Artificial Circulation Research Articles

Use of concomitant anesthesia (endotracheal anesthesia and femoral nerve block) in cardiac surgery: a prospective, cross-sectional study

BACKGROUND: Regional anesthesia reduces pain impulse transmission, which reduces hormonal and metabolic responses to operational stress. No studies have reported on the use of combined anesthesia, such as endotracheal anesthesia and femoral nerve block, in cardiac surgery. OBJECTIVE: To determine the efficacy of combined anesthesia by analyzing the cortisol, glucose, and lactate levels in cardiac surgery. MATERIALS AND METODS: Prospective cross-sectional study was conducted. The study included 60 cardiac surgery patients. The patients were divided into two groups: group 1, with endotracheal anesthesia and femoral nerve blockade, and group 2, with endotracheal anesthesia (control group). All patients underwent aortocoronary bypass grafting under artificial circulation conditions. Cortisol, glucose, and lactate levels at the five stages of the perioperative period were investigated. RESULTS: Data analysis showed that the cortisol level of patients with combined anesthesia was significantly 1.2 times lower (p=0.042) than that in the control group in step 2. Glucose levels were significantly lower in the combined anesthesia group by 1.28 times (p=0.0017) than in the control group in step 4 and significantly lower by 1.2 times (p=0.0016) in step 5. Additionally, lactate level was significantly lower in the combined anesthesia group than in the control group in step 4 by a factor of 1.3 (p=0.03) and in step 5 by a factor of 1.35 times (p=0.005). CONCLUSION: The determination of cortisol, glucose, and lactate levels can be used as a component of endocrine-metabolic anesthesiological monitoring when performing cardiac surgery under artificial circulation conditions. Stable parameters of endocrine-metabolic monitoring were established using both anesthesia methods. The use of femoral nerve block in combined anesthesia reduces stress response to surgery.

Surgical treatment of intravenous leiomyomatosis with intracardial growth in conditions of artificial circulation. Clinical case

Intravenous leiomyomatosis is a smooth muscle tumor of unclear malignant potential capable of intravascular growth with varying levels of intravascular advancement. The only radical treatment method is surgical intervention requiring quality preoperative preparation and determination of optimal surgical tactics taking into account the level of damage. A description of a clinical case of intravenous leiomyomatosis with intracardial growth is presented

Hospital complications in patients with acute kidney injury after coronary artery bypass grafting

The aim was to assess the incidence of hospital complications in patients with acute kidney injury (AKI) after coronary artery bypass grafting (CABG).Patients and Methods. The study included 77 patients with stable angina who underwent CABG, aged 65 (61-69) years, 77,9 % men. The number of patients with arterial hypertension was 96,1 %, with carbohydrate metabolism disorders 45,5 %, with chronic kidney disease (CKD) 22,1 %, and with myocardial infarction (MI) 57,1 %. CABG on the working heart was performed in 28,6 %, bimammary CABG in 49,4 %. The duration of artificial circulation was 64 (55-82) minutes; the number of shunts implanted was 2,7+0,7 units. CKD was diagnosed when the glomerular filtration rate was less than 60 ml/min. The development of AKI was assessed according to the KDIGO criteria (2012).Results. CABG related AKI was detected in 10 (13 %) patients, of which grade 1 in 9 (11,7 %), grade 2 in 1 (1,3 %). The indicators associated with AKI after CABG were more severe initial CKD (stages 3b and 4 CKD – 20 % vs 1,5 %, p=0,043), a higher incidence of acute heart failure (in terms of adrenaline requirement – 30 % vs 5,9 %, p=0,043), more occluded coronary arteries (in the groups with and without CABG: one occlusion 70 % and 52,2 %, two occlusions 0 % and 13,4 %, three occlusions 10 % and 0 %, respectively, p=0,028). More severe CKD (stages 3b and 4) statistically significantly increased the relative risk of AKI after CABG by an average of 2,9 times. Among patients with AKI compared to patients without AKI after CABG, there was a higher incidence of cardiac death (20 % vs 0 %, p=0,015), intraoperative MI (60 % vs 8,9 %, p=0,001), acute heart failure (30 % vs 5,9 %, p=0,043).Conclusion. The incidence of AKI following CABG was 13 %. The development of AKI was associated with more severe initial CKD. Patients with postoperative AKI had a poor hospital prognosis.

