Artificial Circulation Research Articles

Coronary bypass grafting using MICSCAB technique with parallel artificial circulation from mini access

BACKGROUND: Today, minimally invasive coronary surgery is not only a good alternative to classical sternotomy, but also represents a separate developing area of cardiac surgery with the development of more and more low-traumatic techniques, such as minimally invasive direct coronary artery bypass and minimally invasive direct coronary artery bypass (MICSCAB).
 CLINICAL CASE DESCRIPTION: The advantages and disadvantages of these techniques are widely discussed in modern literature, and their practical application is ambiguous. This article describes a clinical case of successful coronary artery bypass grafting using the MICSCAB technique in a patient with a long history of coronary artery disease and a complex multivessel lesion.
 CONCLUSION: The presented clinical case proves the advantage of MICSCAB technique in comparison with traditional coronary bypass surgery.

ПРЕДИКТОРЫ АСПИРИНОРЕЗИСТЕНТНОСТИ У ПАЦИЕНТОВ С ИБС ПОСЛЕ КОРОНАРНОГО ШУНТИРОВАНИЯ

Introduction. After coronary bypass surgery (CABG) under artificial circulation (IC), the problem of preventing vascular shunt thrombosis remains unresolved, due to the formation of resistance to the phenomenon of aspirin resistance (AR). Objective: To study the clinical and laboratory signs of AR and identify predictors of AR. Materials and methods. The study included 260 men aged 45 to 70 years with a diagnosis of coronary heart disease (CHD) in the form of stable angina pectoris and pain-free myocardial ischemia, who underwent CABG. Systemic inflammation activity for surgical intervention was evaluated by the concentration of interleukin-6 (IL-6) and highly sensitive C-reactive protein (HCRP) in blood serum, and the severity of endotheliopathy was assessed by the level of endothelin–1 (ET-1). Platelet aggregation activity (AAT) was also studied. Patients with AR included those individuals whose AAT did not reach target values against the background of taking acetylsalicylic acid (ASA) at a dose of 100 mg / day decreased by less than 50% compared to initial parameters. To analyze the influence of various factors (predictors) on AAT, the method of linear step-by-step regression analysis with inclusions was used. Results. On the second day after CABG, AR was detected in 46.9% of the patients who made up the main group. The comparison group included 53.1% of patients who retained AC. A year after surgery in the background of taking ASA, the proportion of patients with AR decreased to 24% of the initial AC in the preoperative period. In two groups of patients, IL-6, VCHSRB, ET-1, AAT were compared at the three stages of the examination, and the duration of IC, the number of vascular shunts after CABG. Statistically significantly higher indicators of the studied parameters were revealed in the main group than in the comparison group both on the second day and 1 year after the departure. As a result of the regression analysis, a set of five predictors was obtained that statistically significantly (F=12.2, p<0.012) affect AAT: ET-1, IL-6, VCHSRB, IR time, number of shunts. Conclusion. The severity of systemic inflammation in CABG in IR conditions affects the development of induced AR. The persistence of systemic inflammation is associated with prolongation of AR in the long-term postoperative period. Regression analysis revealed the important role of markers of systemic inflammation and endotheliopathy in the development of AR.

Скорость окисления крови как предиктор развития фибрилляции предсердий в послеоперационном периоде при проведении шунтирования коронарных артерий

The development of postoperative atrial fibrillation (AF) is associated with surgical trauma, neutrophil activation, pro-inflammatory cytokine release and oxidative stress. Objective: assessment of the prognostic significance of determining blood oxidation rate in relation to the risk of developing atrial fibrillation in the postoperative period during coronary artery bypass surgery. Material and methods. The study included 68 patients with stable coronary heart disease (CHD) who underwent coronary artery bypass surgery under artificial circulation (On-pump), parallel artificial circulation and on the working heart (Off-pump). Indices of induced blood oxidation were studied using biological oxygen monitor, blood oxidation rate was determined. Results. It was found that within the factor model, the rate of blood oxidation is a significant (p < 0.05) component associated with the development of atrial fibrillation (r = 0.90) during surgical myocardial revascularization. According to the results of logistic regression analysis, it was found that the rate of blood oxidation affects the development of atrial fibrillation in the postoperative period of coronary bypass surgery. Conclusions. The rate of blood oxidation is a predictor of atrial fibrillation during coronary artery bypass surgery, regardless of the surgical procedure chosen.

