Aim. To analyze the results of using a novel method of glomus-saving carotid endarterectomy (CEE) sensu A. N. Kazantsev.

Materials and methods. This cohort, comparative, prospective, open-label study from January 2018 to April 2020 included 475 patients who undergone one of the three glomus-saving types of CEE. Depending on the implemented revascularization strategy, all patients were divided into 3 groups: group 1 — 136 patients (28,631%) CEE sensu R. A. Vinogradov; group 2 — 125 patients (26,316%) — sensu K. A. Antsupov; group 3 — 214 patients (45,053%) — sensu A. N. Kazantsev. Glomus-saving CEE sensu A. N. Kazantsev was carried as follows. Arteriotomy was performed along the inner edge of the external carotid artery (ECA) adjacent to the carotid sinus, 2 to 3 cm above the mouth, depending on the atherosclerotic lesion, with a transition to the common carotid artery (CCA) (also 2 to 3 cm below the mouth of the ECA). The internal carotid artery (ICA) was cut off at the site formed by the wall of the ECA and CCA. Next, an endarterectomy from the ICA was performed using the eversion technique. The next step was an open endarterectomy from EСA and СCA. Next, the ICA at the saved site was implanted in the previous position.

Results. No intergroup differences were observed during hospitalization. Due to intraoperative visualization of an extended lesion of the ICA, in some cases it became necessary to transform the operation: in group 1, 4,4% of cases required ICA prosthetics; in groups 2 and 3 — autologous ICA transplantation in 4,8% and 4,7% of cases, respectively. Also, 1 case of ischemic stroke was recorded in groups 1 and 2. The cause of the latter was ICA thrombosis due to intimal detachment distal to the removed plaque. All cases of ECA thrombosis in the hospital postoperative period were differentiated in group 2.
In the long-term follow-up, the groups were also comparable in the complication rate. The cause of all ischemic strokes was the development of restenosis or thrombosis of the ICA/prosthesis. Among patients who underwent forced autologous transplantation of the ICA, restenosis was not recorded. It should also be noted that new ECA occlusions (n=12; 9,6%) were visualized 6 months after reconstruction only in group 2.

Conclusion. CEE sensu A. N. Kazantsev is the simplest technique of glomus-saving reconstructions, which have demonstrated their safety and effectiveness.

Aim. To optimize the surgical technique for left atrial appendage (LAA) occlusion in patients with atrial fibrillation (AF) during coronary artery bypass grafting.

Material and methods. The study included 60 patients with atrial fibrillation (AF). The patients were randomly divided into 2 groups. In the first group of patients, LAA was closed using the developed two-suture technique. In patients of the second group, a purse string suture was applied to the LAA. All patients underwent transesophageal echocardiography (TEE) before surgery to rule out the presence of intracardiac blood clots. To assess the effectiveness of the method in the postoperative period, TEE was performed.

Results. According to postoperative TEE, one case of LAA recanalization in each group was revealed (p>0,05). In the second group, the residual LAA cavity after applying a purse string suture was revealed. During the follow-up period, there were no neurological complications and deaths.

Conclusion. According to the study results, it was found that the proposed two-suture technique for LAA occlusion is not less effective than the purse-string suture. The developed technique of two-suture epicardial occlusion of LAA showed actual technical advantages, allowing to optimize this surgery in different categories of patients.

Aim. A retrospective analysis of the outcomes of heart transplantation (HT) with extended cold ischemic time of donor heart (more than 4 hours) versus heart transplantation with short cold ischemia time (less than 4 hours).

Material and methods. The retrospective analysis included 52 recipients who underwent HT in the period from July 20, 2012 to October 23, 2019 in Meshalkin National Medical Research Center. The patients were divided into two groups: group 1 (n=26) — orthotopic HT with extended cold ischemic time (more than 240 minutes), group 2 (n=26) — short cold ischemia time (less than 240 minutes). The effect of cold ischemia duration on hospital survival, the function of donor heart, and the postoperative course was assessed.

Results. A retrospective analysis revealed a higher rate of hospital survival in the group of recipients with extended cold ischemic time (more than 240 minutes) 88,5% compared to 80,7% in the second group. There was no difference between the groups in the acute rejection rate, the need for inotropic agents, mechanical circulatory support, and cardiac pacing, as well as the incidence of postoperative renal failure and infectious complications.

