The treatment of coronary artery disease (CAD) in patients with combined pathology of peripheral arteries who are to perform endovascular or surgical interventions is a difficult task. The most important issues are the adequate diagnostics of artery systems’ lesions, determining the most optimal strategy and stages of treatment. This makes a multidisciplinary approach with the involvement of various specialists the most optimal.

Aim. Based on multidisciplinary approach, to determine the prevalence of CAD and treatment strategy in patients with lesions of the aorta and peripheral arteries.

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Material and methods. The study included 693 patients with pathology of the aorta and peripheral arteries: 171 (32,5%) were female, and 522 (75,3%) were male. The age of patients ranged from 29 to 93 years, an average — 67,2+8,8 years. Also 32,5% of patients (n=223) were older than 71 years. Cardiac complaints were present only in 203 (29,3%) patients, while 490 (70,7%) were asymptomatic. The majority of 693 patients had an isolated lesion of the internal carotid artery (ICA) (n=196, 28,3%), a combined lesion of the ICA and lower limb arteries (n=93, 13,4%), a combined lesion of the iliac and superficial femoral arteries (n=70, 10,1%) and femoral arteries lesions (n=60, 8,6%).

Results. Finally, 554 (79,9%) of 693 patients had lesions of at least one coronary artery more than 50%, while 368 (66,4%) of them were clinically asymptomatic. By the decision of the multidisciplinary heart team, 316 (57,0%) patients underwent myocardial revascularization operations: 21 (6,7%) — coronary artery bypass grafting and 295 (50,3%) — percutaneous coronary intervention. Surgical and endovascular operations for pathology of the aorta and peripheral arteries were performed in 486 (70,1%) of 693 patients. Unlike with 260 (53,5%) patients, in 226 (46,5%) patients, in addition to vascular surgery, myocardial revascularization was performed. As a result of 923 (564 endovascular and 359 surgical) operations performed in 580 patients at the hospital stage, 3 (0,51%) of them had a fatal outcome. In other 2 (0,56%) cases, there was stroke: in one case after ICA prosthetics, in the other case — thrombosis of the ICA after the carotid endarterectomy. Acute myocardial infarction at the hospital stage was not detected in any of the patients.

Conclusion. In 79,9% of patients with atherosclerosis of the aorta and peripheral arteries, at least one coronary artery lesion of more than 50% is detected. In 66,4% of patients with pathology of the aorta and peripheral arteries and with lesions of the coronary arteries of more than 50%, there are no cardiac complaints. In 45,6% of patients hospitalized with a diagnosis of atherosclerotic lesions of the aorta and peripheral arteries, myocardial revascularization is required. A multidisciplinary approach is an effective and safe treatment strategy for patients with pathology of the aorta and peripheral arteries of atherosclerotic origin and concomitant CAD.

Aim. To assess the dynamics of blood pressure (BP) and determine the predictors of the hypotensive effect after carotid artery stenting (CAS).

Material and methods. The analysis included 99 patients who underwent CAS in a period of March 2014 and May 2016. Inclusion criteria: (1) the presence of 50% symptomatic or 70% asymptomatic stenosis of the carotid artery (according to NASCET criteria), (2) follow-up for at least 1 year, (3) measurement and recording of BP at four points: 24 hours before surgery, 1 hour, 24 hours and 12 months after surgery.

 Results. According to office measurement of BP, the average systolic/diastolic pressure was 117,11/60,75, 119,73/60,75, 134,75/70,48 mm Hg after 1 hour, one day and 12 months after the intervention, respectively. In comparison with the average numbers of BP before the intervention, 148,13/89,52 mm Hg there was a significantly significant decrease in BP levels after CAS (p<0,01). According to the results of daily monitoring of blood pressure, a statistically important decrease in blood pressure was observed after 1 year of observation (p<0,01) (136,52/76,84 compared with 145,91/87,63 before the intervention). Dissociated circle of Willis (odds ratio=10,37, 95% confidence interval, from 3,64 to 29,52; p<0,001) and the occurrence of intraoperative hypotension (odds ratio =3,62, 95% confidence interval, from 1,16 to 11,28; p<0,027) were predictors of a persistent decrease in BP after CAS. 