ВЛИЯНИЕ ГИБЕРНИРОВАННОГО МИОКАРДА НА ПОСТИШЕМИЧЕСКУЮ ДИСФУНКЦИЮ ЛЕВОГО ЖЕЛУДОЧКА ПОСЛЕ ХИРУРГИЧЕСКОЙ КОРОНАРНОЙ РЕПЕРФУЗИИ. Часть

So far, surgical interventions with artificial circulation remain the most effective treatment method providing favorable long-term outcomes, prognosis and quality of life in patients with coronary heart disease (CHD). Therefore, the main issue of cardiologists and cardiac surgeons is the prognosis of functional recovery of the left ventricle after revascularization, as the treatment strategy is determined by the risk assessment of surgical mortality and perioperative complications. In order to detect hibernating myocardium, we performed a prospective study including 57 patients with CHD and upcoming coronary bypass grafting, mitral valve plasty or prosthesis. All patients underwent stress magnetic resonance imaging, which allowed noninvasive assessment of both structural and functional changes, as well as determination of myocardial functional reserve. The obtained data will allow us to objectively assess the surgical risk during cardiac surgical interventions, which is very important for the prevention of life-threatening cardiovascular complications, as well as increasing the efficiency of surgical treatment in patients with CHD.

Viktor Ivanovich Bulynin - Professor, Chairman of the Voronezh Regional Society of Surgeons, Honorary Citizen of Voronezh. To the 90th of birthday

Viktor Ivanovich Bulynin - Professor, Chairman of the Voronezh Regional Society of Surgeons, Honorary Citizen of Voronezh. To the 90th of birthday

Budesonid as a means of intraoperative lung protection during coronary bypassing in patients with concomitant chronic obstructive pulmonary disease and coronary heart disease: a pilot study

Lung protection during surgeries with artificial circulation (AC) is a vital task in clinical medicine.The aim. Evaluation of the effectiveness of intraoperative administration of nebulized budesonide for correcting the volume status of the lungs and oxygen transport in patients with concomitant coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD) during coronary artery bypass grafting (CABG) with artificial circulation (AC).Methods. The pilot clinical study included 40 patients with concomitant CHD and COPD who were admitted for scheduled CABG with AC. The first groups consisted of 20 patients who underwent low-volume artificial lung ventilation (AVL) with inhalation of nebulized budesonide in the process of AC; the second group consisted of 20 patients who underwent AC according to a routine technique with AVL off. Lung volemic status parameters were recorded by transpulmonary thermodilution using the Pulsion PiCCO in three stages: before the onset of AC, after its completion and one day after AC.Results. It was established that after withdrawal from AC, indices of extravascular water in the lungs (IEWL) decreased by 23% in the first group and increased by 24% in the second group. After the completion of AC and a day after it, IEWL significantly decreased in patients receiving budesonide and increased with a maximum rise at the second stage of the study in the second group. The index of oxygen delivery and utilization over time was within the reference range in all patients. The index of oxygen consumption did not reach the physiologically normal lower limit. The maximum level of pulmonary bypass blood fraction (16 and 12%, respectively) and a significant decrease in oxygenation index (240 – 290 c. u.) were recorded in this cohort of patients at the 2nd and 3rd stages of the study. The duration of postoperative ventilation was significantly longer in the second group, while the duration of in-hospital treatment did not differ significantly before the groups.Conclusion. The protective effects of the combination of aerosol therapy with budesonide and low-volume AVL were manifested by a decrease in the permeability of the pulmonary capillaries, the volume of IEWL, an improvement in the oxygenating function of the lungs, a decrease in the number of respiratory complications and the postoperative duration of AVL.

