Introduction: The development of a new generation of hybrid prostheses is a way to improve the results of surgical treatment of combined lesions of the aortic arch and descending aorta. Objective: The study was aimed to evaluate the biocompatibility of the new branched hybrid stent graft.Methods: The developed hybrid stent graft consisted of two parts including the vascular part and the stent graft part, which were supplemented with a stented branch for reconstruction of the left subclavian artery. To assess the biological compatibility, a stent graft was implanted in the descending thoracic aorta in 25 large pigs. The results were assessed by surgical mortality, postoperative complications, selective aortic angiography and histological examination after 6 month follow up period.Results: Implantation of a hybrid stent graft was successful in all cases, without complications. In the early period, 3 animals died. The causes of animal death were respiratory failure caused by lung barotrauma, intraoperative bleeding and sudden cardiac death. The remaining pigs survived until the end of the follow up period without complications and were subsequently withdrawn from the experiment. The duration of perfusion by carotid-femoral bypass surgery was 55 [50; 60] minutes. The volume of blood sweating through the vascular part of the prosthesis was 2.28 ± 0.23 ml/cm2/min; the blood loss for the first hour through drain tube was approximately 70.2 ± 8.9 ml. In 6 months after surgery the aortic angiography showed that the main body and branches of the hybrid stent graft were completely passable. No migration, deformation or endolics were observed. The analysis of histological sections showed the presence of a confluent layer of neointima continuously and evenly distributed throughout the luminal surface of the conduits, including lateral branchlets and anastomoses. The neointima was hyperplasized and represented by layers of unidirectional fibroblast cells, its luminal surface was covered with a layer of endotheliocytes. Conclusion: These results demonstrate the technical feasibility and safety of using a new hybrid stent graft with an additional stented branch. Received 16 July 2024. Revised 1 August 2024. Accepted 15 August 2024. FundingThe study was carried out within the framework of project No. 22-15-20005 (agreement No. 22-15-20005 with the Russian Science Foundation, dated 22.03.2022, agreement No. р-12 with the Ministry of Science and Innovation Policy of the Novosibirsk Region, dated 13.03.2023). Conflict of interestThe authors declare no conflict of interest. Contribution of the authorsConception and study design: A.M. Chernyavskiy, I.Yu. Zhuravleva, D.A. Sirota, A.A. ShadanovData collection and analysis: A.A. Shadanov, D.A. Sirota, M.M. Lyashenko, S.V. Vladimirov, T.P. Timchenko, A.A. Dokuchaeva, V.P. Borodin, A.K. Sabetov, D.V. Khomushku, M.N. Murtazaliev, Ya.L. Rusakova, E.V. KuznetsovaStatistical analysis: A.A. ShadanovDrafting the article: A.A. Shadanov, D.A. SirotaCritical revision of the article: I.Yu. Zhuravleva, D.A. Sirota, A.M. ChernyavskiyFinal approval of the version to be published: A.A. Shadanov, A.M. Chernyavskiy, D.A. Sirota, M.M. Lyashenko, S.V. Vladimirov, T.P. Timchenko, A.A. Dokuchaeva, V.P. Borodin, A.K. Sabetov, D.V. Khomushku, M.N. Murtazaliev, Ya.L. Rusakova, E.V. Kuznetsova, I.Yu. Zhuravleva

Introduction: Acute aortic dissection of type A is a life-threatening condition where open surgical treatment is the "gold standard". The effect of prehospital double antiplatelet therapy (DAPT) on the results of surgical treatment has not been sufficiently studied. The available literature data indicate the ambiguity of the DAPT results in acute aortic syndrome. Objective: The study was aimed at assessing the effect of double antiplatelet therapy at the pre-hospital stage on the results of surgical treatment of acute aortic dissection type A. Methods: A retrospective analysis of the results of surgical treatment of patients with acute aortic dissection of type A was based on the patient database of Meshalkin National Medical Research Center. We analyzed 33 patients (DAPT group) who received double antiplatelet therapy at the pre-hospital stage and 63 patients (noDAPT group) without double antiplatelet therapy from non-matched cohort before the propensity score matching (PSM) analysis. After PSM analysis of the group, 29 pairs of patients were selected (a matched cohort). The primary endpoint was represented by a combination of events associated to bleeding, namely postoperative bleeding >1500 ml/12h, intraoperative wound tamponing and open bleeding revisions. Secondary, 30-day mortality, inhospital mortality and medium-term survival were evaluated before and after PSM analysis. The effect of preoperative DAPT on 30-day mortality was