Conclusion. The obtained results indicated the need for more thorough conservative postoperative management, especially for patients with a dissociated circle of Willis. It is also necessary to achieve the target blood pressure values by individualized correction of antihypertensive therapy.

Aim. The question of choosing the optimal revascularization strategy for patients with acute coronary syndrome without ST-segment elevation (NSTE-ACS) and multivessel coronary disease (MVCD) remains open. The aim of the work was to assess the results of revascularization by the method of coronary artery bypass grafting (CABG), performed in the early stages of NSTE-ACS.

Material and methods. During the 2016-2018 period we included 87 consecutive patients with NSTE-ACS and MVCD, who underwent CABG. Depending on the timing of revascularization, the patients were divided into 4 groups: the first 24 hours, 24-72 hours, 72 hours — 7 days, more than 7 days — hospital period. Endpoints of the study were such adverse cardiovascular events as death, myocardial infarction (MI), acute cerebrovascular accident/transient ischemic attack, repeated revascularization, bleeding on the BARC scale (Bleeding Academic Research Consortium). Endpoints were evaluated in the hospital period.

Results. Patients of the studied sample were characterized by severe clinical and angiographic status. The mean value of SYNTAX Score was 36 (33; 38) points, GRACE — 136 (123; 144) points. Hemodynamically significant lesion of the left coronary artery was detected in 40% of patients. MI was recorded in 44% of patients, 48% of patients had diabetes. In 8% of cases, patients underwentrevascularization within 24 hours from the time of admission to the clinic, in 9% — in the time interval from 24 to 72 hours, in the remaining cases — during the hospital period. Ninety four percent of the operations were performed under cardiopulmonary bypass. The SYNTAX Score value after CABG in the group was not more 5 (3; 7) points. The average volume of blood loss was 550±150 ml. The total number of deaths was 4,6%.

Conclusion. The high need for CABG, as a reasonable strategy of revascularization for patients with NSTE-ACS and MVCD, and satisfactory results of the surgery demonstrate the need for accessibility of CABG in 24/7 mode, as a percutaneous coronary intervention.

pulmonary artery pressure in Patients with Pulmonary Hypertension and Chronic Heart Failure.

Materials and methods. Inclusion in the study (n=20) was based on the results of an echocardiographic study (systolic pressure in the pulmonary artery ≥35 mm Hg) and clinical assessment (NYHA ≥II FC heart failure). The procedure of pulmonary artery cryodenervation was performed at the bifurcation level of the main pulmonary trunk using single-point cryoablation catheter. The cryoablation was applied in a circular way around the pulmonary trunk at the bifurcation level, rotating the catheter tip with the pace of2 mm with temperature minus 75-80o C and time 120 s at each spot. The study endpoints were the changes in systolic pulmonary artery pressure, mean pulmonary artery pressure, pulmonary vessel resistance and 6 min walking test before and immediately after procedure.

Results. We analyzed intermediate results of sympathetic fibers cryodestruction, located in the bifurcation of main pulmonary trunk. The mean systolic pulmonary artery pressure decreased from 40 [37; 44] tо 31 [28; 35] mm Hg (p<0,05), pulmonary vessel resistance decreased from 5,6 [4,9; 6,1] tо 3,9 [3,5; 4,5] WU (p<0,05) and improvement of 6 min walking test from 287 [233; 332] to 320 [276; 348] m (p<0,05) was observed. There were no cases of early deaths and specific complications.

Conclusion. The cryoablation pulmonary denervation is a new promising treatment in patients with pulmonary hypertension. First clinical results demonstrate the safety of this procedure. Further randomized studies are required to confirm the efficacy of PDCM. However, today we can see decrease of hemodynamic parameters and clinical improvement when using the new technique in a certain group of patients.

Aim. To determine the dynamics of endothelial function and intracardiac hemodynamics during implantation of different types of pacemakers.

Material and methods. The study involved 61 patients, 29 of them were implanted with single-chamber pacemaker (the first group), 32  — two-chamber pacemaker (second group) with sick sinus syndrome (SSS), as well as patients with 2-3 degrees AV conduction disorder. Test with endothelium-dependent vasodilation of the brachial artery was performed using the standard technique and the velocity parameters of blood flow were determined. Parameters of intracardiac hemodynamics and left atrial (LA) function were determined. These studies were conducted in patients initially upon admission to the hospital and 2 months later implantation of pacemaker.

