The aim of this publication is to evaluate the efficacy and safety of transapical septal myectomy for surgical correction of residual midventricular obstruction of the left ventricular outflow tract in a patient with hypertrophic cardiomyopathy in 2 years after alcohol septal ablation (ASA). Transapical septal myectomy, myocardial revascularization and left ventriculoplasty were performed under cardiopulmonary bypass and cardioplegia. Postoperatively, positive dynamics were noted with complete regression of chronic heart failure symptoms. Early postoperative period was uneventful. A follow-up echocardiography demonstrated normalization of intracardiac hemodynamics with elimination of pressure gradient and improvement of left ventricular diastolic function. If transaortic access is impossible due to distal hypertrophy or post-ASA scarring, transapical access to the apical and middle segments of the interventricular septum is essential.
Objective. To evaluate long-term survival, physical activity, hemodynamic parameters on aortic prosthesis and cardiac remodeling after surgical treatment of severe aortic stenosis. Material and methods. In 2019, we retrospectively analyzed the results of 100 consecutive surgeries in patients with critical aortic stenosis. Appropriate surgical intervention, anesthesia, perfusion and intensive care reduced in-hospital mortality and morbidity in these patients. Ninety-eight patients were discharged. Results. The follow-up period was 7.8 (range 6.3—10.0) years. In long-term period, 6 patients died, and 10-year Kaplan-Meier survival rate was 94%. There were no redo surgeries. Dysfunction of aortic prosthesis was observed in one patient due to pannus. Twenty-five (29%) patients were assigned to functional class I, 59 (69%) — class II, and only 2 (2%) patients were assigned to class III. According to transthoracic echocardiography, maximum and mean pressure gradients were 30.5±14.1 and 16.6±9.6 mm Hg, respectively. Regression of myocardial mass and myocardial mass index was 22% and 23% compared to early postoperative data, respectively. Conclusion. In patients with severe aortic stenosis and extremely unfavorable clinical prognosis, surgical treatment remains the main method. Normalization of intracardiac hemodynamics leads to significant reverse cardiac remodeling and improves QoL and life expectancy.
Objective. To evaluate the effects of sulodexide (Vessel Due F), endovenous laser ablation (EVLA), and their combination on the dynamics of endothelial dysfunction and venous-specific inflammatory biomarkers in patients with chronic venous disease (CVD) of the lower extremities classified as CEAP C4—C6. Materials and Methods. Ninety-three patients with CVD (CEAP classes C4—C6) were enrolled in the study. Patients were allocated into four groups: (1) compression therapy; (2) EVLA; (3) sulodexide (Vessel Due F) 250 LSU twice daily for 2 months; and (4) EVLA followed by sulodexide at the same dosage. Serum levels of E-selectin, MCP-1, VEGF, MMP-2, and MMP-9 were measured using quantitative enzyme-linked immunosorbent assay at baseline (V0), 2 months (V2), and 12 months (V3). Results. In the compression group, a moderate reduction in E-selectin was observed at 2 months (60.7±2.8 → 56.6±2.5; p<0.01), with no significant difference at 12 months (60.5±2.7; p=0.84). MCP-1, MMP-2, VEGF, and MMP-9 showed no statistically significant changes (p>0.05). In the EVLA group, a marked early decrease in E-selectin (66.2±3.1 → 40.8±2.9; p<0.001) and MCP-1 (231.9±9.8 → 146.3±8.4; p<0.001) was observed, with partial return toward baseline values at 12 months. No significant changes were detected for MMP-2, VEGF, or MMP-9 (p>0.05). In the sulodexide group, MCP-1 (205.4±8.7 → 134.6±7.2; p<0.001) and MMP-2 (421.7±14.8 → 249.0±13.1; p<0.001) significantly decreased at 2 months, with values approaching baseline at 12 months (MCP-1 205.8±8.1; p=0.96; MMP-2 407.2±15.0; p=0.09). MMP-9 significantly decreased both at 2 months (69.2±3.4 → 58.9±3.1; p<0.001) and 12 months (63.8±3.2; p<0.001). E-selectin and VEGF did not change significantly (p>0.05). In the EVLA+sulodexide group, E-selectin significantly decreased at 2 months (67.4±3.5 → 55.8±3.0; p<0.001) and remained reduced at 12 months (55.9±3.1; p<0.001). MCP-1 decreased at 2 months (284.3±11.2 → 203.4±9.6; p<0.001) and remained significantly lower than baseline at 12 months (235.1±10.4; p=0.03). MMP-2 significantly decreased at V2 (529.3±18.6 → 263.8±14.9; p<0.001) with a trend toward persistence at V3 (489.3±17.4; p=0.07). MMP-9 significantly decreased at both time points (74.8±3.9 → 64.8±3.4; p<0.001; and 69.8±3.6; p<0.001). VEGF did not show significant changes at any follow-up time point (p>0.05). Conclusion. Vessel Due F was associated with significant reductions in MCP-1 and matrix metalloproteinases, with the most sustained decreases in MCP-1, E-selectin, MMP-2, and MMP-9 observed in the combined treatment group (EVLA+sulodexide). In patients with CVD classified as CEAP C4—C6, compression therapy demonstrated minimal impact on systemic inflammatory and remodeling biomarkers. EVLA provided a pronounced early reduction in endothelial activation (E-selectin) and inflammatory activity (MCP-1), although partial attenuation of this effect was observed at long-term follow-up. Serum VEGF levels did not change significantly in this cohort.
The purpose of this review was to describe current data on evidenced based strategy for blood transfusion in adult cardiac surgery. Searching for publications was conducted in May 2025 using the PubMed database, TRANSFUSION EVIDENCE LIBRARY, and eLibrary.RU for the last five years. The following keywords were used: patient blood management in cardiac surgery, transfusion-associated immunomodulation, restrictive and liberal transfusion strategy, blood transfusion. Duplicates were excluded manually. Additional searching was performed in references. The first stage of selection after screening of abstracts took into account clinical trials, meta-analyses, randomized controlled trials, reviews and regular reviews without language restrictions. At the second stage, assessment of full-text articles was carried out with analysis of models for predicting the risk of perioperative transfusion, effectiveness and safety of restrictive or liberal transfusion strategies in cardiac surgery, modern technologies for improving the quality of donated blood components. Final analysis included 48 publications. Evidence based blood transfusion characterizes the effectiveness of blood management system as an integral indicator of quality of care in cardiac surgery. Each transfusion should be reasonable. This entails a reasonable assessment of likelihood, appropriateness of appointment, as well as use of highly effective and safe components of allogeneic blood for a particular patient.
Objective. To compare clinical and hemodynamic outcomes of open transaortic implantation of balloon-expandable prosthesis with PTFE leaflets and Ozaki procedure (AV-Neo). Material and methods. A prospective study included 101 patients who underwent open transaortic aortic valve replacement with balloon-expandable prosthesis with polytetrafluoroethylene leaflets and 277 patients who underwent AV-Neo procedure. The primary endpoint was in-hospital mortality. Results. Significant differences were found in the incidence of blood transfusions (p=0.02), acute kidney injury (AKI) (p=0.018), and total number of complications (in-hospital mortality+myocardial infarction+AKI) (p=0.006). Significant differences were also found in characteristics of surgical interventions: duration of cardiopulmonary bypass (CPB) (p=0.02), aortic cross-clamping (p=0.002), and surgery (p=0.03). Conclusion. Transaortic implantation of balloon-expandable graft has a significant advantage over Ozaki procedure. Comparison of perioperative parameters (time of surgery, CPB and aortic cross-clamping) revealed significant differences in favor of transaortic implantation (p=0.03; 0.002; 0.03), as well as lower risk of in-hospital mortality.