Mimicry of embryonic circulation enhances the hoxa hemogenic niche and human blood development

Precursors of the adult hematopoietic system arise from the aorta-gonad-mesonephros (AGM) region shortly after the embryonic circulation is established. Here, we develop a microfluidic culture system to mimic the primitive embryonic circulation and address the hypothesis that circulatory flow and shear stress enhance embryonic blood development. Embryonic (HOXA+) hematopoiesis was derived from human pluripotent stem cells and induced from mesoderm by small-molecule manipulation of TGF-β and WNT signaling (SB/CHIR). Microfluidic and orbital culture promoted the formation of proliferative CD34+RUNX1C-GFP+SOX17-mCHERRY+ precursor cells that were released into the artificial circulation from SOX17+ arterial-like structures. Single-cell transcriptomic analysis delineated extra-embryonic (yolk sac) and HOXA+ embryonic blood differentiation pathways. SB/CHIR and circulatory flow enhance hematopoiesis by the formation of proliferative HOXA+RUNX1C+CD34+ precursor cells that differentiate into monocyte/macrophage, granulocyte, erythrocyte, and megakaryocyte progenitors.

Comparative Evaluation of Analgesic Effectiveness of Various Anesthelic Drugs in Combination with Dexmedetomidine in Children after Cardiac Surgery

In pediatric practice, for postoperative pain therapy, in addition to analgesia, sedation must also be taken into account in order to prevent the development of delirium and irritation to discomfort. Therefore, the purpose of our work was to evaluate the efficacy and safety of various forms of non–opioid drugs in combination with dexmedetomidine in children with congenital heart defects after cardiac surgery. The study included 60 children aged 2 to 4 years with congenital heart defects operated on for radical corrections of congenital heart defects in conditions of artificial circulation. The patients were divided into 2 groups, identical in anthropometric data. All patients underwent sedation and analgesia with dexmedetomidine, paracetamol and diclofenac. After the conducted examinations and observations, it was concluded that the use of non–opioid analgesics in combination with dexmedetomidine gives good results in the postoperative period, without causing any special complications from organs and systems.

Induced blood oxidation in myocardial revascularization

Background: The use of artificial circulation in surgical myocardial revascularization is one of the key pathogenetic factors in the development of the oxidative stress and systemic inflammatory response in the postoperative period. Aims: the purpose of the study was to describe the dynamics of the induced blood oxidation parameters during coronary artery bypass surgery in the conditions of artificial circulation and on the working heart. Methods: The study included 64 patients who underwent coronary bypass surgery, with 31 (48.4%) on-pump patients and 33 (51.6%) off-pump patients. The oxidative stress simulations were conducted under the in vitro conditions. The blood oxidation-induced values were studied using a biological oxygen monitor. Results: In patients with coronary heart disease, regardless of the choice of the revascularization method (on-pump / off-pump), we observed statistically significantly (p 0.05) higher initial and maximum blood oxidation rates, the oxidative activity factor, and a shorter initiation period than those in healthy volunteers. No significant differences were found by the inter-group comparison analysis both 10 days and 6 months post-surgery. Conclusion: The indicators of induced blood oxidation do not depend on the method of revascularization during coronary bypass grafting (artificial circulation or a working heart). The changes in the parameters indicating activation of the oxidative and antioxidant blood systems may be transient by their nature and occur in the early postoperative period.

Features of cognitive disorders in patients with different forms of neurological and ischemic complications who underwent cardiac surgery