assessed using multivariate logistic regression analysis. Results: In the matched cohort, after PSM analysis for the primary endpoint, the distribution of patient between noDAPT and DAPT groups were 34.5% vs 51.7%, p = 0.210. In the DAPT group, fresh frozen plasma (p = 0.001) and red blood cell mass (p = 0.0009) were transfused significantly more frequently within 24 hours after surgery. There were no significant differences between the noDAPT and DAPT groups on indicators of 30-day mortality (10.3% vs 27.6%, p = 0.094) and 5-year survival (69% vs 60.9%, p = 0.357). In the multifactorial model of logistic regression analysis, DAPT was an independent predictor of 30-day mortality (OR 3.36 [95% CI, 1.02-11.04], p = 0.045); the combined primary endpoint, associated to bleeding indicators, increased its probability by 5 times (OR 4.98 [95% CI, 1.34-18.5], p = 0.016). Conclusion: Preoperative DAPT did not significantly increase either the incidence of bleeding-related events or the early mortality rate, and did not reduce mid-term survival in patients with acute type A aortic dissection. However, preoperative administration of DAPT was an independent predictor of 30-day mortality. Preoperative DAPT is not a limitation to surgical treatment of acute type A aortic dissection. Received 25 September 2024. Revised 13 October 2024. Accepted 15 October 2024. FundingThe study was carried out within the framework of project No. 22-15-20005 (agreement No. 22-15-20005 with the Russian Science Foundation, dated 22.03.2022, agreement No. р-12 with the Ministry of Science and Innovation Policy of the Novosibirsk Region, dated 13.03.2023). Conflict of interestThe authors declare no conflict of interest. Contribution of the authors Conception and study design: D.A. Sirota, A.A. Shadanov, M.M. Lyashenko, A.M. Chernyavskiy, M.N. MurtazalievData collection and analysis: M.N. Murtazaliev Statistical analysis: A.A. ShadanovDrafting the article: A.A. Shadanov, D.A. SirotaCritical revision of the article: D.A. Sirota, A.A. Shadanov, A.M. Chernyavskiy, M.M. LyashenkoFinal approval of the version to be published: D.A. Sirota, A.A. Shadanov, M.N. Murtazaliev, M.M. Lyashenko, A.M. Chernyavskiy

Актуальность. Острое расслоение аорты типа А — жизнеугрожающее состояние, при котором открытое хирургическое лечение является «золотым стандартом». Влияние догоспитальной двойной антиагрегантной терапии на результаты хирургического лечения изучено недостаточно. Данные литературы свидетельствуют о неоднозначности результатов двойной антиагрегантной терапии при остром аортальном синдроме. Цель. Оценить влияние нагрузочной двойной антиагрегантной терапии на результаты хирургического лечения острого расслоения аорты типа А на догоспитальном этапе. Методы. Провели ретроспективный анализ результатов хирургического лечения пациентов с острым расслоением аорты типа А из базы данных НМИЦ им. ак. Е.Н. Мешалкина. На догоспитальном этапе 33 пациента получили двойную антиагрегантную терапию и 63 пациента — без двойной антиагрегантной терапии (несопоставленная когорта до проведения псевдорандомизации — propensity score matching). Выполнили анализ propensity score matching 29 пар пациентов. Первичная конечная точка представлена комбинацией ассоциированных с кровотечением событий: послеоперационное кровотечение > 1 500 мл / 12 ч, интраоперационное тампонирование раны, открытая ревизия по поводу кровотечения. Оценивали вторично 30-дневную смертность, внутригоспитальную летальность и среднесрочную выживаемость, которые оценивали до и после анализа propensity score matching. Влияние предоперационной двойной антиагрегантной терапии на 30-дневную летальность оценивали с помощью многофакторного логистического регрессионного анализа. Результаты. В сопоставленной когорте после анализа propensity score matching по первичной конечной точке группы без двойной антиагрегантной терапии и с двойной антиагрегантной терапией составили 34,5 против 51,7 %, р = 0,210. В группе двойной антиагрегантной терапии в течение 24 ч после операции статистически значимо больше проводили трансфузию свежезамороженной плазмы (р = 0,001) и эритроцитной массы (р = 0,0009). Группы без двойной антиагрегантной терапии и с двойной антиагрегантной терапией статистически значимо не различались по 30-дневной смертности (10,3 против 27,6 %, р = 0,094) и 5-летней выживаемости (69,0 против 60,9 %, р = 0,357). В многофакторной модели логистического регрессионного анализа прием двойной антиагрегантной терапии являлся независимым предиктором 30-дневной летальности (отношение шансов 3,36 [95% доверительный интервал 1,02–11,04], р = 0,045), а комбинированная первичная конечная точка увеличивала ее вероятность в 5 раз (отношение шансов 4,98 [95% доверительный интервал 1,34–18,50], р = 0,016). Заключение. Предоперационный прием нагрузочной двойной