For many decades, heart transplantation has been the “gold standard” for terminal chronic heart failure resistant to medical therapy treatment. However, there is a significant number of patients with contraindications to orthotopic heart transplantation. The only effective treatment method for these patients may be the implantation of long-term mechanical circulatory support systems. This article provides information for practicing physicians on the evolution of long-term mechanical circulatory support systems, the main criteria for selecting patients for implantation, and the specifics of their subsequent outpatient monitoring.

Heart transplantation (HT) with extremely prolonged (>6 hours) graft ischemia is associated with severe cardiac graft dysfunction. The high efficiency of prophylactic (preoperative initiation) veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to prevent severe hemodynamic disorders during cardiac surgery has been demonstrated. Objective: to determine the effect of prophylactic VA-ECMO on the perioperative period in HT with an expected graft ischemia >6 hours. Materials and methods. Thirty-eight recipients (33 (86.8%) males and 5 (13.2%) females), age 11–66 (44.7 ± 12.0) years (median 48.0 years) were examined. Pre-transplant mechanical circulatory support (MCS) using peripheral VA-ECMO was applied in 15 (39.5%) recipients, in 6 of whom by prophylactic technique. The recipients (n = 38) were divided into 3 groups: 1) «no pre-HT VA-ECMO» (n = 23); 2) «pre-HT VA-ECMO» (n = 9) – pre-transplant VA-ECMO as a bridge to HT; 3) «prophylactic VA-ECMO» (n = 6). Results. In «prophylactic VA-ECMO» group, extracorporeal circulation (ECC) (94.0 [85.5; 102.8] min) and reperfusion time (20.0 [18.3; 27.6] min) were shorter (p < 0.05) compared to «no pre-HT VA-ECMO» (161.0 [122; 191.5] and 60.0 [55.3; 70.5] min) and «pre-HT VA-ECMO» (127.0 [117; 150.3] and 35.0 [27.8; 48.8] min) groups. The vasoactive-inotropic score was lower (p < 0.05) in «pre-HT VA-ECMO» and «prophylactic VAECMO» groups compared to recipients in «no pre-HT VA-ECMO» group, 12.1 [11.2; 14.0] and 12.5 [11.7; 14.8] vs. 16.0 [15.0; 18.5], respectively. The groups did not differ in terms of incidence of severe primary dysfunction. The «pre-HT VA-ECMO» and «prophylactic VA-ECMO» groups were characterized by shorter duration of mechanical ventilation (MV) compared with «no pre-HT VA-ECMO» group (11.7 [10.0; 16.5] and 12.7 [11.3; 18.4], respectively, vs. 14.5 [13.0; 19.3]). The «no pre-HT VA-ECMO» and «prophylactic VA-ECMO» groups did not differ in the need for postoperative MST, 21.7% and 16.7%, respectively. The groups did not differ in terms of length of stay in the intensive care unit (ICU) and in-hospital mortality – 0% («prophylactic VA-ECMO») and 8.7% («no pre-HT VA-ECMO») and 11.1% («pre-HT VA-ECMO»), respectively. Conclusion. Prophylactic VA-ECMO in HT with extremely prolonged cardiac graft ischemia reduces ECC duration, reperfusion period, postoperative mechanical ventilation period, and the need for inotropic therapy.

Postoperative pericardial effusion (PPE) represents a very common complication in cardiac surgery. Accumulation of a significant amount of free fluid in the pericardial cavity is a multifactorial process. Identifying the cause is not always possible. This complication occurs more frequently in patients after heart transplantation than in patients who underwent reconstructive cardiac surgery. Having hemodynamically significant effusion requires surgical evacuation of fluid from the pericardial cavity. This can affect the postoperative period and increase the length of stay at the hospital. For this reason, developing and ensuring widespread use of methods for prevention of this complication are urgent and relevant tasks.

