In this article we discuss the results of surgical treatment in patients with different acquired heart diseases. Procedures ranged from valve reconstruction, coronary artery revascularization, surgical repair or graft repair of the thoracic aorta to hybrid surgery in patients with combined acquired heart valve diseases and coronary artery diseases. The implementation of biological grafts for aortic repair in 147 cases was successfully performed with low in-hospital mortality (9.8%). Hybrid procedures in patients older than 70 years allowed reducing hospital mortality rate in 3 times in comparison with the standard surgery: 4% vs. 12%, respectively. We developed and introduced into clinical practice the original protocol for patients with aortal valve disease and low left ventricular ejection fraction (mean – 24.3%). Due to this protocol 46 procedures were performed, in-hospital mortality was 4.4%. Cardiac surgery in patients on dialysis is one of the priorities in our practice. Our experience demonstrates that short waiting time of kidney transplantation after heart valve replacement improves long-term outcomes.

The study has shown that early diagnosis of the type and degree of immune disturbances in preparation for the operation and the fi rst signs of multiorgan failure and septic complications in the postoperative period in cardiac surgery patients were the rationale for the earlier substitution immunocorrection by immunomodulators of cytokine nature and intravenous immunoglobulin. It allowed increasing the ef fi ciency of the treatment of postoperative complications and lower mortality after operations with arti fi cial and assist circulation.

Patients with dissecting aortic aneurysm and associated acute aortic insuf fi ciency form a group of seriously ill patients with signi fi cant cardiac failure, generally involving other organs and systems. It justi fi es an attempt to reduce a surgical risk, by using more sparing procedures, including supracoronary replacement of the ascending aorta with its root reconstruction. The latter has been performed in 27 patients (mean 54,5 ± 2,1 years) with dissecting aortic aneurysm and aortic valvular insuf fi ciency in 1996 to 2009. The major etiological factor was atherosclerosis (88%)/ Seventeen (63%), 6 (22,2%) and 4 (16%) had types I, IIA and II dissection, respectively. Overall hospital mortality was 11%. In late period, progressive aneurysm dissection needed reinterventions in 2 cases. The competence of the reconstructed aortic valve was satisfactory both just after surgery and throughout the follow-up. Indications for this option of chronic correction, surgical techniques, and immediate and long-term results are outlined.

The authors present the analysis of their twelve-year experience in staged treatment of patients with combined pathology using coronary balloon angioplasty (CBA). CBA was performed in 83 patients (mean age 61.7 +/- 9.0 years) prior to heart valve replacement. Mean functional class according to New York Heart Association (NYHA) was 3.3 +/- 0.5. Thirty-one (37.3%) patients displayed signs of circulatory decompensation. Nine (10.8%) patients had had myocardial infarction. Thirteen (15.6%) patients had been operated on for valvular heart disease. The authors present their own method of staged treatment of combined pathology, describe and substantiate a regimen of therapy with desaggregants, the timing of the second stage of treatment, and post-operative therapy with desaggregants. In-hospital lethality was 8.4%, which was lower than the lethality of combined surgery (14.5%). Actual three-year survival rate was totally comparable to that of patients who had undergone a combined surgery (87.8% and 88%, respectively). The method of two-staged treatment of patients with combined (valvular plus coronary) pathology allows for a significant improvement in their surgical treatment, and deserves further study and clinical application.

The article analyses 30 operations for prosthetics of the mitral, aortic, and tricuspid valves in patients with trivalve rheumatic heart disease. Twenty-nine patients had a marked organic tricuspid valvular disease. Various models of prostheses (ball, semispherical, biological, disk) were used for replacement of the valves. Techniques which allowed the subvalvular structures of the tricuspid valve to be preserved partly or completely were applied in 18 patients. The hospital mortality was 16.7%, long-term mortality 4%. Improvement by two functional classes and more occurred in 86% of patients. It is concluded that surgeons are no longer compelled to resort to prosthetics of the tricuspid valve, which has now become an alternative operation, particularly in the category of extremely grave patients with organic affection of 3 valves when the prognosis of the result is needed in view of the patient's severe condition. The techniques for preserving the valvular apparatus provides optimum conditions for functioning of the right ventricle in replacement of the tricuspid valve.