антиагрегантной терапии значимо не увеличивает частоту ассоциированных с кровотечением событий, также нет значимого увеличения ранней летальности и снижения среднесрочной выживаемости у пациентов с острым расслоением аорты типа А. Однако предоперационный прием двойной антиагрегантной терапии является независимым предиктором 30-дневной летальности. Предоперационный прием двойной антиагрегантной терапии не является ограничением к хирургическому лечению острого расслоения аорты типа А. Поступила в редакцию 25 сентября 2024 г. Исправлена 13 октября 2024 г. Принята к печати 15 октября 2024 г. Финансирование Исследование выполнено в рамках проекта № 22-15-20005 (соглашение № 22-15-20005 от 22.03.2022 г. с Российским научным фондом, соглашение № р-12 от 13.03.2023 г. с министерством науки и инновационной политики Новосибирской области). Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: все авторы Сбор и анализ данных: М.Н. Муртазалиев Статистическая обработка данных: А.А. Шаданов Написание статьи: А.А. Шаданов, Д.А. Сирота Исправление статьи: Д.А. Сирота, А.А. Шаданов, А.М. Чернявский, М.М. Ляшенко Утверждение окончательного варианта статьи: все авторы

Objective: The aim of this study was to evaluate the outcomes of autoarterial revascularization involving Y-composite grafts and in situ conduits out of the internal thoracic arteries (ITAs) at the hospital period and after a year follow-up.Methods: The study included 200 patients with coronary artery disease who underwent coronary bypass surgery over the period from March 2018 to March 2021. Patients were randomized using the envelope method into 2 groups: in the first group, autoarterial conduits out of the ITAs were used according to the in situ method (n = 100); in the second group, autoarterial conduits with the formation of a Y-composite grafts out of ITAs (n = 100) were put into practice. The primary endpoints of the study were the incidence of repeat revascularization and amount of major adverse cardiac and cerebrovascular events (MACCE).Results: There was no significant difference between the two groups in the level of freedom from MACCE; in the in situ and Y-composite groups the indicators were 97.9% (95% CI 92.1-99.5) and 94.8% (95% CI 88.1‑97.8; P = 0.24), respectively. In a year follow-up, freedom from repeated revascularization amounted to 97.9% in the in situ group (95% CI 92-99.4), and 97.9% in the Y-composite group (95% CI 91.9-99.4; P = 0.97). A significant difference was registered in the surgery duration, which in the in situ group lasted 235 [197.5; 252.5] minutes versus 252.5 [225; 290] minutes in the Y-composite group, P < 0.002. In the Y-composite group, the rate of infectious complications on the breast bone was significantly more frequent than in the in situ group (P < 0.023).Conclusion: Despite the hypothetical advantages of bimammar coronary bypass surgery over the Y-configuration one, this study did not reveal significant differences in outcomes between the in situ and Y-composite groups. Received 7 November 2023. Revised 10 June 2024. Accepted 24 June 2024. FundingThe study did not have sponsorship. Conflict of interestThe authors declare no conflict of interest. Contribution of the authorsConception and study design: A.K. Sabetov, D.S. Khvan, M.O. ZhulkovData collection and analysis: A.K. SabetovStatistical analysis: A.A. Shadanov, A.K. SabetovDrafting the article: A.K. SabetovCritical revision of the article: D.A. Sirota, D.S. Khvan, A.M. ChernyavskiyFinal approval of the version to be published: A.K. Sabetov, D.A. Sirota, D.S. Khvan, M.O. Zhulkov, A.A. Shadanov, A.M. Chernyavskiy

Цель. Изучить результаты аутоартериальной реваскуляризации с использованием Y-композитных и in situ кондуитов внутренних грудных артерий в госпитальном периоде и через 1 год. Методы. В исследование включили 200 пациентов с ишемической болезнью сердца, которым выполнили коронарное шунтирование с марта 2018 г. по март 2021 г. Пациентов рандомизировали при помощи метода конвертов на 2 группы: в первой использовали аутоартериальные кондуиты из внутренних грудных артерий по методике in situ (n = 100); во второй — с формированием Y-композитных конструкций (n = 100). За первичную конечную точку исследования принимали повторную реваскуляризацию и количество больших неблагоприятных сердечно-сосудистых событий (англ. Major Adverse Cardiac and Cerebrovascular Events, MACCE). Результаты. В уровне свободы от основных неблагоприятных сердечных и мозговых событий достоверной разницы не получили: 97,9 % (95% доверительный интервал 92,1–99,5) для группы in situ и 94,8 % (95% доверительный интервал 88,1–97,8) для группы Y-композитных конструкций, p = 0,24. Через 1 год свобода от повторной реваскуляризации составила для группы in situ 97,9 (95% доверительный интервал 92,0–99,4), для группы Y-композитных конструкций 