ПРИМЕНЕНИЕ МЕТОДА ЭКСТРАКОРПОРАЛЬНОЙ АУТОГЕМОМАГНИТОТЕРАПИИ С ЦЕЛЬЮ КОРРЕКЦИИ ГЕМОДИНАМИЧЕСКИХ НАРУШЕНИЙ В ИНТРАОПЕРАЦИОННОМ ПЕРИОДЕ ПРИ ПРОВЕДЕНИИ КОРОНАРНОГО ШУНТИРОВАНИЯ В УСЛОВИЯХ ИСКУCСТВЕННОГО КРОВООБРАЩЕНИЯ

Purpose of the study. To evaluate the effect of extracorporeal autohemomagnetic therapy on the parameters of central hemodynamics during surgical intervention for myocardial revascularization (aortocoronary and mammary coronary bypass surgery) under conditions of artificial circulation. Material and methods. The parameters of invasive hemodynamics of 100 patients who were treated in anesthesiology and intensive care units were studied. All patients were divided into 2 groups. Group 1 (50 people) received standard anesthesia (multicomponent balanced anesthesia) for coronary artery bypass grafting and mammary coronary artery bypass grafting under artificial circulation without the use of extracorporeal autohemomagnetic therapy. In group 2 (50 people), in addition to standard anesthesia autohemomagnetic therapy was used. Аfter catheterization of a. radialis dextra (sinistra) and v. jagularis interna dextra (sinistra), the invasive hemodynamics parameters were assessed using the Draeger Infinity Delta monitoring system (Germany): systolic blood pressure, diastolic blood pressure, mean arterial pressure, central venous pressure, heart rate. The parameters were studied at 2 stages of the surgical intervention: 10 minutes after induction of anesthesia, 10 minutes after administration of the calculated dose of protamine. Results. The use of autohemomagnetic therapy made it possible to increase the parameters of invasive central hemodynamics: systolic blood pressure, diastolic blood pressure, mean arterial pressure. The study of the parameters of heart rate and central venous pressure revealed no statistical differences. Conclusions. The use of extracorporeal autohemomagnetic therapy in the intraoperative period during myocardial revascularization can help correct hemodynamic disorders.

Chronic thromboembolic pulmonary hypertension in a patient with myxoma of the heart and thrombophilia of mixed genesis

Objective. To describe the clinical case of a young patient with chronic thromboembolic pulmonary hypertension (CTEPH) with heart myxoma and thrombophilia of mixed origin, who underwent surgical treatment.Materials and methods. Patient Z., 24 years old, was admitted to the cardiology department with cough with sputum production that occurs during physical activity, including streaks of blood, shortness of breath with slight physical exertion, legs and feets edema, weakness and dizziness. The examination was carried out: electrocardiography; multislice computed tomography pulmonary angiography; echocardiography (EchoCG); transesophageal EchoCG; magnetic resonance imaging of the heart with contrast; screening for coagulopathy.Results. Based on clinical data, medical history, laboratory, instrumental diagnostic, we have put the diagnosis: Myxoma of the right atrium. Patent foramen ovale. Thrombophilia of mixed origin: hereditary – heterozygous mutation of the prothrombin gene (factor 2), acquired – hyperhomocysteinemia. Postthrombotic deep vein disease of the left lower limb. Recurrent pulmonary embolism (last relapse dated October 19, 2022). CTEPH functional class III (World Health Organization), moderate risk. Congestive heart failure with reduced right ventricular ejection fraction, functional class III (by the New York Heart Association). Relative tricuspid valve regurgitation grade 3. The patient underwent surgery: thromboendarterectomy from the right pulmonary artery under conditions of circulatory arrest and deep hypothermia, removal of a right atrium myxoma under conditions of artificial circulation and blood cold cardioplegia: tricuspid valve plasty according to De Vega. After surgery patient’s condition was significantly improved.Conclusion. The features of diagnosis and treatment of a patient suffering from CTEPH and cardiac myxoma are outlined. Surgery: Pulmonary thrombectomy and cardiac myxoma removal may improve the patient’s condition with CTEPH and left atrial myxoma.