Results. Endothelium-dependent vasodilation significantly deteriorated in patients with single-chamber pacemaker which initially was 6,1 [2,74;9,815]% and in 2 months decreased to 5,4 [2,37;7,55]% (p=0,05). There was a tendency to deterioration of left ventricular (LV) contractile function accompanied by a decrease in ejection fraction (EF) to 55,04 [49,04;68,72]%, and decrease emptying fraction of LA to 37,36 [31,67;52,85]%. There was a tendency to increase the volume index of LA which indicates an increasing overload of the volume and pressure of LA. There was a significant increase in the degree of endothelium-dependent vasodilation in patients of the second group initially compiling a 3,25 [2,15;6,61]% and then reaches 6,15 [2,75;8,97]% 2 months after surgery (p<0,04). There was no overload in the volume and pressure of LA and improved indirect signs of LV compliance parameters (growth of end-systolic dimension and volume) and decreased LV EF to 53,23 [44,1;69,95]%. In patients in the first group there was a tendency to increase peripheral resistance to 1227 [1065;1318] dyne x cm-5 x sec, accompanied by a significant decrease in blood flow rate. In the second group there was a tendency to reduce peripheral resistance to 1215 [1136;1391] dyne x cm-5 x sec and a significant increase in blood flow rate. There was a significant correlation between the systole LA dimension and total peripheral resistance in patients with VVI stimulation (r=0,78, p=0,0022), which indicates an increase in total peripheral resistance with a change in blood flow from LA to LV and a decrease in cardiac output.><0,04). There was no overload in the volume and pressure of LA and improved indirect signs of LV compliance parameters (growth of end-systolic dimension and volume) and decreased LV EF to 53,23 [44,1;69,95]%. In patients in the first group there was a tendency to increase peripheral resistance to 1227 [1065;1318] dyne x cm^-5 x sec, accompanied by a significant decrease in blood flow rate. In the second group there was a tendency to reduce peripheral resistance to 1215 [1136;1391] dyne x cm^-5 x sec and a significant increase in blood flow rate. There was a significant correlation between the systole LA dimension and total peripheral resistance in patients with VVI stimulation (r=0,78, p=0,0022), which indicates an increase in total peripheral resistance with a change in blood flow from LA to LV and a decrease in cardiac output.

Conclusion. Endothelial function deteriorates with single-chamber stimulation and improves with two-chamber stimulation. These changes are based on shear stress and nitric oxide endothelium secretion the changes of which depend on the characteristics of central and peripheral hemodynamics.

Aim. To create a mathematical model for predicting an assessment of the risk of antibody-mediated rejection (AMR) and analyze the survival of recipients with antibodies to leukocyte donor antigens.

Material and methods. A single-center study was conducted on the basis ofS.V.OchapovskyRegionalClinicalHospital № 1. During the 7 years 181 heart transplant recipients were observed. Based on the AMR crisis and detected antibodies to leukocyte donor antigens (HLA), 5 groups were identified: group 1 (n=10) — donor-specific antibodies (DSA) and AMR crisis, group 2 (n=7) — patients without DSA and AMR crisis, group 3 (n=17) — patients with antibodies to HLA, without AMR crisis, group 4 (n=11) — with AMR crisis, without identified antibodies to HLA, group 5 (n=87) — patients, not having antibodies to HLA and signs of both AMR and cell-mediated rejection (according to endomyocardial biopsy). The recipients underwent immunological tests, 2D-speckletracking echocardiography (2D-STE) and transthoracic echocardiography (TTEchoCG). Statistical methods were used to assess the results.

Results. Predictors of the severe form of AMR in TTEchoCG are: left ventricle enddiastolic diameter, interventricular septum thickness, ejection fraction, right ventricle volume. Predictors were determined using the 2D-STE method: global longitudinal peak strain, sensitivity (SE) — 86,2%, specificity (SP) — 90,4%; radial strain, SE — 75,8%, SP — 84,5%; circular strain, SE — 78,6%, SP — 84,4%. When taking into account the indicators of the global longitudinal peak strain of the left ventricle and the longitudinal peak strain of the right ventricle, SE increases to 91,9%, SP — 94,6%, with p<0,001. The survival rate of patients with identified post-transplant (de novo) donor-specific antibodies of the late period is 40%, without identified donor-specific antibodies — 68%. Dedicated predictors are used for mathematical prediction of AMR risk.