Heart transplantation (HT) is considered the optimal therapy for end-stage heart failure. In recent years, the number of operations performed has been growing, which has led to a rise in the number of heart transplant recipients requiring outpatient follow-up. Objective: to evaluate the effectiveness of the model of dual personalized follow-up of heart transplant recipients in the consultative and diagnostic department of Shumakov National Medical Research Center of Transplantology and Artificial Organs. Materials and methods . The study included 1,436 patients under outpatient follow-up from January 2008 to December 2022. Recipient data, results of laboratory and instrumental examination methods, nature and frequency of complications at different follow-up periods were analyzed. Results : At the time of discharge from the hospital, 98.7% of patients had received triple-drug immunosuppressive therapy; 6 months later, methylprednisolone was discontinued in 72.2% of recipients. Mean tacrolimus level during the 1-year follow-up was 8.7 ± 2.7 ng/mL; in the period from 1 to 5 years of followup, the mean was 5.1 ± 2.4 ng/mL. At year 1 after transplantation, 23 (1.7%) recipients had been converted to everolimus; by the end of year 5 of follow-up, the number had increased to 8.6%. The most frequently detected complications during outpatient follow-up were: hypertension (48.65%), post-transplant diabetes mellitus (7.24%), nephropathy (35.97%), and malignant neoplasms (4.2%). Recipient survival, excluding in-hospital mortality, was 96.5%; and 88.0% at year 1 and 5 of follow-up, respectively. Conclusion : The dual personalized approach model for outpatient follow-up and treatment of heart transplant recipients will improve recipient survival and quality of life in the long-term post-HT period.

Amidst the shortage in viable donor hearts, the use of hearts from expanded criteria donors, including those with prolonged ischemic time, remains one of the real ways to increase the donor pool and number of heart transplantations (HTx) performed. The study included 38 recipients (33 (86.8%) men and 5 (13.2%) women) aged 11 to 66 (44.7 ± 12.0 years, median 48.0 years), who underwent primary (n = 37; 97.4%) or repeat (n = 1; 2.6%) HTx (retransplantation). Donor hearts (n = 38) with ischemic time ranged from 362 (6 hours 2 minutes) to 571 (9 hours 31 minutes) or 407 ± 52 minutes (median 400 minutes). In 33 (86.8%) of 38 recipients, the early posttransplant period was characterized by satisfactory initial graft function. Five (13.1%) recipients developed severe primary graft dysfunction, requiring post-transplant venoarterial extracorporeal membrane oxygenation (VA-ECMO) (n = 4; 10.5%) or prolongation of pre-transplant VA-ECMO within 8 days of HTx (n = 1; 2.6%). In-hospital mortality was 7.9% (n = 3). Thirty-five (92.1%) of 38 recipients were discharged from the hospital. Three recipients died in the post-hospital period at day 734, 944, and 2146 after HTx. Thirty-two (84.2%) of the 38 recipients remained alive at the end of the study. Our own experience shows that HTx from donors with prolonged ischemic time could be effective.

Primary cardiac sarcoma is a rapidly progressive, aggressive cardiac tumor that is very rare in the general population. Conservative treatment for this tumor is not very effective. The only effective treatment is radical surgical removal of the malignancy. However, if sarcoma removal cannot be performed, heart transplantation (HT) becomes the only treatment option. The median survival of heart recipients with preoperative cardiac sarcoma is 8.5 months. Globally, such operations are performed in a small number of cases. This paper presents the first experience of HT for a patient with primary cardiac sarcoma in the Russian Federation.

Heart transplantation continues to be the gold standard treatment for end-stage chronic heart failure. As with any cardiac surgery, heart transplantation is associated with postoperative complications. One of the most common complications is postoperative pericardial effusion. Heart recipients have a greater risk of developing pericardial effusion than patients after cardiac surgery on their own heart, due to surgical and immunological features. Severe pericardial effusions negatively affect the postoperative period and may be the cause of life-threatening conditions. Identification of risk factors, prevention, early diagnosis and treatment of this disease can significantly reduce the risks of adverse events in this group of patients. The purpose of this literature review is to analyze the development and course of pericardial effusion in heart recipients in world practice.

The relevance of the work is due to the increase in the number of hospital infections associated with antibiotic-resistant gram-negative pathogens on a global scale. For medical institutions, both from a clinical and economic point of view, the catastrophic situation is that the multidrug-resistant pathogens increasing leads to limited possible treatment options. Analysis of published scientific articles shows that today the strict epidemiological surveillance and the study of the pathogen resistance profile in each medical facility is an effective tool for controlling the growth of multidrug-resistant microorganisms, thus reducing morbidity and mortality.

Deep wound infection of the anterior chest wall tissues in patients after transsternal cardiac surgery despite intensive developments in surgical techniques and improvement of antibacterial chemotherapy, remains a genuine concern worldwide [1]. The incidence of this complication in the general population ranges from 0.5 to 4% [2, 3]. Despite developed approaches in the treatment of cardiac surgery patients, the treatment of deep sternal wound infection and surrounding tissues following a heart transplantation still remains a rather serious and pressing challenge. This paper presents a clinical observation of a heart transplant recipient, complicated by deep postoperative wound infection. The strategy of staged surgical treatment of sternal osteomyelitis consisted of surgical wound debridement, local wound debridement with vacuum dressings, and reconstructive surgery at the final stage (sternal reosteosynthesis, plasty of the anterior chest wall wound with displaced skin and fascial flaps).