97,9 % (95% доверительный интервал 91,9–99,4), p = 0,97. Достоверно значимую разницу получили в продолжительности операции, которая в группе in situ составила 235 [197,5; 252,5] против 252,5 [225; 290] мин в группе Y-композитных конструкций, p < 0,002. В группе Y-композитных конструкций инфекционные осложнения на грудине были достоверно значимо чаще, чем в группе in situ, p < 0,023. Заключение. Несмотря на гипотетические преимущества бимаммарного коронарного шунтирования с Y-образной конфигурацией, в результатах между группами in situ и Y-композитных конструкций нет существенных различий. Поступила в редакцию 7 ноября 2023 г. Исправлена 10 июня 2024 г. Принята к печати 24 июня 2024 г. Финансирование Исследование не имело спонсорской поддержки. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: А.К. Сабетов, Д.С. Хван, М.О. Жульков Сбор и анализ данных: А.К. Сабетов Статистическая обработка данных: А.А. Шаданов, А.К. Сабетов Написание статьи: А.К. Сабетов Исправление статьи: Д,А. Сирота, Д.С. Хван, А.М. Чернявский Утверждение окончательного варианта статьи: все авторы

Актуальность. Разработка гибридных протезов нового поколения призвана улучшить результаты хирургического лечения комбинированных поражений дуги и нисходящего отдела аорты. Цель. Оценка биосовместимости нового браншированного гибридного стент-графта. Методы. Разработанный гибридный стент-графт состоит из двух частей: сосудистой части и стент-графтовой части с дополнительной стентированной браншей для реконструкции левой подключичной артерии. Для оценки биологической совместимости имплантировали стент-графт 25 крупным свиньям в позицию нисходящего грудного отдела аорты. Оценивали операционную смертность, послеоперационные осложнения, результаты селективной ангиографии аорты и гистологического исследования через 6 мес. Результаты. Имплантация гибридного стент-графта во всех случаях прошла успешно, без осложнений. В раннем периоде погибли 3 животных, причинами смерти стали дыхательная недостаточность из-за баротравмы легкого, интраоперационное кровотечение и внезапная сердечная смерть. Остальные свиньи дожили до окончания срока наблюдения (6 мес.) без осложнений, после чего были выведены из эксперимента. Длительность перфузии посредством сонно-бедренного шунтирования составила 55 [50; 60] мин. Объем пропотевания крови через сосудистую часть протеза — 2,28 ± 0,23 мл/см2/мин. Объем кровопотери за первый час по дренажам — порядка 70,2 ± 8,9 мл. По данным ангиографии аорты через 6 мес. после операции, основное тело и ветви гибридного стент-графта полностью проходимы. Миграции, деформации или эндоликов не наблюдалось. Результаты анализа гистологических срезов показали наличие конфлюэнтного слоя неоинтимы, непрерывно и равномерно распространенного по всей луминальной поверхности кондуитов, включая боковые бранши и анастомозы. Неоинтима представлена слоями однонаправленных клеток фибробластного ряда, гиперплазирована, ее луминальная поверхность покрыта слоем эндотелиоцитов. Заключение. Продемонстрированы техническая возможность и безопасность применения нового гибридного стент-графта с дополнительной стентированной браншей. Поступила в редакцию 16 июля 2024 г. Исправлена 1 августа 2024 г. Принята к печати 15 августа 2024 г. Финансирование Исследование выполнено в рамках проекта № 22-15-20005 (соглашение № 22-15-20005 от 22.03.2022 г. с Российским научным фондом, соглашение № р-12 от 13.03.2023 г. с Министерством науки и инновационной политики Новосибирской области). Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: А.М. Чернявский, И.Ю. Журавлева, Д.А. Сирота, А.А. Шаданов Сбор и анализ данных: А.А. Шаданов, Д.А. Сирота, М.М. Ляшенко, С.В. Владимиров, Т.П. Тимченко, А.А. Докучаева, В.П. Бородин, А.К. Сабетов, Д.В. Хомушку, М.Н. Муртазалиев, Я.Л. Русакова, Е.В. Кузнецова Статистическая обработка данных: А.А. Шаданов Написание статьи: А.А. Шаданов, Д.А. Сирота Исправление статьи: И.Ю. Журавлева, Д.А. Сирота, А.М. Чернявский Утверждение окончательного варианта статьи: все авторы

Background: Vascular graft infection is a severe cardiovascular complication with high mortality rates. Antibacterial vascular graft coatings are widely used and continue to be improved.Objective: To develop a sealant with antimicrobial effect for Dacron vascular grafts and experimentally test the coating properties.Methods: We used 2 types of vascular grafts: graft No. 1 (plain weave) with initial water permeability of 78.8 ± 2.7 mL/cm2/min and graft No. 2 (2/1 twill + 6/4 satin weave) with water permeability of 549.8 ± 20.7 mL/cm2/min. We developed an original gelatin impregnation technique, tested it using a scanning electron microscopy, and measured water permeability and kink radius. We evaluated the antibacterial activity of vancomycin and gelatin impregnation by the disk diffusion test using media with