but on artificial circulatory support as well as organ procurement procedure from such donor – all these represents complex non-medical, but socio-humanitarian, philosophical and theological issues. From 2009 till now our transplant team performed 35 procedures of extracorporeal membrane oxygenation in potential organ donors with 60 minutes after irreversible cardiac arrest followed by successful transplantation. Study design, perfusion protocols, procurement and transplant procedures were approved by the Scientific Board and the Ethics Committee of the Saint Petersburg State Research Institute for Emergency (Decision 7/0615/09) and authorized for clinical application by the Federal Advisory Service of the Ministry of Health of the Russian Federation (Resolution N2010/299). All donation and perfusion procedures were approved by local Ethics Committees and Institutional Review Board [1]. Our initial experience clearly demonstrates that new technical knowledge concerning artificial circulatory support in isolated human organs and organ systems all put together with integral knowledge about human (philosophical, theological, anthropological and medical) could lead to a breakthrough in the field of organ donation that does not violate the traditional views of society. Reference: 1. Reznik ON, Skvortsov AE, Reznik AO, Ananyev AN, Tutin AP, Kuzmin DO, et al. (2013) Uncontrolled Donors with Controlled Reperfusion after Sixty Minutes of Asystole: A Novel Reliable Resource for Kidney Transplantation. PLoS ONE 8(5): e64209. https://doi.org/10.1371/journal.pone.0064209.

The treatment of mitral valve infectious endocarditis caused by a foreign body in the pulmonary artery

A case of acquired heart valvular disease (mitral valve insufficiency) is reported as a result of infectious endocarditis caused by a foreign body in a branch of the pulmonary artery. Mitral valve replacement with the mechanical Carbomedics Standard 27 prosthesis was combined with the removal of the foreign body and revision of the aortic valve under artificial circulation and pharmacocryocardioplegia.

Non-Invasive Monitoring of Temperature in the Heart Hypo- and Hyperthermia with Cardiopulmonary Bypass

Background. The implementation of the method of non-invasive control of heart temperature based on the model of heat exchange in the myocardium during extracorporeal circulation is considered. Objective. The purpose of the research is the use of numerical simulation methods in the MSC Sinda system to estimate the temperature gradient that is observed on the surface of the myocardium during hypo- and hyperthermia in the conditions of artificial circulation. Methods. To obtain the original data in the cardiopulmonary bypass loop temperature sensor system in arterial, venous, and cardioplegic lines is used. When assessing the temperature gradient applied of thermal diagnostics methods and analysis of thermograp in the infrared spectrum that allow getting data for the simulation of heat transfer process between the myocardium and coronary vessels in the MSC Sinda system. Results. As a result of numerical modeling 2D-model of heat exchange in the myocardium was proposed and the comparative analysis of thermal images of open heart with hypo- and hyperthermia with cardiopulmonary bypass was carried out. Carrying out non-invasive temperature measurement and simulation results of heat transfer on the surface of the myocardium allow more accurately adjust the speed of warming (hyperthermia) of venous blood in the heat exchanger. Conclusions. The simulation results allow supplementing the qualitative indications of system sensors for cardiopulmonary bypass. Application of thermal diagnostics methods and imaging analysis of thermograms for the monitoring of venous return temperature cardiopulmonary bypass circuit that allows you to adjust the flow of blood to the hollow veins with using venous occlusion line change with the clamp or a special device.

Lethality predictors in adults undergoing Ross procedure: analysis of 760 operations

Aim. This one-center cohort study focused on the identification of predictors of in-patient (up to 30 days) and late lethality in patients after Ross procedure over a period from 2002 to 2015. Methods. 760 patients aged 16-73 were evaluated. The analysis included methods of descriptive statistics and Kaplan-Meyer survival test. To identify the factors related to lethality outcomes, use was made of a log rank test, a chi-square test and Cox regression analysis. Results. In-patient lethality was from 0 to 5 deaths a year (95% confidence interval, 0 to 3), on average 5.6±1.6% (95% confidence interval; 4 to 7) over a period from 2002 to 2015. The cohort mean values of post-operative survival over 5 and 10 years were 98% and 98% respectively (late survival was 2%). The following statistically significant predictors of in-patient lethality (р&lt;0.05) were revealed: type of surgical complications, type of suture used for transplant anastomosis, emergency coronary grafting, cardioplegia type, on-pump duration, New York Heart Association (NYHA) class, patient’s age. No statistically significant predictors of late lethality (р&lt;0.05) were identified. Conclusion. The existing protocols for coronary arteries deformation, leakage from each of six anastomoses, right ventricle autograft bed, obligatory use of artificial circulation should be updated and added to the relevant Ross procedure guidelines.Received 22 December 2016. Accepted 14 March 2017.Financing: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Acknowledgments: The authors are grateful to Dr. Ponomarev D.N., Cand. Sci., for advice on biostatistics when preparing the article for submission.

Flow mixing during peripheral veno-arterial extra corporeal membrane oxygenation – A simulation study

Peripheral veno-arterial extra-corporeal membrane oxygenation (ECMO) is an artificial circulation that supports patients with severe cardiac and respiratory failure. Differential hypoxia during ECMO support has been reported, and it has been suggested that it is due to the mixing of well-perfused retrograde ECMO flow and poorly-perfused antegrade left ventricle (LV) flow in the aorta. This study aims to quantify the relationship between ECMO support level and location of the mixing zone (MZ) of the ECMO and LV flows. Steady-state and transient computational fluid dynamics (CFD) simulations were performed using a patient-specific geometrical model of the aorta. A range of ECMO support levels (from 5% to 95% of total cardiac output) were evaluated. For ECMO support levels above 70%, the MZ was located in the aortic arch, resulting in perfusion of the arch branches with poorly perfused LV flow. The MZ location was stable over the cardiac cycle for high ECMO flows (>70%), but moved 5cm between systole and diastole for ECMO support level of 60%. This CFD approach has potential to improve individual patient care and ECMO design.

PHENOMENON OF DEMIKHOV. "Transplantation of vital organs In experiment" (1960). Transplantation immunity, artifi cial circulation in organ transplantation

The article (the fourth of five) presents the analysis of the 4th and 5th chapters from V.P.Demikhov's monograph "Transplantation of vital organs in experiment" (MedGIz Publisher, Moscow, 1960), where he described his studies of transplantation immunity in originally created models and his use of artificial blood-circulation systems in experimental organ transplantation. It has been shown that V.P.Demikhov changed his views on the tissue biological incompatibility in homoplastic transplants and turned from the Michurin-Pavlov's concepts (1946–1953) to natural-scientific views (1959). Meanwhile, his multiple attempts to study both the morphological and humoral immunological response to transplanted organs did not give conclusive results because of lacking the experience of such studies even in the country's leading scientists and due the imperfection of their techniques. Realizing that the retrieval of a beating heart from a human would have created further problems for its subsequent transplantation, V.P. Demikhov attempted to reanimate human hearts in corpses by means of extracorporeal devices to provide artificial circulation. Methodologically, those devices were based on S.S.Bryukhonenko's research and his "auto-injector" pump modified by V.P.Demikhov. However, by 1960, those studies had not come beyond the experiments.