Objectives . Assessment of the probability of simultaneous infection with two or more pathogens of clinical substrates of transplant patients. Materials and methods . The retrospective analysis of bacteriological studies of clinical isolates among transplant patients operated from January to July 2020 is performed. This study included 93 patients. Results and discussion . Тhe risk of bacterial complications in the postoperative period is associated with representatives of the gram-negative pathogens Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. All the studied strains were resistant to antibiotics. A significant number of coinfections with two or three pathogens cases were recorded in the current period – 20.4 %. For the two and more pathogens’ colonization the highest mortality rate is shown, 42.1 %. Conclusions . Modern epidemiological feature is the Acinetobacter baumannii predominance among the microflora of transplant patients. It has been shown that the incidence of co-colonization by ≥ 2 different gram-negative pathogens is significant and increases the mortality rate.

Artificial OrgansVolume 45, Issue 2 p. 111-114 INVITED EDITORIAL Artificial heart in Russia: Past, present, and future Sergey V. Gautier, V.I. Shumakov National Medical Research Center of Transplantation and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation I. M. Sechenov First Moscow State Medical University, Moscow, Russian FederationSearch for more papers by this authorAlex O. Shevchenko, V.I. Shumakov National Medical Research Center of Transplantation and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation I. M. Sechenov First Moscow State Medical University, Moscow, Russian FederationSearch for more papers by this authorGeorgiy P. Itkin, V.I. Shumakov National Medical Research Center of Transplantation and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian FederationSearch for more papers by this authorVyacheslav M. Zakharevich, V.I. Shumakov National Medical Research Center of Transplantation and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation I. M. Sechenov First Moscow State Medical University, Moscow, Russian FederationSearch for more papers by this authorVitaly N. Poptsov, V.I. Shumakov National Medical Research Center of Transplantation and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian FederationSearch for more papers by this authorAleksandr A. Drobyshev, V.I. Shumakov National Medical Research Center of Transplantation and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian FederationSearch for more papers by this authorDmitry V. Telyshev, Corresponding Author telyshev@bms.zone orcid.org/0000-0002-4221-9882 I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation National Research University of Electronic Technology MIET, Zelenograd, Russia Correspondence Dmitry V. Telyshev, I. M. Sechenov First Moscow State Medical University, 119991, Moscow, Russian Federation. Email: telyshev@bms.zoneSearch for more papers by this author Sergey V. Gautier, V.I. Shumakov National Medical Research Center of Transplantation and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation I. M. Sechenov First Moscow State Medical University, Moscow, Russian FederationSearch for more papers by this authorAlex O. Shevchenko, V.I. Shumakov National Medical Research Center of Transplantation and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation I. M. Sechenov First Moscow State Medical University, Moscow, Russian FederationSearch for more papers by this authorGeorgiy P. Itkin, V.I. Shumakov National Medical Research Center of Transplantation and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian FederationSearch for more papers by this authorVyacheslav M. Zakharevich, V.I. Shumakov National Medical Research Center of Transplantation and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation I. M. Sechenov First Moscow State Medical University, Moscow, Russian FederationSearch for more papers by this authorVitaly N. Poptsov, V.I. Shumakov National Medical Research Center of Transplantation and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian FederationSearch for more papers by this authorAleksandr A. Drobyshev, V.I. Shumakov National Medical Research Center of Transplantation and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russian FederationSearch for more papers by this authorDmitry V. Telyshev, Corresponding Author telyshev@bms.zone orcid.org/0000-0002-4221-9882 I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation National Research University of Electronic Technology MIET, Zelenograd, Russia Correspondence Dmitry V. Telyshev, I. M. Sechenov First Moscow State Medical University, 119991, Moscow, Russian Federation. Email: telyshev@bms.zoneSearch for more papers by this author First published: 03 December 2020 https://doi.org/10.1111/aor.13860Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Citing Literature Volume45, Issue2February 2021Pages 111-114 RelatedInformation