Conclusion. The relationship between immunological changes and data of TTEchoCG, deformation parameters and mechanics of a heart transplant was revealed. The presence of de novo DSA decline the survival, increases the risk of AMR, and contributes to the development of coronary artery disease. The proposed AMR risk prediction model will improve the long-term results of heart transplantation.

Aim. To assess the neuronal damage severity and cognitive status in conditions of unilateral antegrade cerebral perfusion through the brachiocephalic trunk during surgical reconstruction of the thoracic aorta.

Material and methods. The study included 144 patients with aneurysm and dissection of the thoracic aorta. Patients underwent reconstructive surgery under cardiopulmonary bypass, unilateral antegrade cerebral perfusion and circulatory arrest. Before and after the intervention, a cognitive status analysis was performed using the Montreal Cognitive Assessment (MoCA), Amatinu test and Schulte tables. The dynamics of neuron-specific enolase (NSE), a marker of neuronal damage, was determined perioperatively.

Results. The duration of cardiopulmonary bypass was 155 [115; 201] min, cardioplegic arrest — 100 [72; 150] min, unilateral perfusion — 20 [15; 51] min,circulatory arrest — 20 [15; 30]min.Hospital mortality was 7% (10 cases). Neurological complications were noted in 12 (8%) cases. All patients in the postoperative period (within 24 hours) showed an increase in NSE compared with baseline values (3,3 μg/L and 2,07 μg/L, respectively, p=0,0003), but not exceeding the upper limit of normal (9,9 μg/l). According to the results of psychometric tests, which were carried out upon admission to the hospital and 2 weeks after the operation, there were no negative changes (MoCA test: 24 [21; 26] points — 26 [24; 27] points, p=0,00001; Schulte tables: 288 [240; 368] s — 278 [241; 328] s, p=0,01; Amatuni sample 264 [216; 297] s — 254 [221; 280] s, p=0,57).

Conclusion. Based on the analysis of the perioperative dynamics of neuronspecific enolase and cognitive tests, unilateral cerebral perfusion through the brachiocephalic trunk is effective and relatively safe. This method of perfusion protection of the brain helps to minimize postoperative neurological complications during operations on the thoracic aorta.

Aim. To evaluate immediate single-center results of transcatheter aortic valve implantation (TAVI) with use of novel self-expanding bioprosthesis Acurate neo.

Material and methods. TAVI procedure was performed in 69 high-tointermediate surgical risk patients (mean age 76,8±6,1years, 31 males, 68 females) with severe calcified aortic stenosis and diverse comorbidity. Concomitant coronary artery disease was observed in 43 (62%), atrial fibrillation in 23 (33%), diabetes mellitus type 2 in 26 (38%) patients. Median Euroscore II was 4,9 (2,8; 9,0). VARC-2 criteria were applied to assess early effectiveness and safety of the procedure.

Results. There were no all-cause mortality, surgical conversion, acute coronary syndrome and stroke in the study group. In-hospital and 30-day mortality was also 0%. Duration of the procedure was 100 min (75;120), hospital stay — 7 (6;8) days. Patient’s haemodynamics and clinical status were significantly improved after TAVI. Mean aortic valve pressure gradient significantly decreased from 57,4±17,6 to 11,8±4,4 mm Hg, effective aortic valve area increased from 0,65±0,17 up to 1,8±0,41 mm Hg (p<0,001). Left ventricle ejection fraction increased from 54,5±13,2 mm Hg to 57,7±12,3 before discharge (p<0,001). Moderate paravalvular aortic regurgitation was observed in only 13% of patients. Permanent pacemaker rate was 5,8%. NYHA class reduced from 2,9 to 2,0 (p<0,001).

Conclusion. First Russian prospective study of TAVI with use of Acurate neo showed satisfactory hemodynamic characteristics, safety indicators and clinical efficacy of this device. Relative disadvantages of this non-repositionable valve could be generally overcome due to its distinctive features allowing precise planning, adequate navigation and accurate implantation.