Objective — to study the features of cognitive impairment in patients with various forms of neurological and ischemic complications who underwent cardiac surgery (CS), to consider the data obtained in the development of rehabilitation programs for this category of patients.
 Methods and subjects. We examined 700 patients who were treated at the Heart Institute of the Ministry of Health of Ukraine after undergoing CS with an artificial circulation procedure. The sample size is extremely large, and makes it possible to transfer the results to the entire population of patients who have suffered from CS. Among the examined patients the following groups were identified: a) patients with cerebral infarction (CI) in the postoperative period, numbering 86 people, the performance of patients in this group was compared with patients with CS without myocardial infarction in the postoperative period, numbering 614 people taken from the same sample); b) patients with signs of postoperative encephalopathy, numbering 217 people (which included patients with CI). The performance of patients in this group was compared with that of 483 patients with CS without signs of postoperative encephalopathy, taken from the same sample.
 The study was conducted using the Trail Making Test, TMT (R. M. Reitan, Wolfson D., 1993); Verbal Fluency Test, VFT (M. D. Lezak, 1995); Stroop Color Interference Test (J. R. Stroop, 1935); Luria’s test for memorizing ten unrelated words (Luria AR, 1969). Statistical analysis of differences in the quantitative values of indicators was performed using the nonparametric Mann‑Whitney test.
 Results. Our study found significant cognitive impairment in patients with CS. It was found that the presence of ischemic and neurological complications in the postoperative period significantly impairs cognitive function. The most significant negative impact on the cognitive sphere has the presence of CI in the postoperative period: patients with CI showed signs of severe cognitive deficits. Manifestations of cognitive deficits were also found in patients with postoperative encephalopathy, although the quantitative indicators characterizing cognitive functioning in this group of patients were better than in patients with CI.
 Conclusions. The identified patterns should be taken into account when developing treatment, rehabilitation and preventive measures for patients with CS.

The results of the application of a new technique of open implantation of self-opening transcatheter aortic valves in an experiment

Background. In recent years, transcatheter implantation of the aortic valve has become increasingly performed as an alternative to "open" prosthetics. The undoubted advantage of this technology is its minimally invasive nature, which in most cases provides a favorable clinical outcome of the intervention. The transcatheter method of aortic valve prosthetics does not require sternotomy and connection of an artificial circulation device, which significantly reduces the risk of postoperative mortality and complications. However, despite all the advantages of the existing models, they are not without drawbacks that force researchers to develop and test new transcatheter valves. The problem of experimental studies of new models of self-opening transcatheter aortic valves is mainly determined by the anatomical features of the aortic root of animals. In this regard, the development of a reliable method of implantation of valve prostheses in the experiment is an urgent problem of preclinical testing.Aim. Development of a protocol for open implantation of a transcatheter aortic valve in experiment and evaluation of long-term results.Methods. To develop an experimental model, pigs of the "Landras" breed, females weighing 129.83 ± 9 kg were used. Transcatheter aortic valve implantation was performed under conditions of artificial circulation and moderate hypothermia (33-34°C) through a transverse aortotomy under the control of vision. During the experiment, invasive monitoring of blood pressure, central venous pressure, heart rhythm, body temperature, blood gas composition, activated clotting time was performed. The correct positioning and hemodynamic parameters after implantation were evaluated using transesophageal echocardiography.Results. In a series of chronic experiments, 18 open implantations of self-opening transcatheter aortic valves were performed. Successful positioning was achieved in 100% of cases. The developed protocol of open implantation made it possible to achieve reliable fixation of the prosthesis in the orthotopic position, as well as to prevent the migration of the prosthesis, the development of mitral regurgitation, paraaortic fistulas and coronary circulation disorders.Conclusion. In the course of the study, a simple and effective method of open implantation of a transcatheter aortic heart valve prosthesis was developed in an experiment. Received 1 October 2021. Revised 1 November 2021. Accepted 12 November 2021. Funding: This work was carried out within the framework of the state task of Ministry of Health of Russian Federation No. 121032300337-5. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: M.O. Zhulkov, D.A. Sirota, K.V. Kozyr, D.S. SergeevichevData collection and analysis: M.O. ZhulkovDrafting the article: M.O. ZhulkovCritical revision of the article: D.A. Sirota, A.M. ChernyavskiyExperimental part: M.O. Zhulkov, H.A. Agaeva, A.K. Sabetov, I.S. Zykov, A.R. TarkovaFinal approval of the version to be published: M.O. Zhulkov, K.V. Kozyr, I.S. Zykov, A.R. Tarkova, H.A. Agaeva, A.K. Sabetov, D.A. Sirota, D.S. Sergeevichev, A.M. Chernyavski