We herein present our initial report from «ROKKOR-recipient», a national multicenter observational study. The prevalence, risk factors, clinical manifestations and outcomes of the novel coronavirus disease 2019 (COVID-19) in solid organ transplant recipients receiving immunosuppressive therapy were investigated. The study enrolled 251 COVID-19 patients (220 kidney recipients, 7 liver recipients, 1 liver-kidney recipient, and 23 heart recipients). The subjects came from 20 regions in Russia. The symptoms, clinical presentation, imaging and lab test results, therapy and outcomes of COVID-19 were described. It was established that solid organ transplant recipients with COVID-19 have a higher risk of developing adverse events. Predictors of adverse events include associated cardiovascular diseases, pulmonary diseases, diabetes, and kidney failure. Symptoms of the disease include dyspnea, rash and catarrhal signs, as well as initial low blood oxygen saturation (SpO2 <92%), leukocytosis (white blood cell count >10 × 109/L), elevated creatinine levels (>130 μmol/L) and a marked decrease in glomerular filtration rate, requiring hemodialysis. Performing organ transplant surgery in COVID-19 does not increase the risk of adverse events but could save the lives of waitlisted terminally ill patients.

The problem of global expansion of multidrug-resistant nosocomial infections pathogens is under special attention at the moment. Antibiotic resistance increasing give us the limited treatment options. This problem is particularly acute for transplant clinics, because of patients need lifelong immunosuppressive therapy. From the one hand this ensures stable allograft functioning, but from the other increases the risk of severe infectious complications in the postoperative period. The purpose of this article is analysis carbapenem resistance dynamics of Klebsiella spp., Acinetobacter spp., Pseudomonas spp. and Staphylococcus spp. isolated from the blood of recipients of donor organs from 2009 to 2019 in the Shumakov National Medical Research Center of Transplantology and Artificial Organs. A significant annual decrease of carbapenem-sensitive strains of Klebsiella spp. and Acinetobacter spp. are shown. The study of a distinctive pathogen resistance profile specific to each institution can help one in selecting an adequate antimicrobial strategy and is an effective predictive tool for controlling the growth of multidrug-resistant microorganisms.

Abstract. Despite improvements in immunosuppressive therapy, antibody-mediated rejection (AMR) remains one of the most important risk factors for poor prognosis for survival of recipients, cardiac graft dysfunction, and cardiac allograft vasculopathy (CAV) after heart transplantation.Aim: to assess the incidence of case of antibodymediated rejection and cardiac allograft vasculopathy depending on the gender of the patients who underwent heart transplantation in our Center from January 2010 to December 2017.Methods. The median observation was 42 months. The study comprised 606 patients (84 [14%] women) who underwent heart transplantation in 2010 to 2017. We analyzed all the episodes of antibody-mediated rejection, which were diagnosed by the results of endomyocardial biopsies.Results. We comparing the total incidence of antibody-mediated rejection and we are found significant differences among men and women who underwent heart transplantation (p < 0.05), the survival rate during the first year after heart transplantation was 95 and 92%, respectively. The incidence of antibody-consistent rejection was significantly higher among women who had a history of pregnancy and/or use of mechanical circulatory support systems (UNOS status 1A) in the pre-transplantation history (p < 0.05), and we also found significant differences in the incidence of cardiac allograft vasculopathy in women diagnosed with AMR (p < 0.05). The survival rate among women within a year after the diagnosis of AMR is 83% compared to 96% of the recipients free from AMR.Conclusions. Women are at higher risk for AMR after heart transplantation and it increases their risk for cardiac allograft vasculopathy. Females recipients may more frequent myocardial control biopsies and a personalized approach in prescribing immunosuppressive therapy. Women-recipients of transplanted heart should undergo These measures will help to identify in time the development of antibodymediated rejection and reduce the incidence of cardiac allograft vasculopathy after heart transplant.

The aim:to analyze the waiting list for heart transplantation from 2010 to 2017 and to characterize recipients with chronic heart failure III–IV NYHA Class.Methods.The study comprised 997 patients (139 [14%] females and 858 [86%] males) included in the waiting list for heart transplantation the period from January 2010 to December 2017. The average age of patients on the waiting list was 49.0 ± 12.0 (from 10 to 78 years). Before making a decision on inclusion in the waiting list, all patients underwent clinical and instrumental examination, including general clinical studies, echocardiography, measurement of central hemodynamic parameters using a Swan–Gans catheter, computer and/or magnetic resonance imaging of the chest, abdominal and brain.Results.Heart transplantation was performed on 728 patients (99 females – 13.6% and 629 males – 86.4%) including 18 children aged 12 to 17 years (14.18 ± 2.07 years). Mortality in the waiting list in 2010 was 16.1%, compared with 3.2% in 2017.