The Role of Perioperative Risk Factors and Prognostic Value of Leading Biomarkers in the Occurrence of Acute Kidney Injury in Children after Cardiac Surgery

The issue of acute kidney injury in children after cardiac surgery remains topical despite the constant development of modern technologies and methods. Complications arising from cardiac surgery in children have serious adverse effects, leading to increased length of stay in the infant intensive care unit and increased mortality. The aim of study: to analyse modern concepts on the role of perioperative risk factors and prognostic value of leading biomarkers in the development of acute kidney injury in children after cardiac surgery. The review was prepared using the method of searching literature on databases Scopus, PubMed, MedLine, Cyberleninka, Google Scholar, Cochrane library, TripDataBase for the period 2012-2022. Research in the academic setting has revealed that there are several risk factors associated with the development of acute kidney injury in children after cardiac surgery. These factors include early patient age, duration of artificial circulation, complexity of surgery, use of artificial ventilation and inotropic support. Despite the importance of these studies, they have not fully explored many of the issues that have recently become relevant and related to the search for new biomarkers. These biomarkers play an important role in early diagnosis and treatment of acute kidney injury.

Comparative analysis of in-hospital and long-term results of patients with acute dysfunction of coronary bypass grafts depending on treatment tactics

Comparative analysis of in-hospital and long-term mortality of patients in whom acute dysfunction of coronary bypass grafts was detected in the early postoperative period depending on conservative or surgical tactics. The study is a retrospective analysis of data from 8801 patients who underwent elective coronary artery bypass grafting (CABG) between 2011 and 2022 at the Federal Center for Cardiovascular Surgery (Russia, Chelyabinsk). Among them, 196 patients underwent emergency coronary artery bypass grafting due to suspected perioperative myocardial infarction in the early postoperative period. In 119 patients, dysfunction of coronary bypass grafts was detected, in 77 patients no pathological changes were found. The criteria for inclusion in the study were patients with dysfunction of coronary bypass grafts (n=119). The 1st group included patients who underwent conservative therapy (n=33), the 2nd group (n=86) included those who underwent repeated myocardial revascularization. The primary endpoint was hospital mortality, secondary endpoints were long-term mortality and adverse cardiovascular events (myocardial infarction, stroke, repeat myocardial revascularization). Patients were surveyed via telephone. In-hospital mortality in the group of surgical reintervention was 8.1%, in the group of conservative treatment - 9.1% (p=0.867). According to the results of multivariate analysis, predictors of hospital mortality in patients of both groups were extracorporeal membrane oxygenation (p=0.014), time of artificial circulation (p=0.031), duration of artificial ventilation (p=0.001), number of days in intensive care (p<0.001). When analyzing long-term mortality using the Kaplan-Meier method in group 1 and group 2, no statistically significant differences were found; in the group of conservative therapy - 85±9.6 [66.2-103.7] months versus 108.2±4.8 [98.8-117.6] months in the surgery group (log-rank p=0.06). When analyzing long-term mortality from cardiovascular causes and the occurrence of adverse cardiovascular events, statistically significant differences were determined: in the group of conservative therapy - 92.5±9.3 [74.2-110.7] months versus 117.8±3.3 [111.2-124.3] months in the surgical treatment group (log-rank p=0.007) and 78.1±9.2 [60-96.3] months versus 98.9±3.9 [91.3-106.5] months (log-rank p=0.008), respectively. In-hospital mortality was comparable between groups. Long-term mortality from cardiovascular causes and the number of adverse cardiovascular events were significantly higher in the conservative therapy group. With timely detection of acute dysfunction of coronary bypass grafts, an active surgical approach has an advantage over conservative tactics and can improve the long-term prognosis of patients.