Aim. To assess the clinical and hemodynamic results of transcatheter aortic valve replacement with the MedLab-CT prosthesis.

Material and methods. MedLab-CT is the first Russian transcatheter implantable cardiac valve prosthesis. It is a balloon — an expandable stent, the cusps of which are made of 0,1 mm thick polytetrafluoroethylene plates. The use of synthetic material for the manufacture of the locking mechanism of the transcatheter implantable cardiac valve prostheses is a priority choice in the world. The reason was the hypothesis suggesting the absence of biodegradation of polytetrafluoroethylene in the body. The mechanical stability of the valve was tested on the pulse duplicator with a load equivalent to 10 years of functioning in the aortic position. The study included 69 patients who underwent implantation of the MedLab-CT prosthesis. One of the exclusion criteria for surviving patients was a follow-up period of less than 6 months. We estimated survival and incidence of clinically significant stroke, as well as hemodynamic parameters according to echocardiography for up to 3 years. Thirty nine patients were examined by face-toface approach, the rest ones underwent a telephone questionnaire survey.

Results. The average follow-up was 9,6 months, the maximum — 3 years. Most patients belonged to the elderly group (average age 73,3 years). For 51 patients (74%) according to the EuroSCORE scale and for 37 (54%), according to the STS scale, a high risk of surgical intervention was determined: ≥8%.Mortality rate was 13% — 6 deaths were noted at the hospital stage, 3 patients died in the long term. No strokes recorded. In the face-to-face group, mean gradient on the aortic valve prosthesis was determined to be 8,41±4,21 mm Hg; insufficiency due to paraprosthetic fistulas not higher than I degree was observed in 7 patients (18%), not higher than II degree — in 1 patient; cases of transvalvular aortic insufficiency was not revealed.

Conclusion. The results on the studied parameters are comparable with the data presented by foreign randomized clinical trials of imported models of transcatheter aortic valve prostheses.

Aim. To perform a comparative assessment of vessel wall stiffness parameters and left ventricle (LV) remodeling in groups of patients with arterial hypertension (AH) receiving renal replacement therapy (RRT) and patients with hypertensive heart disease.

Material and methods. One hundred fifty eight people were examined: 32 patients on program hemodialysis (PG), 37 — after kidney transplantation (KT), 69 — with essential hypertension and 20 healthy volunteers. All patients underwent 24-hour blood pressure (BP) monitoring with an assessment of the parameters of daily vessel wall stiffness, aortic pressure and Mand B-mode echocardiography.

Results. In groups of patients with PG and after KT, the central and peripheral blood pressure did not differ significantly. When comparing with the group of essential hypertension in RRT patients, with similar values of office systolic and diastolic BP, higher average values of peripheral and central BP were determined. An increase in the values of the pulse wave velocity in the aorta of more than 10 m/s was observed only in RRT patient groups. In all groups of patients with AH, BP and vessel wall

Conclusion. Patients receiving RRT have higher values of the average daily pulse wave velocity in the aorta, central BP and a longer period of an increase in the pulse wave velocity in the aorta during the day, higher vessel wall stiffness values, and less pronounced LV spherification than in patients with hypertensive heart disease and comparable values of office BP.

Aim. To study the relationship between the angiographic dynamics of the state of the coronary bed in patients undergoing percutaneous coronary intervention (PCI) due to myocardial infarction (MI) and the carriage of polymorphic rs1800470 variants of the transforming growth factor beta-1 gene (TGF-β1).

Material and methods. The study included 89 men with MI of the Caucasian race aged 32 to 65 years (52 [45,0-58,0]). Genomic deoxyribonucleic acid (DNA) was extracted from venous blood by phenol-chloroform technique. The rs1800470 polymorphism of the TGF-β1 gene was tested using real-time polymerase chain reaction (PCR) (TaqMan probes, AB 7900HT). Assessment of the severity of coronary lesions was carried out initially according to the standard coronary angiography (CAG) protocol with the calculation of the Gensini score. CAG was also conducted in the dynamics after 5-103 months (42,3±29,5 months) of the study beginning.