The article deals with the immediate and late-term results of surgical management of aneurysm of the ascending aorta with aortic incompetence in 33 patients, on whom 34 operations were conducted. The etiology, diagnosis of the disease, and the main moments of the surgical techniques are discussed. For the solution of surgical problems, setting apart patients with dyshistogenetic predisposition is suggested. Among the instrumental methods of examination preference was given to radiocontrast aortography and magneto-resonance tomography. The last named is preferable because it is noninvasive, highly informative, and specific. The choice of the method was determined by the existence of stratification and the level of the orifices of the coronary arteries above the fibrous ring. The conduit was wrapped in the remnants of the aneurysmatic sac in all cases; the approach to the formation of the communication between the last named and the right atrium was differentiated. The central moment of the reconstruction is the formation of the distal anastomosis of the conduit with the aorta in stratification. In the late-term postoperative periods particular attention was paid to patients with dyshistogenetic predisposition because of the possible spreading of stratification to the distal parts of the aorta.

The results of retrograde cardioplegia through the right atrium in 50 patients are analysed. The uniform cooling of the myocardium, frequent restoration of the sinus rhythm, and the low hospital mortality rate are evidence of the high efficacy of this method of myocardial protection. Electronmicroscopy showed marked intactness of the myocardial ultrastructure and moderately manifested and reparable reperfusion changes. It is concluded that the method must be employed in coronary disease, combination of ischemic heart disease with heart valvular disease, as well as in mild forms of aortic insufficiency which cannot be corrected.

Functional and structural safety of the myocardium following 6-hour preservation at 4-6 degrees C in ion-balanced cardioplegic solution alone or in combination with pharmacological corrective was evaluated in rats. Langendorff and Neely model of isolated heart perfusion was used. The addition of creatine phosphate in a conservation of 10 mM/l to the solution or donor pretreatment with 70 mg/kg vitamin E was found to potentiate the protective properties of the solution under deep hypothermia. The combined use of the agents proved to warrant the initial intact structural and functional status of the rat myocardium.

The article analyses the first clinical experience in orthotopic allotransplantation of the heart at the Scientific Research Institute of Transplantology and Artificial Organs, USSR Ministry of Health, in the period from October, 1986 to July, 1989 (26 transplantations of the heart and one two-stage transplantation of the heart with the use of "Poisk-10M" artificial heart for 3.5 days in the first stage). Eleven patients are alive. Follow-up periods: maximum over 2.5 years, minimum 3 months. Sixteen patients died in different periods (up to 12 months). Three-component therapy (cyclosporine A, methylprednisolone, azathioprine) was applied for immunosuppression. The authors analyse the problems of the selection of potential recipients (indications and contraindications) and donor, the optimum surgical techniques, complications of immunosuppressive therapy, and infectious complications. The first clinical experience in two-stage transplantation of the heart is analysed. The first experience in transplantation of the heart in patients allows the conclusion that the use of this method for the management of the terminal stage of congestive cardiac insufficiency is a reality.

Ultrastructural changes in normal and hypertrophied dog hearts under conditions of total ischemia were studied by electron microscope method. In the control group sings of irreversible damage appeared in 90 min, in the presence of phosphocreatine, 10 mM, these changes became apparent in 120 min. In the hypertrophied hearts signs of the irreversible damages became evident in 60 and 90 min in the absence and presence of phosphocreatine, respectively. Ability of phosphocreatine to protect both normal and hypertrophied myocardium allows to use it safely.

The article deals with the clinical evaluation of the results of mitral valve prosthetics with preservation of the subvalvular structures in 40 patients and comparative evaluation of the hemodynamic indices after prosthetics with preservation of the subvalvular structures of the posterior cusp and after routine mitral valve prosthetics. The authors show good clinical results in patients after valvar-preserving prosthetics of the mitral valve and essential improvement of left-ventricular contractile activity after such an operation. Comparative analysis showed that the total ejection fraction increased by 10.8 +/- 4.5% in the main group and reduced by 11.4 +/- 2.6% (p less than 0.01) in the control group. Left-ventricular end diastolic pressure did not change in the main group but increased significantly (p less than 0.05) in the control group. A conclusion is drawn that preservation of the subvalvular structures in mitral valve prosthetics is expedient even in patients with an initially grave condition because the method makes it possible to normalize intracardiac hemodynamics more rapidly in the postoperative period and essentially improve the contractility of the left ventricle.

The article deals with the first experience in the USSR in using the method of mitral valve prosthesis with complete or partial preservation of the subvalvular apparatus. The operation was performed in 10 patients with mitral insufficiency or combined mitral valvular disease of various etiology. The advantages of employing during operation by this method mechanical prostheses with an obturator element which changes its position are pointed out. Only one patient needed inotropic support in the postoperative period. There were neither complications nor fatal outcomes.

Long-term results of aortic-valve ball prosthesis implantation in 184 patients, followed up for about 15 years, are presented. The performance of Soviet-made ball prosthesis in the aortic position has been shown to be fairly satisfactory for a long time. Prostheses of this design are also highly wear-resistant and show satisfactory hydrodynamic properties.