Analysis of the hydrodynamic causes of thrombosis and hemolysis in the centrifugal pump of the artificial blood supply system

The article is devoted to the analysis of the hydrodynamic causes of complications of the use of centrifugal pumps in artificial circulation systems. In the treatment of cardiovascular diseases, rotary pumps began to be used: centrifugal, axial and disk. Of the three types of rotary pumps, centrifugal pumps have the highest power density due to the use of centrifugal force. Statistics show that the greatest blood damage in the form of thrombosis and hemolysis is observed in these pumps. The article concludes that the main hydrodynamic cause of thrombosis and hemolysis is the force field formed by the centrifugal force of inertia, which generates vortex and separation zones. When passing through these zones, red blood cells experience intense hydrodynamic effects in the form of local accelerations and impacts against the walls of the channels, which leads to their deformation, and then to the destruction of some red blood cells. On the one hand, thanks to this force, the intensity of energy conversion in a centrifugal pump becomes higher compared to other types of pumps. On the other hand, a large unevenness of speed and pressure occurs in the channels, which has a traumatic effect on red blood cells. Hydrodynamic solutions to weaken the force field that injures red blood cells will inevitably be accompanied by a decrease in the intensity of energy conversion and the benefits of using this type of pump.

The problem of the diagnosis of acute kidney injury in children operated under the conditions of artificial circulation

Acute kidney injury (AKI) associated with cardiac surgery in children is one of the most frequent complications of the postoperative period appearing due to various perioperative factors. Generally accepted criteria for the diagnosis of AKI, on the one hand, may underestimate the frequency of development of this complication, on the other hand, require verification for use in the pediatric population. The application of kidney injury markers in pediatric practice is associated with a number of difficulties. For example, the high variability of the concentration of markers depending on age complicates the interpretation of the result, and maternal molecules can circulate in the blood of newborns. At the same time, in the cardiac surgery practice, the greatest impact of the measurement of kidney injury markers in children has been noted, which allows significantly accelerate the diagnosis of this complication and the starting of its therapy.

Gene networks for use in metabolomic data analysis of blood plasma from patients with postoperative delirium

Postoperative delirium (POD) is considered one of the most severe complications, resulting in impaired cognitive function, extended hospitalization, and higher treatment costs. The challenge of early POD diagnosis becomes particularly significant in cardiac surgery cases, as the incidence of this complication exceeds 50 % in certain patient categories. While it is known that neuroinflammation, neurotransmitter imbalances, disruptions in neuroendocrine regulation, and interneuronal connections contribute significantly to the development of POD, the molecular, genetic mechanisms of POD in cardiac surgery patients, along with potential metabolomic diagnostic markers, remain in adequately understood. In this study, blood plasma was collected from a group of patients over 65 years old after cardiac surgery involving artificial circulation. The collected samples were analyzed for sphingomyelin content and quantity using high-performance liquid chromatography coupled with mass spectrometry (HPLC-MS/MS) me thods. The analysis revealed four significantly different sphingomyelin contents in patients with POD compared to those who did not develop POD (control group). Employing gene network reconstruction, we perceived a set of 82 regulatory enzymes affiliated with the genetic coordination of the sphingolipid metabolism pathway. Within this set, 47 are assumed to be regulators of gene expression, governing the transcription of enzymes pivotal to the metabolic cascade. Complementing this, an additional assembly of 35 regulators are considered to be regulators of activity, degradation, and translocation dynamics of enzymes integral to the aforementioned pathway. Analysis of the overrepresentation of diseases with which these regulatory proteins are associated showed that the regulators can be categorized into two groups, associated with cardiovascular pathologies (CVP) and neuropsychiatric diseases (NPD), respectively. The regulators associated with CVP are expectedly related to the effects on myocardial tissue during surgery. It is hypothesized that dysfunction of NPD-associated regulators may specifically account for the development of POD after cardiac surgery. Thus, the identified regulatory genes may provide a basis for planning further experiments, in order to study disorders at the level of expression of these genes, as well as impaired function of proteins encoded by them in patients with POD. The identified significant sphingolipids can be considered as potential markers of POD.

Results of correction of coarctation with hypoplasia of the aortic arch: “ascending sliding” against plasty of the aortic arch with a patch from the pulmonary homograph