Results. In male carriers of the rs1800470 A allele of the TGF-β1 gene, the mean values of the Gensini score statistically significantly increased (47,5±34,1 (CAG-1) and 64,5±35,5 (CAG-2), p <0,001) in comparison with carriers of the homozygous GG rs1800470 variant of the TGF-β1 gene (43,5±21,1 (CAG-1) and 46,2±23,2 (CAG2), p=0,066). In patients who had rs1800470 A allele of the TGF-β1 gene, a 20%decrease in the Gensini score was observed after 7 months (p=0,013), and 30% — after 5 months (p=0,003) of the initial CAG. The development of late stent restenoses in carriers of the rs1800470 A allele and the homozygous risk genotype AA of the TGF-β1 gene was noted at an earlier date — 8 (p=0,047) and 12 months (p=0,002), respectively.

Conclusion. Currently, the conduct of CAG in dynamics in patients undergoing PCI is recommended as clinically indicated. The exception is the group of patients who underwent endoprosthesis replacement of the left coronary artery or have uncorrected stenosis of a different location from 3 to 12 months after PCI. The presented data show a possible predictor role of rG1800470 polymorphism of the TGF-β1 gene in relation to the progression of coronary atherosclerosis and the development of late stent restenoses.

Currently, the analysis of the fibrosis severity during the restructuring of the surrounding extracellular matrix (ECM) is studied in most of the research works devoted to “cardiac remodeling”. At the same time, the role of the basal membrane of cardiomyocytes in heart diseases was not studied. The basal membrane of cardiomyocytes is a highly organized layer of the ECM which is located on the outer side of the sarcolemma. Degradation of ECM components is carried out by different types of matrix metalloproteinases (MMP), which have proteolytic activity and are actively involved in the process of ECM remodeling, destroying its components such as collagen, elastin, fibronectin, glycosaminoglycans and other structural components.

Aim. To evaluate the ECM status in patients with coronary artery disease and its effect on left ventricular myocardial remodeling.

Material and methods. Morphological and immunohistochemical (IHC) examination of left ventricular myocardial biopsies was performed in 16 patients undergoing left ventricular reconstruction in combination with coronary artery bypass grafting.

Results. The IHC study revealed the accumulation of matrix metalloproteinase-9 in the cytoplasm of cardiomyocytes. This accumulation was combined with partial or complete destruction of the basal membranes (BM) of cardiomyocytes formed by type IV collagen.

Conclusion. Type IV collagen destruction in basal membranes of left ventricular cardiomyocyteswasrevealed. It iscausedbytheactionofmatrixmetalloproteinase-9, which accumulates in the cell cytoplasm.

Aim. Inflammatory abdominal aortic aneurysm may be one of the manifestations of Ig G4-related disease. This study analyzes the clinical manifestations of Ig G4related inflammatory abdominal aortic aneurysm.

Material and methods. We examined twenty patients with abdominal aortic aneurysm (AAA). The clinical performance of the disease, the results of laboratory and pathomorphological studies were studied. In 8 cases, Ig G4-related inflammatory AAA criteria were identified.

Results. Compared to atherosclerotic AAA, Ig G4-related cases were characterized by a less frequent presence of abdomen or back pain. The concentration of IgG4 in serum in Ig G4-related cases was significantly increased. Patients with Ig G4-related inflammatory AAA often had a history of allergic reactions to drugs, autoimmune diseases, a high concentration of Ig E and a high titer of antinuclear antibodies in blood serum. According to a histological study of intraoperative biopsy samples, Ig G4-related cases were characterized by thickening of adventitia and numerous infiltrates with Ig G4-positive plasma cells.

Conclusion. The presence of Ig G4-related disease is diagnosed in the presence of irregular fibrous tissue proliferation with Ig G4 plasma cell infiltrates and with an increase in the concentration of Ig G4 in blood serum. Ig G4-related inflammatory AAA has clinical specifics in comparison with atherosclerotic aneurysm.

Coronary artery bypass graft (CABG) using short-scar incision (without median sternotomy) allows minimizing the invasiveness of the intervention, reducing the risks of postoperative complications, and also ensuring patient comfort and quick social and physical rehabilitation. The successful implementation of such operations is due not only to surgical skills and the integration of technological achievements into practice, but also to the appropriate selection of patients. The article presents a clinical case of successful re-operation of the subclavian-coronary artery bypass grafting on a beating heart using antero-lateral thoracotomy approach in a patient with angina relapse after CABG.