Conclusion. Due to the small number of patients, our experience in HT with extended cold ischemic time does not allow us to draw global conclusions, but a preliminary comparison of HT with extended and short cold ischemic time did not reveal significant advantages in one group or another. This provides a basis for further accumulation of experience and research.

Aim. To compare the effectiveness and safety of ascending aortic hemiarch replacement performed during hypothermic circulatory arrest with different temperature regimens.

Material and methods. The study included 104 patients with ascending aortic aneurysm, who underwent ascending aortic hemiarch replacement under hypothermic circulatory arrest and antegrade cerebral perfusion. Depending on the temperature regimen, all patients were divided into two comparable groups: group 1 (n=28) — patients operated on under mild hypothermia (29-31^oС), group 2 (n=76) — patients operated on under moderate hypothermia (25-28^oC).

Results. Comparative analysis of intraoperative data between groups of patients with mild and moderate hypothermia revealed a significant difference in the duration of cardiopulmonary bypass (111 [97; 135] min vs 125 [108.5; 170] min, p=0,031) and surgery (240 [210; 270 ] min vs 275 [240; 330] min, p=0,003). In the early postoperative period, the best results were also obtained in patients of mild hypothermia group. In these patients, compared with moderate hypothermia group, there was a lower frequency of reoperation due to bleeding (3,5% vs 5,2%, p=0,572), a decrease in transfused fresh frozen plasma volume (2 [2; 4] vs 4 [2; 4], p=0,03), a decrease in the ventilatory support duration (10 [7; 16] hours vs 18 [10; 24] hours, p=0,002), as well as a bed-day decrease in intensive care unit (2 [2; 3] and 3 [2; 4] days, p=0,005). No neurologic deficit was found in any of the patients. In-hospital mortality had no significant intergroup differences (p=0,541).

Conclusion. An increase in the temperature regimen during the ascending aortic hemiarch replacement performed under hypothermic circulatory arrest is relatively safe in relation to early postoperative complications. Mild hypothermia does not increase early postoperative surgical risks compared to moderate hypothermia.

Aim. To evaluate the results of a three-year follow-up of patients with chronic thromboembolic pulmonary hypertension (CTEPH) and quality of life (QOL) dynamics after pulmonary thromboendarterectomy (PTE).

Material and methods. The study included 125 patients with CTEPH aged 49,7± 11,9 years. Three-year follow-up included the recording of adverse cardiovascular events, surgeries, death during the period from the end of hospitalization and up to three years. The SF-36 questionnaire was used to assess physical and mental wellbeing before and three years after PTE. Multivariate linear regression was used to assess the factors affecting QOL in the long-term postoperative period.

Results. During a three-year follow-up, adverse cardiovascular events was recorded in 1,9% of patients. One patient underwent coronary artery bypass graft surgery and one patient — cholecystectomy. Reoperative PTE was not carried out. The overall three-year survival rate was 90,4%.
At baseline, patients with CTEPH had a low level of physical and mental well-being (<40 points). Three years after the operation, these parameters significantly increased (p<0,05), but did not exceed 50 points. Multivariate linear regression revealed an unfavorable effect of early postoperative residual pulmonary hypertension on the physical health three years after PTE. Other factors (age, sex, body weight, comorbidity, hospital acquired complications) did not affect the physical and emotional aspects of QOL.

Conclusion. Three-year survival rate in patients with CTEPH after PTE was 90,4%. During the follow-up period, no recurrent thromboembolic events were recorded. Adverse cardiovascular events were recorded in 1,9% of patients. Three years after surgery, the physical and mental health increased in comparison with preoperative values, but did not exceed 50 points on the SF-36 questionnaire. The physical aspect of QOL after surgery is affected by early postoperative residual pulmonary hypertension.

Aim. To assess long-term survival depending on the presence and severity of frailty in patients with heart failure (HF) and implanted cardiac resynchronization therapy devices.