The main complications in the long-term period in children after the elimination of obstructive pathology of the aortic arch are arterial hypertension and recoarctation of the aorta. It is possible that persistent arterial hypertension is associated with the architectonics of the aortic arch and the nature of blood flow in it.Aim: To evaluate the immediate and long-term results after reconstruction of the aortic arch in conditions of artificial circulation by two methods: aortoplasty by “ascending sliding” (technique with native tissues) and aortoplasty using a patch of pulmonary homograft (technique using foreign material).Materials and Methods. In the presented single-center, pilot, prospective randomized study, the results of surgical treatment of coarctation with hypoplasia of the aortic arch in conditions of artificial circulation were assessed. According to the study design, depending on the method of correction of aortic coarctation, all patients were divided into two groups: aortoplasty by the “ascending sliding” method (30 patients); aortoplasty with a patch from a pulmonary homograph (30 patients).Results. There was no lethality in the hospital period. In the early postoperative period, the compression of the bronchi or trachea in the “ascending sliding” group was 20% versus 0% in the aortoplasty group using a patch from a pulmonary homograph. Recoarctation of the aorta in the aortoplasty group using a patch from a pulmonary homograph was 30%, while in the “ascending sliding” group there was no recoarctation. Arterial hypertension in the “ascending sliding” group was 13.3%, and in the aortoplasty group, using a patch from a pulmonary homograph was 56.6%.Conclusion. Patients after “ascending sliding” correction have a higher chance of bronchial and tracheal compression in the early postoperative period, while patients after correction by aortoplasty with a patch from a pulmonary homograph had a higher incidence of hypertension and aortic recoartcation.

The Successful Replacement of Aortic Valve and Ascending Aorta in Patients with Type A Aortic Dissection in the Postpartum Period. The Analysis of Literature and Demonstration of Own Observations

Abstract. Aortic dissection is a rupture of the inner layer of the aorta with subsequent penetration of blood into the degeneratively altered middle layer with the formation of false lumen and true lumen. Pregnancy is one of the risk factors for the development of aortic dissection. The incidence of aortic dissection during pregnancy is only 0.0004% of cases.Aim of the study. To analyze national and foreign literature, as well as share own clinical observations in the diagnosis and treatment of patients with aortic dissection in the postpartum period.Material and methods. Two patients after successful childbirth, in the late postpartum period, were admitted with a diagnosis of aortic dissection type A according to Stanford.CT angiography confirmed the presence of Stanford type A aortic dissection. After additional examination, surgical treatment was performed to replace the aortic valve and ascending aorta under artificial circulation, with a satisfactory clinical result.Conclusion. The diagnosis of aortic dissection should be considered in all pregnant women with chest pain, as this condition often goes undiagnosed.The pregnancy period is one of the risk factors for the development of aortic dissection with a high mortality rate. The likelihood of developing aortic dissection in women at risk peaks in the third trimester and the first 12 weeks after delivery.The risk group should include women with confirmed syndromic and non-syndromic genetic diseases, bicuspid aortic valve, coarctation of the aorta, or at least one major criterion indicating the presence of aortopathy (ectopia lentis, aortic aneurysm, habitus, genetic testing).If Marfan syndrome is present, surgical intervention should be considered if the maximum aortic diameter is more than 4.5 cm before pregnancy. In women with Marfan syndrome and aortic dissection in the family history, as well as in the presence of more aggressive genetic diseases (Loeys-Dietz syndrome, Ehlers-Danlos syndrome), it is possible to consider preventive surgical treatment for an aortic diameter of 4.0 cm or more.The delivery in high-risk patients is recommended to be performed in a hospital that has a cardiac surgery service and an “aortic” team.

Post-coronary Artery Bypass Graft Complications; Potential Causes and Risk Factors

Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide despite the coexistence of the current COVID-19 pandemic. Current emergency management involves revascularization of the coronary arteries. Aims: Retrospectively evaluate the association between the used number of shunts and postoperative complications. Objectives: Several complications are reported after coronary artery bypass graft (CABG) surgery, such as postoperative arrhythmia and postoperative stroke. However, the risk factors for the development remain not elaborated. Materials and Methods: A retrospective cohort study involved 290 patients for the period 2017-2021 treated surgically for ischemic heart disease. The surgery includes shunts of the internal thoracic arteries with the post-occlusion coronary arteries. The number of shunts is varied depending on the size and number of occluded arteries. According to the number of shunts, the patient may be operated on with artificial circulation (CPB; cardiopulmonary bypass), or without a working heart (OFF pump; without artificial circulation. For statistical analysis, T-test, one-way ANOVA test, X2 test, COX proportional hazards, and Pearson correlation test were used by using the Statistica program. Results: The most frequently reported complication is postoperative hydrothorax, in 28 (11.20%) patients. Patients with post-CABG LV aneurysm had a longer CPB time and aortic cross-clamp time, t-value -5.58113, p &lt; 0.000000; t-value -4.72802, p &lt; 0.000004, respectively. Patients with postoperative hydrothorax with low BMI and longer CPB and Aortic cross-clamp time, t-value of-2.33929, p &lt;0.020021; t-value 3.83233, P &lt; 0.000157; t-value 2.71109, p &lt; 0.007119, respectively. Subsequently, post-operative hydrothorax increases the intensive care unit (ICU) and total hospitalization days, t-value 5.80811, p &lt; 0.000000; t-value 7.37431, p &lt; 0.000000, respectively. Patients who have preoperative progressive angina have a higher number of complications, t-value of 2.108504, p &lt; 0.035866. Post-myocardial infarction patients with myocardial sclerosis (PMIMS) have a higher number of complications, t value of 2.516784, p &lt; 0.012396. A direct correlation between the number of complications and age/CPB time/ aortic cross-clamp time/ICU hospitalization days/total hospitalization days, r= 0.138565, 0.204061, 0.162078, 0.487048, 0.408381; respectively. Conclusion: Postoperative complication rate associated with the pre-existence of progressive angina and PMIMS. Elderly people undergoing CABG are at higher risk of psychosis, arrhythmia, longer total and ICU hospitalization days, and stroke. Advanced age, longed CPB time, prolonged aortic cross-clamp time, long ICU hospitalisation, and long total hospitalization days are risks of more frequent post-CABG complications. Others: The number of complications is not associated with the dead and alive status of patients or with the number of shunts.

CLINICAL CASE OF CORRECTION OF VENTRICULAR SEPTAL DEFECT COMBINED WITH AN ANOMALY OF THE SYSTEMIC VENOUS CONNECTION OF THE INFERIOR VENA CAVA

Interrupted inferior vena cava is a rare condition that can occur either in isolation or in combination with asplasia or polysplasia syndromes. Abnormal development of systemic veins is closely related to atrial situs. In levocardia, there are signs of abdominal organ inversion, which is called visceral situs. The present paper describes a clinical case of a infant with a large interventricular septal defect combined with interrupted inferior vena cava with azygous continuation of visceral situs ambiguous heterotaxy. The defect plasty was performed at the operation, and the complete venous cannulation required for artificial circulation was performed by the correctly chosen method of drainage of the superior venous system - through the auricle of the right atrium and the inferior venous system - through a separate hepatic vein cannulation, with a good clinical result.

Extracorporeal Circulation and Venous Hemodynamics: A Literature Review on Physiological Foundations to Clinical Applications

The venous system constitutes a vital component of the human circulatory system, facilitating the return of deoxygenated blood from tissues and organs back to the heart. During cardiac surgeries while using cardiopulmonary bypass (CPB), a critical step involves diverting venous blood from a cannula through the heart-lung machine, where it undergoes oxygenation before re-entering the arterial circulation. This process demands careful control and management to ensure safe and effective perfusion throughout the body. This research paper offers an exploration of venous drainage strategies in the context of cardiac surgery and other applications of extracorporeal life support. The PRISMA method was employed as the guiding framework for conducting this review. The investigation utilized a qualitative research design to assess the artificial circulation and venous dynamics. Out of 85 selected journal publications, 63 peer-reviewed and evidence-based research works were shortlisted. Through an examination of existing evidence, the author underscores the significance of precise venous cannulation techniques and drainage approaches, underscoring the influence on hemodynamics, clinical outcomes, and potential complications. The study delves into advanced monitoring methods and future prospects within the realm of venous drainage. The insights presented in this review serve as a valuable resource for evidence-based decision-making, ultimately contributing to improved patient outcomes and elevated surgical practices.