Staphylococcus aureus ATCC 29213 and Enterococcus faecalis ATCC 29212 and measured inhibition zones after 24-hour incubation. We used samples cut out of grafts with vancomycin-containing (experimental group) and no vancomycin-containing (control group) impregnation.Results: The gelatin coating of the samples is visualized as a thin even film and provides zero water permeability. On the negative side, it increased stiffness and the kink radius. Thanks to vancomycin added to the coating, bacterial growth significantly inhibits: the mean diameter of the growth inhibition zone for Staphylococcus aureus and Enterococcus faecalis was 15.60 ± 0.65 and 14.40 ± 0.66 mm, respectively. The grafts untreated with vancomycin showed no growth inhibition zones.Conclusion: Vascular graft treatment with gelatin impregnation and vancomycin solution is a simple measure to prevent the growth of gram-positive bacteria on vascular grafts. Received 14 November 2022. Revised 15 December 2022. Accepted 19 December 2022. Funding: The work was supported by Russian Science Foundation (project No. 22-15-20005). Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: I.Yu. Zhuravleva, A.A. Shadanov, D.A. SirotaData collection and analysis: A.A. Shadanov, L.M. Samoylova, S.V. Vladimirov, T.P. Timchenko, N.E. Luchnikov, E.V. KarpovaStatistical analysis: A.A. ShadanovDrafting the article: A.A. Shadanov, L.M. Samoylova, T.P. Timchenko, A.G. EdemskiyCritical revision of the article: D.A. Sirota, I.Yu. Zhuravleva, A.V. Bogachev-Prokofiev, A.M. ChernyavskiyFinal approval of the version to be published: A.A. Shadanov, I.Yu. Zhuravleva, L.M. Samoylova, T.P. Timchenko, S.V. Vladimirov, E.V. Karpova, N.E. Luchnikov, D.A. Sirota, A.G. Edemskiy, A.V. Bogachev-Prokofiev, A.M. Chernyavskiy

Background: One of the most feared long-term complications of surgical treatment of proximal aortic dissections is an aneurysm of the non-operated compartments of the aorta.Objective: To conduct a comparative analysis of different methods for surgical treatment of proximal aortic dissections in relation to false lumen thrombosis development in non-operated compartments.Methods: We conducted a simple observational retrospective multicenter study to study the effectiveness of the frozen elephant trunk technique compared with a standard surgical intervention (aggressive hemiarch anastomosis or total aortic arch replacement with a multibranched prosthesis). Our study included 101 patients grouped based on the method of treatment: group 1 for frozen elephant trunk (n = 31); group 2 for thoracic aorta reconstruction by the standard methods (control group, n = 70). Due to the retrospective nature of the study and the disparity of groups by certain characteristics, we used propensity score matching to increase the reliability of the results. All patient data were collected in the preoperative period, from the protocols of surgical interventions, in the postoperative and long-term periods (3-6 months, 1 year, 2 years, 3 years after surgery). All statistical calculations were conducted in the RStudio software, version 0.99.879 (RStudio Inc., Boston, USA).Results: The absence of false lumen thrombosis at the thoracic aorta level persisted after the surgical treatment in half of the patients in the control group (n = 13; 52%) and was not determined in the frozen elephant trunk group. Complete false lumen thrombosis at the thoracic aorta level (level of stent graft placement and distal to the diaphragm) was achieved in more than half of the patients in the frozen elephant trunk group and only in 3 (12%) control patients. Aneurysmal transformation of the non-operated aorta occurred in 12 (48%) patients from group 2 and was absent in group 1.Conclusion: The frozen elephant trunk technique reduces the frequency of aorto-related events to 0% within 3 years compared with the standard approach (32%, P < .005). Patients operated on for proximal aortic dissection using the frozen elephant trunk technique are significantly more likely to have false lumen thrombosis in the thoracic aorta (P = .004), significantly lower incidence of aneurysmal transformation or thoracic aorta growth rate of >5 mm per year in the long-term period (P = .016) compared with those who underwent the standard methods. Received 15 February 2023. Revised 31 July 2023. Accepted 4 August 2023. Funding: The study was carried out within the framework of the grant of the President of the Russian Federation НШ-5096.2022.3 (agreement No. 075-15-2022-823 dated 12.05.2022). Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.M. Chernyavskiy, M.M. Lyashenko Data collection and analysis: M.M. Lyashenko, A.A. Shadanov, D.S. Panfilov, E.V. SkurikhinaStatistical analysis: M.M. LyashenkoDrafting the article: M.M. LyashenkoCritical revision of the article: A.M. Chernyavskiy, D.A. Sirota, B.N. KozlovFinal approval of the version to be published: A.M. Chernyavskiy, M.M. Lyashenko, D.A. Sirota, A.A. Shadanov, B.N. Kozlov, D.S. Panfilov, E.V. Skurikhina

Актуальность. Инфицирование сосудистого протеза является серьезным осложнением в сердечно-сосудистой хирургии, характеризуется тяжелым течением и высокой смертностью. Несмотря на то что антибактериальные покрытия для сосудистых протезов широко распространены, в мире продолжаются работы по их улучшению. Цель. Разработка и экспериментальное изучение свойств герметизирующего покрытия с антимикробным эффектом для синтетических сосудистых протезов из дакрона. Методы. Использовали 2 типа сосудистых протезов: протез № 1 (полотняный ткацкий раппорт) с исходным уровнем водопроницаемости 78,8 ± 2,7 мл/см2/мин, протез № 2 (саржа 2/1 + атлас 6/4) — уровень водопроницаемости 549,8 ± 20,7 мл/см2/мин. Разработали оригинальную методику желатиновой пропитки, выполнили сканирующую электронную микроскопию, тесты на водопроницаемость и устойчивость к радиальному перегибу. Антибактериальную активность желатиновой пропитки с ванкомицином оценили диско-диффузионным методом на средах с Staphylococcus aureus ATCC 29213 и Enterococcus faecalis ATCC 29212 путем измерения зон задержки роста микроорганизмов после 24-часовой инкубации. Для этого использовали образцы, выкроенные из протезов с пропиткой, содержащей ванкомицин (опытная группа) и не содержащей ванкомицин (контрольная группа). Результаты. Желатиновое покрытие на образцах визуализируется в виде тонкой ровной пленки и обеспечивает нулевую водопроницаемость. Негативным эффектом является увеличение жесткости и, соответственно, радиуса перегиба. Введение ванкомицина в покрытие привело к значительной задержке роста в культурах микроорганизмов: средний диаметр зоны задержки роста в культуре Staphylococcus aureus составил 15,60 ± 0,65 мм, в культуре Enterococcus faecalis — 14,40 ± 0,66 мм. В протезах, не обработанных ванкомицином, не обнаружили зон задержки роста. Заключение. Обработка желатиновой пропиткой с раствором ванкомицина — простая профилактическая мера для предотвращения роста грамположительных бактерий на материалах сосудистых протезов. Поступила в редакцию 14 ноября 2022 г. Исправлена 15 декабря 2022 г. Принята к печати 19 декабря 2022 г. Финансирование Работа выполнена при финансовой поддержке Российского научного фонда (проект № 22-15-20005). Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: И.Ю. Журавлева, А.А. Шаданов, Д.А. Сирота Сбор и анализ данных: А.А. Шаданов, Л.М. Самойлова, С.В. Владимиров, Т.П. Тимченко, Н.Е. Лучников, Е.В. Карпова Статистическая обработка данных: А.А. Шаданов Написание статьи: А.А. Шаданов, Л.М. Самойлова, Т.П. Тимченко, А.Г. Едемский Исправление статьи: Д.А. Сирота, И.Ю. Журавлева, А.В. Богачев-Прокофьев, А.М. Чернявский Утверждение окончательного варианта статьи: все авторы

The aim of the study is to determine physical and structural properties of woven synthetic prostheses depending on the type of the weave.Materials and Methods. Ten vascular prostheses manufactured at the Science and Technology Park of the BNTU "Polytechnic" (Minsk, Republic of Belarus) have been analyzed. The prostheses differed in the type of weaving, duration and temperature of thermal fixation during crimping. Three samples had a single-layer structure and 7 samples had a double-layer structure. Tests for water permeability, resistance to radial bending, and porosity of the prostheses have been performed.Results. The single-layer woven prostheses have demonstrated a low level of water permeability: the best result was shown by sample No.1: 80 [77.1; 80.5] ml/min/cm2. A strong direct correlation was revealed for these prostheses: the larger the pore diameter, the greater permeability (r=0.778; p=0.05). The single-layer woven prostheses appeared to be most resistant to radial bending, samples No.1 and 3 had no deformations at the minimum radius of the cylinder (R<4 mm), sample No.2 showed deformation on the cylinder with R=5 mm. For the single-layer prostheses, a strong negative correlation was noted (r=-0.97; p=0.04) between the density of the warp threads and the kinking radius.All double-layer prostheses have demonstrated higher water permeability and weak resistance to deformation during radial bending. Samples No.4 and 8 were found to have minimum and maximum water permeability of 276.5 [258.3; 288.4] and 538.8 [533.3; 564.3] ml/min/cm2, respectively. The minimum kinking radius (7 mm) was shown by samples No.9 and 10. The worst results were demonstrated by sample No.6, which was deformed with minimal bending.Conclusion. Samples with ordinary plain weave have a low level of water permeability and high resistance to radial deformation, which makes them look most promising for the application in vascular surgery.

Purpose. To establish the methods for estimating the volume of the true and false aortic canals applying computed tomography angiography (CTA) to a clinical case with hybrid stent-graft thoracic aorta with distal stent-graftinduced new entry associated (d-SINE) in the long-term follow-up period in comparison with a widely used technique of measuring diameters of the aorta on different levels.Materials and methods. Sequential analysis of CTA in a 7-year follow-up was performed. Aorta was divided into 3 segments, in each segment total aortic volumes (AV), volume of the true canal (TC), and volume of functional lumen of the false canal (FLFC) were calculated. The following were mathematically calculated: volume of the false canal (FC) via difference in volume between AV and TC, volume of the thrombosed lumen of FC as the difference between FC and FLFC, the coefficient of FC thrombosis, the degree of stent-graft opening. Mathematical assessment of excess volume of the graft was performed.Results. Modelling of aortic cavity, evaluation of changes in the volumes of TC and FC during a long-term follow-up, analysis of the factors inducing the development of the d-SINE syndrome were performed. When comparing the volume of the graft and the volume of the implantation zone, an excess of 234% was found, while the opening of the graft was 80%. When using the reference method based on the diameter of the true lumen of the aorta, the excess was 22% during one-year follow-up period showing no changes subsequently.Conclusion. Potentially, the method of measuring volumes based on CTA results can be used to complement the generally accepted method based on measuring diameters, since it does not require additional financial resources and has the potential to estimate effectiveness of treatment and identify complications predictors in the postoperative period to determine indications for reoperation.

Relevance. The frozen elephant trunk technique is recognized as a safe and effective method of surgical treatment for aneurysms and dissections of the thoracic aorta. The hybrid prostheses, available on the territory of the Russian Federation, are foreign-made, characterized by a high price, and, accordingly, unpopular. Due to unavailability of domestic hybrid prostheses in the home market, the development of domestic prosthesis is the key point to further progress in aortic surgery in the Russian Federation. Aim . The aim of the study was to evaluate the implantation characteristics of prototype hybrid thoracic aorta prosthesis in the pig model and the transformation of the prosthesis in the postoperative period. Material and Methods . The hybrid prosthesis consists of two parts including the vascular part and a stent graft. The prosthesis is made of Dacron and Z-shaped nitinol wire stents. A Landrace pig aged six months with body weight of 120 kg underwent open reconstruction of the descending aorta through the left-sided lateral thoracotomy, under conditions of extracorporeal bypass with a roller pump from the left subclavian artery to the descending aorta. The animal was removed from the experiment after six months as planned. The macro- and microscopic evaluation of the removed implant was performed. Results . The technical success of implantation of hybrid stent graft prototype was confirmed. Macroscopy of the stent graft, removed after six months, demonstrated a complete coverage of the neointimal inner surface of the synthetic prosthesis. The lumen of the product was patent. Histological examination revealed the neointima presented as a structured connective tissue without signs of inflammation. The luminal surface was lined with a single layer of evenly spaced endotheliocytes. The thickness of the neointima in the vascular part was significantly greater than in the stent-graft part ( p = 0.0121). Conclusion. The study demonstrated the technical feasibility of implantation of the prototype hybrid prosthesis developed by Angioline Research LLC. The effectiveness of sealing impregnation was confirmed by the absence of active signs of bleeding during the perioperative and early postoperative stages. The prosthesis demonstrated satisfactory bio- and hemocompatibility.

Background. The frozen elephant trunk (FET) technique for the treatment of both thoracic aortic aneurysms and dissections has become universally popular over the past two decades because extensive open surgical reconstruction of the thoracic aorta has been found to be associated with high complication and mortality rates or unfavourable long-term outcomes as it requires repeated interventions. The FET technique has also been shown to produce excellent, immediate and long-term results. Hence, it is important to evaluate the outcomes of thoracic aortic reconstruction using this technique.Aim. This study aimed to investigate immediate and long-term outcomes of the FET technique in patients with thoracic aortic diseases.Methods. We retrospectively analysed the pre-, intra- and post-operative data of 40 patients with distal aortic arch aneurysm who had undergone aortic arch reconstruction using the FET technique at Meshalkin National Research Medical Center from February 2012 to October 2020. To assess the early and long-term post-operative survival of these patients, we categorised them into group I (including 14 patients without aortic dissection) and group II (including 26 patients with type I and type III aortic dissections).Results. The in-hospital survival rates for groups I and II were found to be 68.5% and 95.9%, respectively (log rank, p = 0.048). Groups I and II did not differ significantly in the incidence of stroke (7.1% vs 7.7%, respectively; p = 0.724) and spinal cord ischaemia (14.3% vs 0%, respectively; p = 0.117). Long-term (1-, 3- and 5-year) survival rates in group II remained unchanged at 95.9%, whereas survival rates at 30 days, 6 months and 1 year in group I were 91.3%, 68.5% and 57%, respectively. The risk of mortality was 90% lower in group II than in group I, with a hazard ratio of 0.096 and a 95% confidence interval of 0.01–0.81 (p = 0.038). The rates of freedom from thoracoabdominal aortic interventions in group II were 91.8%, 83%, 64.7%, 59.3% and 59.3% at 30 days, 6 months, 1 year, 3 years and 5 years, respectively; these rates in group I were 90.9%, 75.7% and 75.7% at 30 days, 6 months and 1 year, respectively. There was no significant difference between the groups concerning thoracoabdominal aortic interventions (log rank, p = 0.587).Conclusion. The use of the FET technique in patients with thoracic aortic diseases is associated with acceptable rates of mortality and thoracoabdominal aortic interventions in immediate and long-term post-operative periods.Received 28 January 2021. Revised 28 April 2021. Accepted 29 April 2021.Funding: This work was carried out within the framework of the state task of the Ministry of Health of the Russian Federation (No. 121032300337-5).Conflict of interest: The authors declare no conflicts of interests.Contribution of the authors: The authors contributed equally to this article.

Aim. Assessment of normal and variant aortic arch anatomy in patients with type A aortic dissection and aneurysm of the arch and descending thoracic aorta.Methods. We retrospectively studied computer tomography (CT) data of chest organs with contrast in patients who underwent reconstruction of the aortic arch in type I aortic dissection according to DeBakey classification (n = 61) and resection of the aortic arch and descending thoracic aorta aneurysm (n = 14) at the Meshalkin National Medical Research Center, Novosibirsk, Russian Federation. The control group included patients without aortic arch pathology (n = 52). To identify relationships between the anatomical type of aortic arch and the risk of aortic pathology development, univariate and multivariate binary logistic regression analyses were used.Results. Our analysis revealed four types of aortic arch anatomy. Normal aortic arch anatomy occurred in 66.1 % of patients (n = 84), the proportion of abnormalities of the left common carotid artery was 30 % (bovine aortic arch occurred in 15 %, and the same site of origin of left common carotid artery and brachiocephalic trunk occurred in 15 %). Divergence of the left vertebral artery from the aortic arch between the left common carotid and left subclavian arteries occurred in 3.1 % (n = 4), and the combination of “bovine trunk” and divergence of the left vertebral artery from the aortic arch was detected in 0.8 % patients (n = 1). Logistic regression analyses revealed no statistically significant relationships between variant aortic arch anatomy and the development of type A aortic dissections and aortic arch aneurysms. The presence of the common origin of brachiocephalic trunk and left common carotid artery was associated with a reduced risk of acute aortic dissection type I by 89 %, or an OR of 0.11 (95% CI: 0.03–0.46) (p = 0.002).Conclusion. Our data will help with future planning surgical interventions on the aortic arch and descending thoracic aorta.Received 17 June 2020. Revised 16 July 2020. Accepted 17 July 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributionsConception and design: A.A. ShadanovData collection and analysis: A.A. Shadanov, T.A. BergenStatistical analysis: D.A. Sirota, A.A. ShadanovDrafting the article: A.A. ShadanovCritical revision of the article: D.A. Sirota, M.M. Lyashenko, A.M. ChernyavskiyFinal approval of the version to be published: A.A. Shadanov, D.A. Sirota, T.A. Bergen, M.M. Lyashenko, A.M. Chernyavskiy