Material and methods. We examined 77 patients (men — 74%, women — 26%, mean age 58,7±10,7 years) with NYHA class II-IV HF. The follow-up period was 42,4±27,1 months. On the basis of 31 parameters (medical history, diagnostic tests, questionnaire survey of physical activity limitations), a frailty index was calculated. Depending on the index value, the patients were divided into 2 groups: group 1 (n=41) — <0,375 (no frailty), group 2 (n=36) — ≥0,375 (patients with frailty).

Results. Long-term survival of patients in group 1 was 87,8%, in group 2 — 52,8% (Log rank p<0,001). According to the univariate analysis, the presence of frailty was significantly associated with long-term mortality (odds ratio (OR) 6,108; 95% confidence interval (CI) 2,207-16,907; p<0,001). When sex, age, left ventricular ejection fraction, left bundle branch block, QRS duration, left ventricular volume were included in the multivariate analysis, the presence of frailty remained a significant predictor of long-term mortality (OR 5,763; 95% CI 1,837-18,083; p=0,003).

Conclusion. Frailty has an independent effect on the long-term all-cause death risk in patients with HF and implanted cardiac resynchronization therapy devices.

Aim. To compare strategy and early results of coronary artery bypass grafting (CABG) in patients with and without calcification of target coronary arteries (TCA).

Material and methods. The prospective study analyzed the data of patients (n=462) who underwent elective isolated CABG in 2017-2018 using cardiopulmonary bypass and microsurgery. Two groups were distinguished: group 1 — patients with TCA calcification (n=108), group 2 — patients without TCA calcification (n=354). In cases where the distal coronary artery lesion did not allow standard bypass grafting, additional complex anastomoses were provided. A comparison of intraoperative parameters and early results of CABG was carried out.

Results. In groups 1 and 2, the revascularization index did not differ significantly and was 4,5 and 4,3, respectively. The frequency of complex surgical interventions in group 1 was higher: for example, ‘Y’ grafts were used in groups 1 and 2, respectively, in 32% (35/108) and 12% (44/354), p<0,05; sequential anastomoses in 14% (15/108) and 7% (26/354), p<0,05; prolonged patch-angioplasty — in 21% (23/108) and 5% (16/354), p<0,05; anastomoses with arteries <1,5 mm in diameter — in 33% (36/108) and 4% (14/354), p<0,05; coronary endarterectomy in 17% (18/108) and 5% (16/354), p<0,05, respectively. The duration of cardiopulmonary bypass was longer in group 1. At the same time, the hospital clinical results did not differ significantly: mortality was not registered; the frequency of perioperative myocardial infarction was 1,8% (group 1) and 1,1% (group 2); the need for inotropes, frequency of arrhythmia, length of stay in the intensive care unit and hospital were similar; there were no cases of in-hospital angina recurrence.

Conclusion. CABG in patients with calcification of TCA is associated with surgical challenges and need for complex adjunct techniques. Nevertheless, complete surgical revascularization is real in these cases, and the hospital results are comparable to those in patients without calcification.

Aim. To evaluate the effect of culprit coronary artery revascularization after 48 hours from the symptoms’ onset on the prognosis of patients with ST-elevation myocardial infarction (STEMI).

Material and methods. Of the 1172 patients admitted to City Clinical Hospital № 13 in 2018 due to STEMI, 43 patients (4%) were included in the retrospective study. There were following inclusion criteria: hospitalization after 48 hours from the symptoms’ onset, no clinical signs of myocardial ischemia, and complete coronary artery occlusion according to angiography. The mean age of the subjects was 61,3±10,6 years, 34 (79%) men and 9 (21%) women. The subjects were divided into two groups: group 1 (n=22) — management with percutaneous coronary intervention (PCI), group 2 (n=21) — management with medications. The groups differ only in the severity of coronary atherosclerosis according to SYNTAX score: group 1 — 14,0 [11.0; 19.5], group 2 — 26,0 [16,5; 31,0] (p=0,009). At the end of inpatient treatment, patients underwent echocardiography. Death and myocardial infarction were monitored during hospitalization and for 12 months after discharge.

Results. During hospitalization, 2 patients died (4,7%; one in each group, p=1,00). No recurrent MI were reported. The left ventricular ejection fraction in the PCI group was 50 [46; 54] %, in the group with drug therapy — 43 [38; 50] % (p=0,01). Out of 43 included patients, long-term outcomes were followed up in 32 (74%). Among them, 1 (5,8%) patient died in group 1, 6 (33,3%) patients — in group 2 (p=0,04). In total, death or recurrent MI in the first group was observed in 2 (12%) patients, in the second group — in 5 (33%) patients (p=0,14).