Two-Stage Pulsatile Human Placenta Model for Microvascular Anastomosis Training in Neurosurgery

The development of microsurgical skills is crucial for neurosurgical education. The human placenta is a promising model for practicing vascular anastomosis due to its similarities with brain vessels. We propose a 2-stage model for training in extracranial-to-intracranial anastomosis using the placenta. Initially, we propose practicing anastomosis in 2 adjacent placentas. Once successful, the procedure advances to a more challenging configuration that employs a 3-dimensionally printed skull with a window simulating a pterional craniotomy. It is positioned an intracranial placenta and an extracranial one, and the latter has a prominent vessel exposed toward the side of the craniotomy. Both placentas have one artery and vein cannulated in the umbilical cord, and we present an artificial placental circulation system for microvascular training that regulates pulsation and hydrodynamic pressure while keeping veins engorged with a pressurized bag. To verify anastomosis patency, we utilize sodium fluorescein and iodine contrast. The 2-stage model simulated several aspects of microvascular anastomosis. Our perfusion system allowed for intraoperative adjustments of hydrodynamic pressure and pulsation. Using iodine contrast and fluorescein enabled proper evaluation of anastomosis patency and hydrodynamic features. Training in the laboratory is essential for developing microsurgical skills. We have presented a model for microvascular anastomosis with artificial circulation and postoperative imaging evaluation, which is highly beneficial for enhancing the learning curve in microvascular procedures.

Dynamic Changes in the Immune Status and Biochemical Markers of the Blood in Patients after Cardiac Surgery in Conditions of Artificial Circulation

On a limited contingent of patients who died and survived after cardiac surgery under conditions of artificial circulation, a general nonspecific adaptive reaction is considered – stress, which develops during the sequential implementation of the “anxiety stage”, “resistance” and “resolution”. The immune markers of the stress response, its ambiguous changes in deceased patients and those discharged from the clinic with improved health are considered. Interesting innovations in changes in patients have been discovered that can be used in assessing the condition of patients, predicting the outcome of cardiac surgery, and even substantiating the use of immunomodulatory therapy in alternative clinical and immunological changes in the state of health in patients.

Construction of a song for teaching cardiopulmonary resuscitation

Cardiopulmonary resuscitation or resuscitation (CPR) is performed through chest compressions, with the aim of maintaining myocardial contraction after a cardiorespiratory arrest (CRA), making an artificial circulation with oxygen supply to the body. Effective CPR education of professionals and laypeople is a key variable in improving survival outcomes after cardiac arrest. The use of teaching tools and techniques with active methodologies are essential for building this knowledge. One possible resource for CPR education is the use of music. Music is inherent to the human constitution, which is why it is so important for human beings. This study aimed to build a song for learning the CPR maneuver. The entire composition of the song is presented, achieving the objective of this study.

Vascular access for isolated hepatic perfusion in liver metastases. Place of artificial circulation. Literature review

The use of an artificial circulation and endovascular technologies in the treatment of liver metastases of uveal melanoma is a highly relevant area. Uveal melanoma is a rare cancer from the uveal tract of the eye. The liver is the most common site of metastasis and is affected in 70-90% of cases, being the only site of metastasis in about 50% of cases. Survival ranges from two to three months. This literature review describes the following methods of treatment of liver metastases of uveal melanoma using a heart-lung machine: arterial (arterio-caval), portal (porto-caval), arterio-porto-caval, retrograde arterio-portal. Special attention is paid to the endovascular method of treatment.Literature sources were searched in the following electronic libraries: elibrary.ru, pubmed.ncbi.nlm.nih.gov, researchgate.net.

Historical review of development of indirect methods of myocardial revascularization

The article presents a historical review. For several decades, the diseases of the circulatory system have remained one of the most pressing problems of mankind. However, in the recent years there has been a tendency to decrease in mortality from cardiovascular pathologies including coronary heart disease. At the dawn of the study of coronary artery disease, the problem of surgical treatment of coronary artery pathology looked practically unsolvable: there was no knowledge of pathophysiology, no microsurgical instruments, and artificial circulation apparatus. Among other things, the stereotype of the "inviolability" of the heart muscle firmly entrenched in the minds of operating surgeons. A safe operation on a human heart was only a dream and the object of ridicule among most surgeons of the XIX early XX centuries. The article describes the history of the study of angina pectoris and indirect methods of myocardial revascularization. The first operations were aimed at eliminating pain syndrome and inducing angiogenesis, creating neocollaterals from blood vessel-rich organs and tissues to improve regional myocardial perfusion. Exactly these surgical techniques have become a "bridge" from the tactics of exclusively conservative management of heart pathologies to modern cardiac surgery.