Wrapping of the ascending aorta: history and prospects

Historically, exoprosthetics is one of the first surgical procedures used for aneurysmal dilatation of such great vessels as the aorta. Despite the acceptable results of this method it is not widespread now because of the possible negative consequences of aortic wall wrapping (rupture or dissection). According to the latest guidelines, it is necessary to consider prosthetics of the ascending aorta by the patients with aortic valve surgery and aneurysmal dilatation of the ascending aorta more than 45 mm. However, early postoperative mortality reaches 20 % by elderly patients with severe comorbidities. In such situations, it is worth to choose a less traumatic surgical approach. Exoprosthetics of the aorta reduces the invasiveness of procedure, time of artificial circulation and aortic occlusion thereby taking down the risks of early postoperative complications. The purpose of this literature review is to analyze the current data on the technique of exoprosthetics of the aorta by the patients with moderate ascending aorta dilatation. The Scopus, Web of Science, PubMed databases were used for searching and selecting literature sources. The results demonstrate that aortic wrapping is a safe method causing rapid and permanent aortic remodeling. The technique has comparable long-term results with prosthetics of the ascending aorta despite the presence of histological changes in the aortic wall with a changing in its mechanical properties. Received 28 September 2021. Revised 19 January 2022. Accepted 20 January 2022. Funding: This work was carried out within the framework of the state task of Ministry of Health of Russian Federation No. 121032300337-5. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: S.A. Alsov, D.A. SirotaDrafting the article: V.A. AkulovCritical revision of the article: S.A. Alsov, D.A. Sirota, M.M. Lyashenko, A.M. ChernyavskiyFinal approval of the version to be published: V.A. Akulov, S.A. Alsov, D.A. Sirota, M.M. Lyashenko, A.M. Chernyavskiy

Differential Approach to Surgical and Endovascular Treatments of Pulmonary Thromboembolism in Patients with Neurological and Neurosurgical Problems

INTRODUCTION: Pulmonary embolism (PE) is one of the most threatening complications in patients with neurological and neurosurgical problems. The high epidemiological threshold values and mortality in the considered group of patients attracted the interest of researchers in the methods of early diagnosis and selection of methods of reperfusion of the pulmonary arterial bed.
 AIM: To analyze clinical and hemodynamic results of the surgical and endovascular treatment of PE of the high and intermediatehigh risks in the group of patients with neurological and neurosurgical problems.
 MATERIALS AND METHODS: This study involved 24 patients with PE of high and intermediate high-risks. The first group involved seven patients with neurosurgical problems who underwent thromboembolectomy from the main and lobular branches of the pulmonary artery in conditions of parallel perfusion of the artificial circulation. The duration of perfusion was 26.0 7.4 min. The second group consisted of 17 patients with acute hemorrhagic stroke, in whom endovascular mechanical fragmentation of thromboemboli was performed using a modified Pig-Tail type catheter introduced by puncture through the subclavian or jugular vein. The first clinical manifestations of PE appeared 4.78 2.02 days after the neurosurgical intervention and 8.45 2.6 days after the onset of stroke. The initial systolic pressure in the pulmonary artery was 67.24 5.15 mm Hg in the first group and 70.53 4.53 mm Hg in the second group. Both groups had American Society of Anesthesiologist physical status IV and V classes of surgical risk and Pulmonary Embolism Severity Index class V (130174 points).
 RESULTS: The hospital survival rates were 100% and 82.36% in the first and second groups, respectively (three lethal cases due to progressing right-ventricular failure in the first 18 h after the procedure). On discharge, signs of reverse remodeling of the right heart chambers and reduction of the mean and systolic pressure in the pulmonary artery to 21 2.16 and 31 4.12 mm Hg, respectively, were noted in the first group and to 46 5.23 and 57 3.16 mm Hg, respectively, in the second group.
 CONCLUSION: Surgical treatment of PE is effective and safe with predictable results. Endovascular catheter induced destruction of the thromboembolus substrate is an alternative to the surgical treatment of patients with a high-risk of open surgery and absolute contraindications for thrombolytic therapy.