Conclusion. Revascularization of a fully occluded culprit coronary artery in stable patients with STEMI after 48 hours of symptoms’ onset is associated with a higher inhospital left ventricular ejection fraction and a decrease in 12-month mortality.

Aim. The main aim of our study was to compare the results of transcatheter atrial septal defect (ASD) closure versus minimally invasive cardiac surgery (MICS) focusing on cardiopulmonary exercise capacity and echocardiographic findings preoperatively and 1 month after defect closure.

Material and methods. 54 patients with ASD and finally 43 patients who were followed up were included in the study. 21 patients were in MICS (robotic or endoscopic approach) and 22 patients were in transcatheter closure arm. All patients investigated in detail by transesophageal echocardiography and underwent cardiopulmonary exercise test (CPET). At the end of first month, CPET and transthorasic echocardiography were reperformed.

Results. There was significant improvement of physical capacity after 1 month following the transcatheter closure procedure documented by exercise time and VO 2 max. Tricuspid annular plane systolic excursion (TAPSE) and tricuspid lateral annular systolic velocity (Tri S) were not changed. In surgery group right heart diameters declined significantly; but VO 2 max, TAPSE and Tri S significantly decreased.

Conclusion. Cardiopulmonary exercise function is increased in transcatheter closure group 1 month after closure and contrary not in MICS group. This may be caused by long recovery time of the right ventricle after surgery. Device closure of ASD is preferable to surgical closure if the anatomy is suitable. However, MICS for ASD closure is safe, with short recovery period and less scarring.

Aim. To determine independent predictors of recurrent myocardial infarction (MI) and to create a model for predicting recurrent coronary events in working-age patients.

Material and methods. The study included 424 patients (median age 50 (43,5; 55,0) years). In 2017, all patients underwent treatment at the Perm Regional Vascular Center due to the first MI. We retrospectively analyzed the patient data with regard to medical history, comorbidities, diagnostic results, and treatment. After 2 years, information on recurrent MI was collected by analyzing data from electronic medical records of patients. Depending on the outcome, all patients were divided into two groups: with (n=78) and without (n=346) recurrent MI. Using the SPSS Statistics v.20, v.23 software package, we compared the central demographic, clinical, diagnostic parameters in the groups. Univariate and multivariate regression analyzes were performed to determine independent predictors of recurrent MI.

Results. Multivariate regression established the following independent predictors of recurrent MI: left ventricular ejection fraction <50% (odds ratio (OR) 5,5, 95% confidence interval (CI) 1,56-19,34, p=0,008), anemia (OR=2,95, 95% CI 1,089- 9,765, p=0,046), multivessel coronary artery disease (OR 2,24, 95% CI 1,285- 3,909, p=0,004). Logistic regression model was created that allows predicting the 2-year risk of recurrent MI after the initial hospitalization with a sensitivity of 73,7% and a specificity of 79,6%.

Conclusion. The results of this study suggest that risk stratification for recurrent MI in working-age patients may need to take into account decreased left ventricular ejection fraction, hemoglobin level, and multivessel coronary artery disease.

Aim. To assess the efficacy and safety of PCSK9 inhibitor alirocumab as part of a combination lipid-lowering therapy in patients with acute coronary syndrome (ACS).

Material and methods. This prospective, open-label, single-center activetreatment study included 13 patients hospitalized due to ACS. The main inclusion criterion was nonachievement of target low-density lipoprotein cholesterol (LDL-C) values (<1,4 mmol/L) with high-intensity statin therapy prior to ACS. During the first 30 days after ACS, all patients received therapy with atorvastatin 40-80 mg/day or rosuvastatin 20-40 mg/day in combination with alirocumab 150 mg/ml (Praluent) administered by subcutaneous injection. Lipid and biochemical profiles were monitored. The first injection of the PCSK9 inhibitor was performed on days 3-5 of hospitalization, the second — after 2 weeks.