There is a presentation of the results of a two-year follow-up after surgical treatment of a patient with chronic heart failure and a permanent form of atrial fibrillation, in which isolated apex hypoplasia and non-compaction of left ventricular myocardium were revealed.

Infective endocarditis (IE) has become an increasingly significant problem in cardiology and cardiac surgery over the past 30 years. Despite the noticeable progress made in the diagnosis and treatment of IE, the prognosis for this condition is still poor and the mortality rate reaches 15-30% [1, 2]. The risk of developing IE is especially high in patients with «intracardiac» artificial materials (artificial valves, prostheses of any type, implantable antiarrhythmic devices). This article presents a rare clinical case of   IE of synthetic patch after left ventricle reconstruction (Dor procedure).

The article discusses the main stages of the diagnostic process (clinical evaluation, determination of pre-test probability, non-invasive tests). In this part of the review, two new approaches of non-invasive tests are considered. First one — with a focus on non-invasive determination of anatomical changes in the coronary bed using multispiral computed tomography-angiography, second one — with the calculation of the post-test probability of obstructive coronary artery disease. In general, this review will help researchers and clinicians about in better understanding of modern diagnostic capabilities in identifying of obstructive coronary artery disease.

Today, the treatment of patients with chronic coronary occlusion is one of the most difficult problems in interventional cardiology. This is due not only to the technical difficulties of endovascular recanalization, but also to the difficulty in selecting patients for whom revascularization will be beneficial. Due to the low evidence base and the conflicting results of large clinical trials, these patients are rarely referred for endovascular recanalization. The purpose of this article is to review the literature and systematize relevant knowledge on the management of patients with chronic coronary occlusion.

The incidence of perioperative complications, including perioperative myocardial damage and infarction, remains high with the increasing number of coronary artery bypass grafting (CABG) performed worldwide. These conditions are predictors of poor prognosis in the postoperative period. Therefore, it is relevant to develop strict diagnostic criteria for these conditions and to search for optimal preventive measures.

Cardioprotection is used at all stages of patient management in the perioperative period after CABG. The comprehensive approach containing preoperative management of the patient (prehabilitation), intraoperative cardioprotection and risk factor management in the postoperative period is considered to be the most effective one.

The review presents current approaches to the diagnosis of myocardial infarction after CABG, as well as the basic concepts of its prevention at all stages of patient management.

The review article provides an analysis of domestic and foreign studies evaluating the dynamics of temporary indicators of prehospital medical care for patients with acute coronary syndrome (ACS)/myocardial infarction (MI). It was noted that the delay in applying for medical care of patients with ACS/MI is currently a significant factor determining the effectiveness of the treatment of these diseases. Over the past decades, modern treatment methods and bright-line health system recommendations have appeared. Significant progress has been made in reducing the time from calling an ambulance to receiving treatment, especially in developed countries. However, in spite of the efforts made, the problem of late appealability of patients is still unresolved. In the world and inRussia, experience aimed to educate patients in terms of ACS/MI symptoms and the importance of timely help-seeking has been gained at the population level. There is no doubt that along with organizational measures aimed to treat cardiovascular patients, increasing public awareness of the ACS symptoms and emergency aid should be considered as one of the priority areas.

Every year, the frequency of use of biological prostheses for treatment of valvular heart disease increases.

The implantation of a biological prosthesis allows avoiding lifelong anticoagulant therapy, but at the same time it may require further replacement due to the dysfunction development.

Traditional reoperation is associated with a certain risk of trauma to various structures and cardiac chambers during explantation of non-functioning valve.

Transcatheter replacement of the prosthesis (“valve-in-valve”) is not always realizable due to lack of routes for the delivery system and small diameter of the initial valve.

“Valve-in-valve” is not always demanded because it does not provide an option to choose mechanical or biological prosthesis.Valve-on-valve implantation technique implies that the new prosthesis is implanted in the carcass of the previous valve. It allows avoiding severe intraoperative complications, reducing the duration of the main stage of the surgery and adverse events in the early postoperative period, and provide an option to choose implantable device.

In this review, the authors attempted to comprehensively evaluate the world experience in applying the “valve-on-valve” technique.

Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI)