Secondary malignant cardiac tumors are extremely rare cases, however, since the expansive growth of the tumor quickly leads to the development of life-threatening conditions. There is still no unified treatment strategy for this type of myocardial damage, and the prognosis is unfavorable due to the progression of the disease. This clinical case represents the experience of surgical treatment of melanoma metastasis with involvement of the right atrium.

High mortality from cardiovascular diseases, due to the low regenerative potential of the myocardium, requires the search for new therapeutic approaches for the treatment of cardiac patients.Aim of the present work was to assess the regenerative potential of myocardial cells in cardiac surgery patients of middle and older age. Materials and methodsThe biopsy samples of the myocardial auricles were destroyed by enzyme technique.Confocal microscopy was performed on cells cultivated in the primary culture and on a suspension of fixed cells.In addition, histological and electron microscopic studies of myocardial biopsies were performed. ResultsRegenerative ability of cardiac cells was estimated by the presence of cardiac stem cells (CSCs), their progeny, transitory amplifying cells (TACs) inside the colonies, as well as by the presence of "cell-in-cell structures" (CICSs), which were found in each biopsy sample.In this study, in vitro experiments demonstrated the release of TACs from the vacuoles of non-encapsulated CICSs of the heart auricles of cardiac patients. ConclusionThe data obtained enable us to evaluate the level of cardiomyogenesis in each individual patient.Moreover, they open up prospects for the possible use of in vitro expanded autologous TACs as a cell product for the treatment of cardiovascular diseases.

Objective: to develop algorithm of prediction of troponin I elevation 3d day postoperatively depending on troponin I level on 1st after on-pump coronary artery bypass grafting using SAS Enterprise Guide6.1 software. Materials and methods Data collection was performed according to prospective non-randomized clinical trial AMIRI CABG in Pavlov First St. Petersburg State Medical University, Saint Petersburg, Russia between 2016-2019 years with 336 patients with indications to coronary artery bypass grafting. Algorithm was developed for on-pump group (n=128). There is database which include following information: troponin I level 1st and 3в days postoperatively. There was determined distribution of variables and linear regression was used for predicting model construction and its precision was estimated as well. Results. There was developed algorithm of prediction of myocardial damage after on-pump coronary artery bypass grafting with linear regression model using SAS Enterprise Guide6.1 software. Conclusion. Presented algorithm of linear regression allows to compare independent groups for nominal data.

Objective: to develop algorithm of presentation of baseline characteristics of patients which enrolled in prospective non-randomized clinical trial AMIRI CABG (ClinicalTrials.gov Identifier: NCT03050489). Materials and methods. Data collection was performed according to prospective non-randomized clinical trial AMIRI CABG in Pavlov First St. Petersburg State Medical University, Saint Petersburg, Russia between 2016-2019 years with 336 patients. Patients were allocated into three groups of treatment. There is database with clinical, laboratory and instrumental data. Comparison for nominal data (gender and incidence of myocardial infarction and stroke) were calculated with SAS Enterprise Guide 6.1 software with Chi-squared test and exact Fisher test. Baseline characteristics were presented in table. Results. There was developed algorithm of baseline characteristics presentation in APA-table. Conclusion. There was developed algorithm of baseline characteristics presentation SAS Enterprise Guide 6.1 could be useful for manuscript preparing for Russian and foreign journal.

In 2017, the European Society of Cardiology outlined the importance of the problem of diagnosing myocardial ischemia-reperfusion injury following coronary artery bypass grafting. Myocardial injury can be accompanied by a critical decline in the cardiac index and an increase in cardiac troponin I plasma levels. The prognostic value troponin I elevation after coronary artery bypass grafting is poorly understood. Objective : to determine the prognostic value of troponin I plasma levels in relation to a fall in the cardiac index after coronary artery bypass grafting (CABG). Task : To determine the probability the cardiac index falling below 2.2 for troponin I levels in the first hours, and on days 1, 2, 3, 4 after CABG. Materials and methods . The single-center, non-randomized prospective study, running from 2016 to 2019, included 336 patients admitted for elective surgical treatment of coronary artery disease. The CABG patients were divided into three observation groups: off-pump (n = 175), on-pump (n = 128), and pump-assisted (n = 33). Troponin I levels were measured in the first hours, and on days 1, 2, 3, 4 after surgery using the Pathfast Compact immunoassay analyzer. Cardiac index was measured by invasive method. Results . In patients with a cardiac index higher than 2.2, troponin I level did not exceed 0.5 ng/mL in the off-pump group, 6 ng/mL in the on-pump group, and 3.5 ng/mL in the pump-assisted group. Patients with cardiac index lower than 2.2 have comparable troponin I levels in all groups - 21 ng/mL. Troponin I thresholds on day 1 after surgery, which, when exceeded, was associated with the likelihood of the cardiac index falling below 2.2, was 3.78 ng/mL in the off-pump group, 9.67 ng/mL in the on-pump group and 17.06 ng/mL in the pump-assisted group. Conclusion . After off-pump CABG, clinically significant myocardial injury should be expected at lower troponin I levels (3.78 ng/mL) than after on-pump CABG (9.67 ng/mL) and pump-assisted CABG (14.7 ng/mL).

Objective:to develop algorithm of independent groups comparison for nominal data of prospective non-randomized clinical trial AMIRI CABG (ClinicalTrials.gov Identifier: NCT03050489) using SAS Enterprise Guide 6.1. Materials and methods.Data collection was performed according to prospective non-randomized clinical trial AMIRI CABG in Pavlov First St. Petersburg State Medical University, Saint Petersburg, Russia between 2016-2019years with 336 patients. Patients were allocated into three groups of treatment. There is database which include following information: gender, myocardial infarction, stroke and postoperative bleeding. Comparison for nominal data (gender and incidence of myocardial infarction, stroke and bleeding) were calculated with SAS Enterprise Guide6.1 software with Chi-squared test and exact Fisher test. Results.There was developed algorithm of two independent groups comparison for nominal data. Conclusion.Presented algorithm of data analysis allows to compare independent groups for nominal data.

Introduction. Despite resounding success in treatment of patients with coronary heart disease (CHD), researchers are yet unable to significantly reduce mortality in this disease. With this in mind, there are ongoing studies everywhere, which are aimed at investigating new techniques in order to boost the efficiency of existing standards. One of such promising techniques is cell/regenerative therapy with autologous bone marrow mononuclear cells (ABMMCs). However, even though ABMMCs have been studied for more than 10 years, there are no unambiguous data yet on several issues. Objective: to evaluate the outcome of ABMMC transplantation during coronary artery bypass grafting (CABG) surgery in combined treatment of CHD. Materials and methods. The data of 408 patients admitted to the clinic from 2013 to 2016 for planned surgical treatment of CHD were analyzed. The work included 117 people based on the design of the study. Patients were randomized in 3 groups: Group 0 (control group) – CABG surgery and intramyocardial injection of 0.9% NaCl solution, Group 1 – CABG surgery and intramyocardial injection of ABMMCs, Group 2 – CABG surgery, intramyocardial and intra-graft injection of ABMMCs. The dynamics was assessed 12 months later – functional class of angina pectoris and heart failure, echocardiography, speckle tracking (assessment of the degree of myocardial deformation), treadmill test, 6-minute walk test, daily ECG monitoring, quality of life questionnaires, coronary angiography. Qualitative indicators were calculated using the Pearson’s chi-squared test and Fisher criteria. Quantitative indicators were calculated using the Kruskal–Wallis and Wilcoxon tests. Factor analysis was used to identify certain severity factors and to study data homogeneity. Discriminant analysis was performed to investigate the leading characteristics that determine differentiation between the groups. For analysis of variance, taking into account various factors, the model of variance analysis for dependent samples – Repeated Measures ANOVA – was used. Results. In the observation groups, an improvement in both systolic and diastolic myocardial function was universally noted. A six-minute walk test showed statistically significant increase in Groups 1 and 2 compared with the control Group 0 – 315.06 ± 17.6 (433.54 ± 20.6), Group 1 – 319.8 ± 24.5 (524.4 ± 28.7), Group 2 – 329.9 ± 25.3 (452.7 ± 29.7) meters. A significant decrease in the functional class of exertional angina pectoris in Groups 1 and 2 was noted unlike in the control group. The percentage of functioning coronary shunts after a 12-month follow-up period was 87.6% in Group 0. In Groups 1 and 2, this ratio was 96.2% and 97.3%, respectively. Predictors of overall effectiveness were identified: smoking, initial diastolic myocardial dysfunction, left ventricular ejection fraction. Conclusion. In addition to surgical treatment of coronary heart disease, ABMMC transplantation can improve myocardial contractility, boost exercise tolerance, and increase the duration of the functioning of coronary shunts at the follow-up period of 12 months. The study showed the need for stage-by-stage analytical calculations with the aim of possible correction of further work.

Objective: to develop algorithm of assessment of prognostic value of biomarker (troponin I) for predicting death after coronary artery bypass grafting. Materials and methods. Data collection was performed according to prospective non-randomized clinical trial AMIRI CABG in Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia between 20162019 years with 336 patients. There is database with clinical, laboratory and instrumental data. Statistics were calculated with SAS Enterprise Guide 6.1 software. Prognostic capability of biomarker for death were evaluated with logistic regression. Spline of relation between death and biomarker level were plotted using coefficient of logistic regression and intercept. Upper reference limit was calculated with Youden index. Results. There was developed algorithm to assess prognostic value of biomarker and its usefulness for clinical application and to define upper reference limit of biomarker. This algorithm could be useful for physicians and researchers for data analysis. Conclusion. Presented algorithm of data analysis allows to assess prognostic value of novel biomarker and its clinical usefulness.

Objective: to develop algorithm of correlation analysis of prospective non-randomized clinical trial AMIRICABG (ClinicalTrials.gov Identifier: NCT03050489) data using SAS Enterprise Guide 6.1. Materials and methods. Data collection was performed according prospective non-randomized clinical trial AMIRICABG (ClinicalTrials.gov Identifier: NCT03050489) in Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia between 20162019 years with 336 patients. There is database with clinical, laboratory and instrumental data. Correlation analysis was performed with SAS Enterprise Guide 6.1. Results. There was developed algorithm of correlation analysis data of prospective non-randomized clinical trial AMIRICABG (ClinicalTrials.gov Identifier: NCT03050489). This algorithm could be useful for physicians and researchers for data analysis. Conclusion. Presented algorithm of correlation analysis could make easier and improve efficient data analysis with SAS Enterprise Guide 6.1.

Objective: to develop algorithm of multiple comparisons data of prospective non-randomized clinical trial AMIRI CABG (ClinicalTrials.gov Identifier: NCT03050489) using SAS Enterprise Guide 6.1. Materials and methods. Data collection was performed according prospective non-randomized clinical trial AMIRI CABG in Pavlov First St. Petersburg State Medical University, Saint Petersburg, Russia between 20162019 years with 336 patients. There is database with clinical, laboratory and instrumental data. Multiple comparisons test was performed with SAS Enterprise Guide 6.1. Results. There was developed algorithm of multiple comparisons data of prospective non-randomized clinical trial AMIRI CABG for independent group. This algorithm could be useful for physicians and researchers for data analysis. Conclusion. Presented algorithm of data analysis could make easier and improve efficient data analysis. SAS Enterprise Guide 6.1 allows fast and accurate process data

Introduction . Coronary artery bypass grafting is worldwide accepted method of treatment of ischemic heart disease. Nevertheless, intraoperative ischemic-reperfusion injury, especially when associated with graft dysfunction, could influence on surgical outcomes. There is no data about precise cut-off level of troponin I associated with graft failure after coronary artery bypass grafting. Aim – to evaluate relationship between troponin I elevation and probability of graft thrombosis. Materials and methods . During single-center non-randomized clinical trial involving 336 patients, admitted for elective coronary artery bypass grafting, role of troponin I level for surgical approach after coronary artery bypass grafting was evaluated in three groups: off-pump, n=181, on-pump, n=128 and pump-assisted (with cardiopulmonary bypass without aortic cross-clamping), n=27. Results . In patients with cardiac index >2.2, troponin I level exceeded the upper reference limit by almost 100 times: 0.5 ng/ml in off-pump group, 4.5 ng/ml in on-pump group. In patients with cardiac index <2.2, troponin I level was more than 2 times higher than in patients with cardiac index >2.2 and amounted to 1.6 ng/ml in off-pump group and 13 ng/ml in on-pump group. In patients with graft thrombosis, troponin I level was 1.6 ng/ml in off-pump group and 25.8 ng/ml in on-pump group. Conclusion . Troponin I level has an important role in choice of surgical approach after coronary artery bypass grafting. Intraoperative ultrasound examination of grafts with assessment of blood flow according to Doppler sonography and visualization of the stenotic area, if any, could be recommended for early diagnosis of graft failure and choice of surgical approach after coronary artery bypass grafting.

ЖУРНАЛ ИМЕНИ АКАДЕМИКА Б.В.ПЕТРОВСКОГО Том 8 ■ № 4 ■ 2020 Цель -определить тип коронарного шунтирования (КШ), ассоциированный с наименьшим ишемически-реперфузионным повреждением (ИРП) миокарда и воспалительным ответом.Задачи.Оценить степень ИРП, степень воспалительного ответа по уровню тропонина I (TnI), миелопероксидазы (MPO) и С-реактивного белка (СРБ) в плазме крови до и после разных типов операций КШ.Материал и методы.В рамках проспективного нерандомизированного одноцентрового исследования (уровень доказательности II) выполнена оценка ИРП миокарда и воспалительного ответа после КШ у пациентов, поступивших с 2016 по 2019 г. в ПСПбГМУ им.акад.И.П.Павлова для оперативного лечения ишемической болезни сердца (ИБС).ИРП миокарда и воспалительный ответ оценивали по уровням TnI (определяли до операции, после наложения коронарных анастомозов, а также на 1, 2, 3, 4, 5-7-е сутки после КШ), СРБ (определяли до операции на 1, 2, 3, 4, 5-7 и 8-12-е сутки после операции), MPO в плазме крови (определяли до и после наложения коронарных анастомозов) в 3 группах наблюдения.1-я группа -КШ без искусственного кровообращения (ИК) на работающем сердце (n=177), 2-я группа -КШ с ИК с пережатием аорты (n=128), 3-я группа -КШ с вспомогательным ИК без пережатия аорты (n=33).Результаты.Во 2-й и в 3-й группах повышение TnI на 1-е сутки происходит больше, чем в 1-й группе, затем во 2-й группе уровень TnI плавно снижается.В 1-й и в 3-й группах, наоборот, с 1-го дня уровень TnI хотя и меньше, чем в группе 2, его значение нарастает, достигая пика на 4-е сутки.Операции с ИК сопровождаются меньшим воспалительным ответом в период от 2 до 10 дней после операции, чем операции без ИК.Повышение уровня TnI ассоциировано с увеличением летальности после КШ (площадь под ROC-кривой AUC=0,8), прогностическое значение MPO в отношении летальных исходов (AUC=0,7) требует дальнейших исследований.Заключение.Операции КШ с ИК с пережатием аорты ассоциированы с меньшей степенью проявления ИРП миокарда и меньшим воспалительным ответом.Финансирование.Научно-исследовательская работа: «Оценка регенеративного потенциала пациента при операциях на сердце (2018)».

Introduction . Despite resounding success in treatment of patients with coronary heart disease (CHD), researchers are yet unable to significantly reduce mortality in this disease. With this in mind, there are ongoing studies everywhere, which are aimed at investigating new techniques in order to boost the efficiency of existing standards. One of such promising techniques is cell/regenerative therapy with autologous bone marrow mononuclear cells (ABMMCs). However, even though ABMMCs have been studied for more than 10 years, there are no unambiguous data yet on several issues. Objective : to evaluate the outcome of ABMMC transplantation during coronary artery bypass grafting (CABG) surgery in combined treatment of CHD. Materials and methods . The data of 408 patients admitted to the clinic from 2013 to 2016 for planned surgical treatment of CHD were analyzed. The work included 117 people based on the design of the study. Patients were randomized in 3 groups: Group 0 (control group) – CABG surgery and intramyocardial injection of 0.9% NaCl solution, Group 1 – CABG surgery and intramyocardial injection of ABMMCs, Group 2 – CABG surgery, intramyocardial and intra-graft injection of ABMMCs. The dynamics was assessed 12 months later – functional class of angina pectoris and heart failure, echocardiography, speckle tracking (assessment of the degree of myocardial deformation), treadmill test, 6-minute walk test, daily ECG monitoring, quality of life questionnaires, coronary angiography. Qualitative indicators were calculated using the Pearson’s chi-squared test and Fisher criteria. Quantitative indicators were calculated using the Kruskal–Wallis and Wilcoxon tests. Factor analysis was used to identify certain severity factors and to study data homogeneity. Discriminant analysis was performed to investigate the leading characteristics that determine differentiation between the groups. For analysis of variance, taking into account various factors, the model of variance analysis for dependent samples – Repeated Measures ANOVA – was used. Results . In the observation groups, an improvement in both systolic and diastolic myocardial function was universally noted. A six-minute walk test showed statistically significant increase in Groups 1 and 2 compared with the control Group 0 – 315.06 ± 17.6 (433.54 ± 20.6), Group 1 – 319.8 ± 24.5 (524.4 ± 28.7), Group 2 – 329.9 ± 25.3 (452.7 ± 29.7) meters. A significant decrease in the functional class of exertional angina pectoris in Groups 1 and 2 was noted unlike in the control group. The percentage of functioning coronary shunts after a 12-month follow-up period was 87.6% in Group 0. In Groups 1 and 2, this ratio was 96.2% and 97.3%, respectively. Predictors of overall effectiveness were identified: smoking, initial diastolic myocardial dysfunction, left ventricular ejection fraction. Conclusion . In addition to surgical treatment of coronary heart disease, ABMMC transplantation can improve myocardial contractility, boost exercise tolerance, and increase the duration of the functioning of coronary shunts at the follow-up period of 12 months. The study showed the need for stage-by-stage analytical calculations with the aim of possible correction of further work.

Aim: to assess the safety of transplantation of autologous bone marrow mononuclear cells when performing coronary artery bypass grafting in the combined treatment of ischemic heart disease in patients with coronary and heart failure. Materials and methods. During the period from 2013 to 2016 years 117 patients, who meet the established criteria, were included in the work. Randomization was performed in observation groups: group 0 control group (coronary artery bypass grafting (CABG) and intramyocardial administration of a 0.9% NaCl solution), group 1 - CABG surgery and intramyocardial administration of autologous bone marrow mononuclear cells (ABMMS), group 2 - CABG surgery and intramyocardial and intragraft administration of ABMMS. Clinical, laboratory - CPK MB, myoglobin, troponin I, HCT, Hb, K +, ABC; instrumental (stress tests, echocardiography, speckle tracking, coronary angiography) data were evaluated in these groups. The analysis of the frequency of postoperative complications (hydrothorax, hydropericardium, rhythm disturbances) was performed; the length of stay in the intensive care unit, the length of stay in the hospital and other indicators. After 6 and 12 months, the overall mortality was assessed, major cardiac events - the development of acute myocardial infarction, ventricular arrhythmias, oncological alertness. Number in international register clinical trials Clinical Trial.gov Identifier: NCT02059512. Results. Statistical analysis showed no statistically significant differences in the observation groups for the compared criteria. Conclusion. Transplantation of autologous bone marrow mononuclear cells during aorto-coronary bypass surgery in the combined treatment of coronary heart disease is a safe method.

We present a 13-years follow-up results in patient with dilated cardiomyopathy. We performed intracoronary infusion of bone marrow mononuclear fraction in patient with 4th heart failure functional class in 2005. We observed an improvement in symptoms (patient had 1st functional class of heart failure) during 10-years follow-up. In 2015 due to clinical worsening we performed 2nd and 3rd bone marrow mononuclear cells infusion with 9-month interval. We observed a signifcant improvement in symptoms, EF and LV sizes. We continue the follow-up.

Objective. To develop algorithm of data analysis of prospective non-randomized clinical trial AMIRICABG (ClinicalTrials.gov Identifier: NCT03050489) using SAS Enterprise Guide 6.1. Materials and methods. Data collection was performed according prospective non-randomized clinical trial AMIRICABG in Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia between 20162019 years with 336 patients. There is database with clinical, laboratory and instrumental data. Statistical analysis was performed with SAS Enterprise Guide 6.1. Results. There was developed algorithm of data analysis of prospective non-randomized clinical trial AMIRICABG. This algorithm could be useful for physicians and researchers for data analysis. Conclusion. Presented algorithm of data analysis could make easier and improve efficient data analysis. SAS Enterprise Guide 6.1 allows fast and accurate process big data.

Surgical treatment of coronary heart disease was introduced into clinical practice more than 50 years ago. Only one intervention – the use of left internal thoracic artery for bypass grafting of the anterior interventricular artery – Kolovos’s operation– remains practically unchangeable version of execution as a standard for coronary artery bypass grafting. This review summarizes the half-century use of internal thoracic arteries, autoveins, radiate arteries as conduits for coronary arteries on the basis of the randomized studies and meta-analyzes published by 2018.

The treatment of patients with CHF using autologous bone marrow-derived mononuclear cell fraction (or its derivatives) is a promising therapy for this serious and numerous group of patients. The article analyzed international and Russian experience of using the cell therapy in patients with CHF and possibilities for extensive use of the autologous bone marrow-derived mononuclear cell fraction in clinical practice.