An Integrated Approach to the Treatment of Pulmonary Embolism: Current State of the Problem


 The aim. Treatment of venous thromboembolism remains perhaps the most challenging problem of modern phlebology. The aim of our study was to analyze current data and guidelines on the use of surgical and minimally invasive approaches in the treatment of pulmonary embolism (PE) and to compare these with our own results.
 Materials and methods. The results of treatment of 168 patients with PE, who underwent inpatient treatment at the clinic from 2009 to 2021, were analyzed. Among them, 162 (96%) patients had deep vein thrombosis, in 6 patients the cause of PE could not be identified. Recurrent PE was observed in 2 patients. PE with a high risk of death was observed in 51 (30.3%) patients, with a medium and low risk of death in 117 patients (69.6%).
 Systemic thrombolysis was performed in 44 (26%) cases. In 5 (2.9%) cases, vena cava filters were implanted. One (0.6%) patient underwent aspiration thrombectomy of the pulmonary artery using an Aspirex catheter. Two (1.1%) patients underwent pulmonary artery thrombectomy using an artificial circulation device.
 Results. Significant improvement in patients treated with thrombolytic therapy was observed in 40 (92.8%) cases. After surgical treatment of PE, significant improvement was observed in 100% of cases, 2 patients after PE showed complete de-obstruction of the pulmonary artery. No hemorrhagic complications were observed during the study period. No fatalities were reported. No recurrent PE was observed during the study period.
 Conclusions. The choice of treatment for PE is determined by the degree of the impact on the pulmonary tract, the stability of the patient’s condition, indicators of dysfunction of the right heart, the period from the onset of the disease, the risk of death.
 The use of aspiration thrombectomy using an Aspirex catheter (Straub, USA) and pulmonary artery embolectomy in the absence of thrombolytic therapy allows to obtain satisfactory results in patients with PE.

Comparative analysis of intraoperative lung protection technologies in patients having cardiorespiratory comorbidity during coronary bypass surgery with artificial circulation

Objective: Comparative analysis of the effect of budesonide and low-volume artificial lung ventilation (ALV) on pulmonary volemia, oxygen transport and respiratory biomechanics in patients having cardio-respiratory comorbidity during сoronary artery bypass graft (CABG) with artificial blood circulation (ABC).Methods: The clinical study included 50 patients having cardiorespiratory comorbidity with a median age of 66 years who were admitted to the clinic of the Far Eastern Federal University for planned CABG in conditions of ABC. The patients were divided into 2 groups by random sampling method. The first group consisted of 25 patients who underwent low-volume artificial lung ventilation (ALV) with inhalation of nebulized budesonide during ABC; the second – 25 patients underwent isolated low-volume ALV during ABC. The study was carried out in three stages: before the start of ABC, after its completion and a day after CABG. Extravascular lung water index (ELWI) and pulmonary vascular permeability index (PVPI) were registered using method of transpulmonary thermodilution. Oxygen transport indicators were determined: oxygen delivery index (DO2I) and oxygen consumption index (VO2I), pulmonary blood bypass fraction (Qs/Qt), oxygenation index (OI).Results: After turning off ABC in the first group, the ELWI decreased by 23%, in the second group it declined by 8%. Among patients treated with budesonide, PVPI significantly decreased after providing ABC. However among patients of the second group it remained unchanged. DO2I remained in the reference range among all patients. However VO2I was below it with a minimum value in the second group after ABC stopping. In this cohort the level of Qs/Qt was significantly higher, and OI was lower than in patients of the first group. The resistance of the lung tissue decreased on the background of an increase in its compliance among patients who received budesonide immediately after ABC and 2 hours after it. In the second group there was opposite dynamics of these indicators.Conclusions:The combination of low-volume ALV and inhalation of nebulized budesonide during ABC stabilizes the volemic status of the lungs, improves their oxygenating function and respiratory biomechanics in the postperfusion and early postoperative periods of CABG.