Results. On admission, the median LDL-C was 4,3 [3,5;5,3] mmol/L. A day after administration, there was a decrease in LDL-C by 41,9% (median 2,5 [1,8;3,2] mmol/L; p=0,001) without a negative effect on high-density lipoproteins (HDL-C) (median 1,2 [0,8;1,4] mmol/L; p=0,270). Before the next injection, LDL-C decreased by another 8% (median 2,3 [1,1;4,1] mmol/L). A day after the second injection, a decrease in LDL-C from the baseline values was 69,8% (median 1,3 [0,7;1,5] mmol/L; p=0,010). Strengthening lipid-lowering therapy with a PCSK9 inhibitor within 30 days after ACS did not lead to clinical and biochemical deterioration.

Conclusion. The use of subcutaneous 150-mg injections of alirocumab 2 times a week 30 days after ACS in patients who did not reach target LDL-C values with statin therapy, leads to a 69% decrease in LDL-C from baseline values and is safe.

SGLT2 inhibitors have been shown to reduce the risk of cardiovascular events and the development and decompensation of heart failure (HF) in patients with type 2 diabetes (T2D). The improved prognosis in HF may be related not only to the hypoglycemic effect of this drug class. The DAPA-HF study, which included patients with HF with reduced ejection fraction, demonstrated the benefit of dapagliflozin in reducing the risk of cardiovascular death and worsening HF, as well as improving HF symptoms compared to placebo, regardless of the presence of T2D and the recommended therapy for HF.

Aim. To study the effect of combined antihypertensive therapy on the characteristics of venous reflux in working-age men with hypertension (HTN).

Material and methods. We examined 44 men aged 30-50 years with uncontrolled HTN. The dynamics of the rate, temporal and velocity parameters of venous reflux was analyzed for a 14-15 days of combined therapy with an angiotensin-converting enzyme inhibitor (perindopril, 8 mg) and a diuretic (indapamide, 1,5 mg) both in the general group (n=44) and in groups of 22 men with/without chronic venous disease (CVD). CVD was diagnosed by physical examination according to the CEAP criteria. Reflux was assessed at rest by ultrasound of symmetric superficial, deep and perforator veins.

Results. In the general group of patients (n=44), a decrease in blood pressure was associated with significant negative dynamics of the reflux rate in all veins from 0 to 37, a positive dynamics only from 7 to 0 (p=0,0001). Analysis of the dynamics of reflux duration and velocity before and after treatment did not show any differences. The use of combination therapy in patients with HTN and CVD was associated with an increase in the reflux number (p=0,0001), while in patients with HTN without CVD, no significant dynamics was recorded. The proportion of patients with reflux after treatment in the CVD group more than doubled. Comparison of the temporal and velocity reflux parameters after treatment between the groups with/without CVD did not reveal any differences.

Conclusion. Two-week therapy with an angiotensin-converting enzyme inhibitor and a diuretic in working-age men with uncontrolled hypertension is accompanied by the appearance of a significant number of new venous refluxes, which is due to the presence of CVD among patients with hypertension. After treatment, the proportion of patients with reflux in the group with AH and CVD more than doubled.

Aim. To conduct a cost analysis of using novel inhibitors of P2Y 12 (prasugrel and ticagrelor) in patients with acute coronary syndrome (ACS) in the Russian healthcare system.

Material and methods. The analysis was performed using the design of a comparative study of prasugrel and ticagrelor ISAR-REACT 5. The loading and maintenance doses of the drugs, the percentage of patients who stopped therapy and the median duration of administration before withdrawal were taken into account. The cost of treating clinical events associated with the primary and secondary endpoints was estimated according to the data on diagnosis-related groups for 2020. The cost of hospitalization was calculated as the average of the cost of treating various diseases, taking into account the base rate for a hospital. The result was expressed as the weighted average cost per patient for 1 year (365 days). The maintenance dose used in calculations was 10 mg/day for prasugrel and 90 mg 2 times/day for ticagrelor.

Results. Prasugrel is less expensive for use than ticagrelor. For 1-year therapy, the difference is 8386,31 rubles or 10,57%. The proportion of using prasugrel in 2019 was only 2,17%. With the current ratio of using ticagrelor and prasugrel, the budgetary pressures of therapy corresponding to 19,382.7 patient-years will amount to 1,534 billion rubles. An increase in the proportion of prasugrel leads to a decrease in the total expenses of managing patients with ACS after percutaneous coronary intervention who require antiplatelet therapy. With the complete replacement of ticagrelor with prasugrel, the savings will be 10,36% or 159,03 million rubles. With an increase in the proportion of prasugrel, the total expenses will decrease, and with a complete replacement of ticagrelor with prasugrel, the savings compared to using only ticagrelor will amount to 1,353.7 million rubles.

Conclusion. The analysis showed that the use of prasugrel in the population is less costly in the healthcare system. However, the result obtained is relevant only with price changes for one of the drugs not exceeding 10% and not relevant with multidirectional simultaneous changes in prices for compared drugs. Increasing the proportion of prasugrel and replacing it with ticagrelor will reduce the budgetary pressures.

The article discusses the limitations of the evidence from observational studies. Modern approaches to reducing bias in observational studies are discussed in detail, in particular, propensity score matching, which has become popular in recent years. The main differences between randomized and observational studies are discussed. Arguments against the observational studies and improved methods of analysis to compare the treatments’ effectiveness in clinical practice are presented. The role of observational studies as a source of evidence is discussed. The article points out the validity of performing large-scale prospective observational studies to assess the effects of postmarketing drug use in clinical practice, as well as to obtain data on drug use in patients that differ from those in randomized clinical trials.

Although myocardial revascularization is one of the most studied types of medical interventions, there is a heated discussion in cardiology about the feasibility and indications for it in patients with stable coronary artery disease (chronic coronary syndrome). The recently completed ISCHEMIA trial is the largest current study comparing conservative versus invasive strategies in this category of patients. The article discusses the rationale for revascularization to improve prognosis according to the ISCHEMIA trial.

Aim. To compare the data of pre- and postnatal expert echocardiographic diagnostics of obstructive left heart defects (LHD) to identify a possible predictors and reasons for hypo- and overdiagnosis of this.

Material and methods. A retrospective analysis of data from expert echocardiography of 194 fetuses and newborns with suspected obstructive LHD (coarctation of the aorta (CA), interruption of the aortic arch, aortic stenosis (AS), CA or interruption of the aortic arch with AS, hypoplastic left heart syndrome (HLHS)) was performed.

Results. After birth, critical obstructive LHD was confirmed in 59,3% of newborns (115 out of 194): in cases of prenatally diagnosed CA — in 41% of children (42 out of 103); AS — in 67% (4 out of 6); CA with AS — in 65,9% (27 out of 41); HLHS — in 93,9% (39 out of 44); or interruption of the aortic arch with and without AS — in 100% (11 out of 11). After birth, the discrepancy in diagnoses of critical congenital heart defects was detected in 2 cases — obstructive LHD were not confirmed, but total anomalous pulmonary venous drainage (APVD) was detected. In children with a confirmed diagnosis of HLHS after birth, there was a hypodiagnosis of obstructive forms of APVD in three newborns.

Conclusion. The probability of confirming a critical obstructive LHD after birth is higher, the more LHD were hypoplasized during intrauterine imaging. APVD may be “hemodynamically masked” as HLHS when prenatal echocardiography is performed. The combination of HLHS and obstructive forms of APVD can lead to HLHS “hemodynamic aggravation” due to an additional decrease in blood flow of left heart.

Aim. To retrospectively analyze the long-term results of primary aortic valve repair (AVR) in children.

Material and methods. The study included 163 patients operated on from 2004 to 2019. The mean age was 9,58±9,3 years. The patients underwent commissurotomy, decalcification, raphe resection, Trusler technique, raphe shaving, free margin plication, leaflet replacement, leaflet extension, subcommissural annuloplasty, valve sparing aortic root replacement and neocuspidization. Primary endpoint was a composite outcome of freedom from reoperation, recurrent greater than moderate aortic regurgitation, stenosis, whereas secondary — overall survival.

Results. The indications for the procedure were stenotic, regurgitant or mixed defect in 80 (49,1%), 38 (23,3%), and 45 (27,6%) patients, respectively. The 10-year survival rate was 99,4%. The mean follow-up was 3,6±1,8 years. Freedom from reoperation, recurrent moderate and greater aortic regurgitation, stenosis at 1,5 and 7 years was, 95%, 70% and 47%, respectively. In multivariate analysis, Trusler technique, leaflet extension, raphe shaving, use of patch, leaflet retraction, complexity of repair were predictors for composite outcome.