Structure of subjective manifestations of psychopathological symptoms in patients who have carried out cardiosurgical interventions in the conditions of art

The aim of the research was to study the structure of psychopathological symptoms in patients who underwent cardiac surgery (UCS) in the conditions of artificial circulation (AC), in the postoperative period, both in general and in terms of individual types of vascular and neurological pathology. Using the approaches of a structured clinical diagnostic interview with the assistance of a specially developed questionnaire, we clinically examined 700 patients who were treated at the Heart Institute of the Ministry of Health of Ukraine and who underwent UCS in the AC. Among the examined patients were 86 patients (12.3 %) with cerebral infarction (CI), 217 patients (31.0 %) patients with signs of postoperative encephalopathy and 504 patients (72.0 %) with manifestations of cognitive dysfunction. The study found that patients who underwent UCS with AC have a wide range of subjective manifestations of psychopathological symptoms. Such symptoms are represented by disorders of cognitive functioning, as well as affective (depressive and anxiety), asthenic and somatovegetative symptoms (in particular, dyssomnias and, to a lesser extent, appetite disorders). The highest prevalence of psychopathological symptoms was found in patients with CI, slightly less — in patients with postoperative encephalopathy, and the lowest — in patients with cognitive dysfunction. The results obtained should be taken into account when developing a system of specialized medical care and rehabilitation of this group of patients.

Transcranial Duplex Ultrasonography Measurements Towards Identification of Blood Vessel Conditions: Artificial Cerebral Blood Flow in Pathologies

Abstract The aim of the study was to investigate how cerebral vasospasm, vasodilation and haemorrhage under artificial circulation conditions during cardiopulmonary bypass affect transcranial duplex ultrasonography measurements. A description of transcranial duplex ultrasonography and phantom development is provided. Measurements were made using a commercially available ultrasound system and cardiopulmonary bypass machine, water phantom and 32% glycerol solution with cornstarch. The experiments showed that the cerebral blood vessel condition in artificial circulation affects transcranial duplex ultrasonography measurement limit values. The most sensitive parameter for blood vessel condition changes is Peak Systolic Velocity (PSV) for which changes were observed in 100% of cases. The most insensitive was Time-Averaged Peak-Velocity (TAPV), and Minimum Diastolic Velocity (MDV) for which changes were observed in 83% of cases.

Double strengthening of the neck of the aortic aneurysmal sac

INTRODUCTION. The article presents the experience of treatment of abdominal aortic aneurysms from 2011 to 2016 using the author’s technology, which contains the method of double strengthening of the neck of the aortic aneurysm, on the basis of the Department of Hospital Surgery in the Department of Vascular Surgery of the RCH of Nalchik.METHODS AND MATERIALS. According to this method, 202 patients with abdominal aortic aneurysm (group I) were operated on, 116 were admitted as planned, 86 were admitted as emergency and urgent, while 183 were men and 19 were women. Without using the technique of double strengthening of the aneurysm neck, 205 patients were selected for the period from 2006 to 2011. They were included in group II. Among them, 118 were received as planned, 87 were received in special and urgent cases. The patients were examined thoroughly. CT angiography in 3-dimensional reconstruction was performed using special research methods.RESULTS. All patients were transferred to the intensive care unit after the operation. In the operative and immediate postoperative periods, among the operated patients admitted in an emergency and urgent, 19 patients with a ruptured aortic aneurysm died in group I, 23 patients – in group II. Among the planned patients, 2 in group II died from a combined severe concomitant pathology. All other patients were activated on the 2nd-3rd day, and subsequently discharged in a satisfactory condition.CONCLUSION. The advantages of the proposed method of surgical treatment of abdominal aortic aneurysm are: technical simplicity of execution, double strengthening of the neck of the aneurysmal sac, tightness of the anastomosis, therefore, the reduction of intraoperative blood loss, the possibility of performing aortic prosthetics with suprarenal and renal aneurysms and weakness of the wall in the neck area in the absence of an artificial circulation apparatus.

Assessment of the Budesonid Protective Effects in Patients with Cardio-Respiratory Comorbidity During Coronary Bypassing with Artificial Circulation

The objective: evaluation of the effect of budesonide and low-volume mechanical ventilation (LVMV) on pulmonary volemia, oxygen transport and respiratory biomechanics in patients with concurrent ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) during coronary artery bypass grafting (CABG) with artificial circulation (AC).Subjects and Methods. 50 patients with concurrent IHD and COPD were enrolled in the study. During AC, patients of Group I (20 people) received mechanical ventilation with the peak inspiratory pressure of 15 mbar, tidal volume of 3‒4 ml/kg, positive end-expiratory pressure of 5 mbar in combination with inhalation of nebulized budesonide. In Group II (30 people), the similar isolated respiratory support was provided. Pulmonary blood volume, indices of extravascular lung water (EVLW), pulmonary vascular permeability (PVPI), oxygen delivery (DO2I) and consumption (VO2I), oxygen extraction ratio (O2ER), pulmonary shunt fraction (Qs/Qt), oxygenation index were determined. The study consisted of 3 stages: before AC, after its completion and one day after CABG.Results. Before CABG, the EVLW index in all patients exceeded the standard level by 67‒72%. After weaning from AC, it decreased by 23% in Group I and by 8% in Group II. In patients receiving budesonide, PVPI significantly decreased after artificial circulation, while in patients from Group II, it remained unchanged. DO2I and O2ER in all patients were within the reference range, and VO2I was below it with a minimum value in Group II after weaning from AC. In this cohort, the Qs/Qt level was significantly higher, while OI was lower versus patients from Group I. Among patients who received budesonide immediately after AC and 2 hours after it, pulmonary resistance decreased while lung compliance increased. In Group II, those parameters changed oppositely. In Group I, one case of hydrothorax was recorded, and in Group II, 2 patients were diagnosed with polysegmental pneumonia and 2 patients – with pneumothorax. The median duration of mechanical ventilation in the postoperative period made 220 minutes in Group I, and 290 minutes in Group II (p = 0.018).Conclusion. In patients with concurrent IHD and COPD, use of the combination of low-volume mechanical ventilation and inhalation of nebulized budesonide during AC stabilizes the volemic status of the lungs, improves the oxygenating function and respiratory biomechanics in the postperfusion and early postoperative periods of CABG.

Academician of the Russian academy of sciences Yu.L. Shevchenko and his contribution to the development of the Military Medical Academy and health care of the Russian Federation (on his 75th anniversary)

April 7, 2022 marks the 75th anniversary of the outstanding national cardiac surgeon, Academician of the Russian Academy of Sciences Yuri Leonidovich Shevchenko. Yu.L. Shevchenko graduated from the Military Medical Academy in 1974 and after a year of servicing in the military he returned to the Academy, where he worked for a quarter of a century, having done his way up from a senior resident of the clinic of the Hospital Surgery Department to the Head of the Academy. During his leadership of the Academy (19922000) he did a lot not only for its preservation but also for its development and re-equipment. Great attention was paid to the international scientific cooperation, increasing the public prestige of the Academy and preserving its historical heritage: the academician B.V. Petrovsky medal "For outstanding surgeon in the world" was established; the monument "Military medics who died in wars" was opened; the Institute of honorary doctors and academicians of the Military Medical Academy was restored; the Academy was included in the State List of especially valuable objects of cultural heritage of Russian Federation. Internship and certification of graduates were introduced in the educational and scientific activities, and the Academy scientific schools were preserved and strengthened. As the Minister of Health of Russian Federation Yu.L. Shevchenko participated in the development of a number of federal target programs: justified and implemented in practice the territorial system of health care, also he was one of the initiators of creation and formation of health insurance system. Yu.L. Shevchenko contributed greatly to the development of Russian and world cardiosurgery. His works were a milestone in solving the problems of surgical treatment of infectious endocarditis. For the first time, the "sanitizing effect" of artificial circulation was theoretically substantiated and proved in practice, the optimal values of perfusion during surgical treatment of generalized forms of infection were developed, and the integral approach to sanitation of the heart chambers was substantiated. Since 2002 Yu.L. Shevchenko has been the head of Pirogov National Medical-Surgical Center. For his great contribution to the development of medical science academician Yu.L. Shevchenko was awarded the State Prize and honorary titles of Honoured Scientist and Honoured Physician of Russia, he was awarded the Order of Merit for the Motherland of 4th Class and the Order of Honour.