Conclusion. Reconstruction of aortic valve in children is effective and safe. Avoidance of predictors may significantly improve the long-term results of aortic valve repair.

Aim. To assess the influence of resting partial pressure of end-tidal carbon dioxide (P_etCO₂) levels on the long-term results of cardiac surgery.

Materials and methods. This prospective cohort study included 454 patients with coronary artery disease who underwent elective coronary artery bypass graft surgery. Before surgery, all patients underwent pulmonary function tests, including body plethysmography, lung diffusion capacity assessment and cardiopulmonary exercise testing with the determination of ventilatory and gas exchange parameters, including P_etCO₂ at rest. The endpoint was the 2-year survival rate after surgery.

Results. Parameters characterizing the obstructive breathing pattern, the lung diffusion capacity, and resting P_etCO₂ levels had a significant predictor value in relation to long-term survival after cardiac surgery. Among the baseline clinical and functional characteristics, a significant influence on long-term results was shown by the EuroSCORE II (OR 1,69 (1,26-2,27), p=0,001). The highest sensitivity and specificity in relation to long-term mortality risk after coronary artery bypass grafting was shown by resting P_etCO₂ value equal to 31 mm Hg (area under the ROC curve 0,74 (0,64-0,86), p<0,001).

Conclusion. The resting P_etCO₂ level below 31 mm Hg in patients with coronary artery disease showed a significant effect on the increased long-term mortality risk after cardiac surgery, which is important for patients with exercise intolerance.

The article discusses a rare clinical case of successful off-pump coronary artery bypass surgery in a patient with dextrocardia and situs inversus totalis (SIT). SIT is a rare condition in which the arrangement of the internal organs is a mirror image of normal anatomy.

In March 2015, a 62-year-old patient with advanced heart failure underwent a failed radiofrequency ablation, followed by paresis of muscles in the anterior compartment of the leg. After rehabilitation, partial recovery of the paresis was achieved. Orthotopic heart transplantation was performed 9 months after ablation at the at the Institute of Cardiology, followed by a bilateral paresis of muscles in the anterior leg compartment. Rehabilitation was implemented. The possible cause of paresis is most likely to be due to food shortages, mainly related to a folic acid deficiency.

We present a case report of successful transcatheter implantation of a Russian-made cardiac valve prosthesis in a patient with dysfunction of biological mitral valve prosthesis (valve-in-valve). A patient aged 78 years with a high surgical risk and severe heart failure due to mitral valve bioprosthesis dysfunction is described. Fluoroscopyand transesophageal echocardiography-guided transapical implantation of a MedLab-CT prosthesis (23 mm) was made. When a heart rate of 180 beats per minute, a stent prosthesis was implanted. Transcatheter implant valve functioned properly after surgery. The patient was discharged in satisfactory condition.

The review presents current data transseptal transcatheter mitral valve replacement, which is becoming an alternative method of managing mitral valve disease. Despite the fact that the transapical transcatheter approach is technically simpler, the transseptal method is less invasive. It has confirmed effectiveness and is predicted to be the most promising. The review describes the relevance, indications, methodology for selecting the required endoprosthesis, stages of procedure, complications, and the postoperative follow-up of patients. The results of publications on transseptal transcatheter mitral valve replacement are analyzed. A case report is given.

The feasibility of dual antiplatelet therapy as early as possible in patients with ST-segment elevation acute coronary syndrome, where percutaneous coronary intervention is recommended, has been proven: it improves treatment outcomes by reducing the risk of adverse ischemic events, including stent thrombosis and myocardial infarction.
This article provides a detailed analysis of the evidence data and current recommendations on the validity and timing of dual antiplatelet therapy for acute coronary syndrome. The emphasis is made on the controversy regarding the early dual antiplatelet therapy in non-ST-segment elevation acute coronary syndrome. The rationale for using dual antiplatelet therapy only after coronary angiography and determining the revascularization strategy is described, which should increase the accessibility of coronary artery bypass graft surgery for patients.