Concomitant cardiovascular diseases in elderly patients with a hip fracture significantly increase the risk of developing postoperative complications. Developing the treatment algorithm for a combination of two or more diseases in this category of patients is the main task. The advantages of simultaneous surgery are one-stage repair of two or more surgical diseases, the implementation of one anesthetic procedure, the reduction in the total time of the patient’s stay in the hospital and the reduction in rehabilitation time. This paper presents the clinical observation of simultaneous surgical treatment of severe aortic stenosis and femoral neck fracture in an elderly patient.

The objective was to assess the prognostic value of D-dimer level in peripheral venous blood and arterial blood to the risk of developing complications in the short-term period after open reconstructive surgery on the aortoiliac segment.Methods and materials. The study included 89 patients who were determined the D-dimer level in peripheral venous blood, as well as arterial blood intraoperatively.Results. Statistically significant differences in the D-dimer level were established depending on the presence or absence of early postoperative complications.Conclusions. The intraoperative D-dimer level in arterial blood has a predictive ability in relation to the development of early postoperative complications.

THE OBJECTIVE was to evaluate the immediate results of open reconstructive operations for renal artery aneurysm.METHODS AND MATERIALS . From March 2019 to September 2023, 55 patients with visceral artery aneurysms were operated at the Department of Vascular Surgery at the Pavlov University. 4 patients with renal artery aneurysms were operated on by open surgical method and 5 patients underwent endovascular operation. There are two clinical cases of open reconstruction of renal artery aneurysm in situ and one ex vivo. In all cases, the indication for the operation was the presence of a symptomatic aneurysm. For in situ reconstructions, a retroperitoneal thoracophrenopararectal access to the tenth intercostal space on the left side with the opening of the left pleural cavity and partial diaphragmatic cavity and a transverse laparotomy of «chevron» type were used. Autovena was used as a bypass. For surgery of the renal artery ex vivo laparoscopic nephrectomy with autotransplantation of the kidney was performed. In the near postoperative period, we made the assessment of the patency of the reconstruction zone using MSCT angiography, the analysis of indicators of renal function.RESULTS . All the observations noted satisfactory near-term results – the reconstruction zone is unobstructed, indicators of renal function without negative dynamics, absence of clinical manifestations of this pathology. Long-term results (observed for more than 4 years) were traced in one patient. During this period, normal renal function and adequate functioning of the reconstruction zone are maintained.CONCLUSION . Open reconstructive surgery in the surgical treatment of renal artery aneurysm remains relevant due to the inability in some cases to perform its endovascular correction without high risk of ischemic damage to the parenchyma of the kidney.

Objective: To identify risk factors for unfavorable outcome in newborns operated on for congenital pathology of the aortic arch. Materials and methods of research: Data from the results of treatment of 79 patients with congenital pathology of the aortic arch were analyzed and the effectiveness of the therapy was assessed. All patients underwent an examination with the study of obstetric and gynecological history, life history and illness, with an assessment of existing complaints after birth and their changes over time. The obtained clinical, echocardiographic and laboratory parameters were analyzed and compared. The following surgical methods were used for surgical correction of congenital pathology of the aortic arch: resectionof coarctation with plastic surgery of the aortic arch with native tissues, resection of aortic coarctation with the imposition of an extended end-to-end anastomosis, hybrid version. The results of the performed operations and complications were evaluated. Results: Factors such as the development of small ejection syndrome before surgery, the emergency nature of the intervention, and reduced left ventricular ejection fraction (less than 35%), increased heart rate, had a significant association with an unfavorable outcome. Signs of moderate significance that were associated with an unfavorable outcome of surgical treatment were the following clinical and hemodynamic preoperative parameters: increased respiratory rate, reduction of diastolic pressure in the lower extremities and reduction LV EDC. Anthropometric data and reduction of systolic pressure in the lower extremities had a weak connection with mortality. Conclusions: The most significant factors of unfavorable outcome before surgery in newborns with congenital pathology of the aortic arch, those operated with the use of artificial blood circulation are: increased heart rate, decreased LV EF. Low anthropometric indicators of the child (weight, height, body surface area) are also have an impact on the outcome. Index of the end-diastolic size of the left ventricle as a factor reflecting his anatomically determined ability to produce a systemic blood flow it is important when choosing an option for surgical.

Introduction. Changes in the hemostasis and fibrinolysis system in patients with aortoiliac segment lesion can cause the development of specific thromboembolic and hemorrhagic complications, accompanied by a high level of mortality. Preoperative laboratory analysis of the D-dimer blood level may help to objectify the risk assessment of open surgery in this category of patients. Objective. Assessment of the significance of preoperative blood D-dimer level in predicting the development of morbidity and mortality after open surgery on the aortoiliac segment. Materials and methods. The study included 108 patients who were determined the D-dimer blood level before planned reconstructive intervention on the aortoiliac segment at the Pavlov University from 2013 to 2021. The first group consisted of 56 patients with aneurysmal aortoiliac segment lesions, and the second group included 52 patients with occlusive-stenotic lesions of the aortoiliac segment. Results. 92 (85%) patients had an increase of D-dimer level above 500 μg/L, among them 18 patients developed early postoperative complications, and 4 cases were fatal. In 16 (15%) patients with normal D-dimer levels, the postoperative the period was uneventful. Both groups showed statistically significant differences in preoperative blood D-dimer levels depending on the presence or absence of early postoperative complications. In the first group, the median of D-dimer level in the smooth course of the postoperative period was 2035 μg/L, and in patients with complicated course – 3770 μg/L (p=0.04), in the second group these indicators were 635 μg/L and 1231.5 μg/L (p=0.02), respectively. The threshold value of D-dimer level in predicting the risk of death in the first group was 4150 μg/L (p=0.001). Conclusion. The blood D-dimer level may be an additional laboratory risk factor for adverse outcome of open surgery in patients with aortoiliac occlusive disease.

An outstanding Russian scientist, a major specialist in the field of thoracic and cardiac surgery, Anatoly Panteleimonovich Kolesov was born on July 5, 1924 in Verkhneudinsk (now Ulan-Ude). In 1941, he graduated with honors from school ¹ 15 in Kiev. With the outbreak of the Great Patriotic War, he volunteered for the Western Front, where he served as an interpreter for the intelligence department until 1942. In 1942, he was sent to study at the S.M. Kirov Military Medical Academy, which he graduated with a gold medal in 1947. After graduating from the Academy, he was enrolled in the postgraduate program at the Department of Faculty Surgery ¹ 2. In 1950, he defended his candidate’s dissertation «The Origin, the Development, and the Recognition of Some Forms of Bronchiectasis». In 1951, he was sent on a business trip to the Democratic People’s Republic of Korea. In 1956, he defended his doctoral dissertation «Some Issues of Treating Gunshot Fractures with the Use of Antibiotics». In USSR, he was one of the first to perform economical lung resections (including bilateral ones) for bronchiectasis, heart surgery under hypothermia, and then artificial circulation. From 1963 to 1986, he headed the Department of Surgery for Advanced Medical Studies ¹ 1, which was named after P. A. Kupriyanov in 1965. During his leadership, the department became one of the leading medical institutions in the country for the treatment of cardiac surgery patients. Anatoly Panteleimonovich Kolesov died on June 17, 1987 and was buried at the Bogoslovskoye Cemetery in Leningrad. In memory of this outstanding scientist, a memorial plaque was installed on the wall of the clinic where he worked in 1988.

Throughout the pandemic, a new coronavirus infection has led to the death of more than 6 million people worldwide. One of the most severe complications of this extremely dangerous infection is damage to the coronary vascular system caused by damage to the endothelium of the vessels, which leads to the development of thrombotic complications. They can occur in the basins of the brain, heart, in the splanchnic circulatory system, as well as in the vessels of the extremities, especially in conditions of concomitant atherosclerotic lesion. We present the case of treatment of an elderly patient with obliterating atherosclerosis and critical lower limb ischemia after a COVID-19 infection complicated by thrombosis of the femoral-popliteal shunt.

Professor Lev Valeryevich Lebedev worked at the Department of Faculty Surgery of the Pavlov University for 34 years, including 17 years as the head of the Department. On the occasion of the 100th anniversary of the birth of the surgeon, teacher and organizer of the angiosurgical service in St. Petersburg, we publish materials dedicated to the life of L. V. Lebedev, the scientific directions that he developed in Leningrad-St. Petersburg and in the 1st LMI – Pavlov University.

Purpose of the study: to evaluate the results of using a protocol for the prevention of bleeding in cardiac surgical patients with pathology of the aortic valve and aortic root to optimize tactics for preventing bleeding.Materials and methods: the first group included 185 cardiac surgical patients with pathology of the aortic valve and aortic root, who underwent surgery on the aortic valve, during the treatment of which a bleeding prevention protocol was applied. The second group consisted of 237 cardiac surgical patients with pathology of the aortic valve and aortic root who underwent surgery on the aortic valve, during whose treatment a bleeding prevention protocol was not used. Data were collected on the management tactics of the preoperative, intraoperative and postoperative periods, such as:– anamnestic data, results of echocardiographic examination, laboratory data: preoperative level of hemoglobin, fibrinogen;– intraoperative level of hemoglobin, fibrinogen, dose of transfused cryoprecipitate, thromboelastometry data, intraoperative blood loss;– drainage discharge during 1 day of the postoperative period, frequency of bleeding, resternotomy, and deaths.Study results: In the second group of patients, the number of cases of intraoperative hypofibrinogenemia was almost 5 times greater than in group 1; out of 237 patients, 62 (26.2%) had a critically low level of fibrinogen. Fibrinogen hemodilution coagulopathy (intraoperative hypofibrinogenemia) was associated with resternotomy: Х2 = 63.375, p = 0, df = 1, HR = 11.686, 95% CI: 5.61-24.33. Complications associated with bleeding were more common in the second group of patients – 44 (18,6%) cases out of 237 operated patients, Х2 = 10,6; р = 0,001, Х2Yates = 9,693; р = 0,002, RR = 2,453, 95% CI: 1,39-4,34. In the first group, there were only 14 (7,6%) cases of complications associated with bleeding out of 185 operated patients. Significant differences were also found in the frequency of resternotomies: in group 1 – 3 (1.6%) cases, in group 2 – 28 (11.8%) Х2 = 15,859; р = 0 (Х2Yates = 14,397, р = 0; р (F) = 0; RR = 7,286, 95% CI: 2,25-23,59). Of 185 operations in group 1, only 3 cases of resternotomy were observed, which corresponds to 1.6% of all patients in group 1. Upon repeated inspection of the surgical wound, surgical sources of bleeding were identified in all 3 cases. Of the 237 operations in group 2, there were 28 cases of repeated revision of the surgical wound. Of the 28 resternotomies, only in 15 cases a surgical source of bleeding was identified, therefore, the remaining 13 cases of bleeding occurred due to coagulopathy. In group 1, there were no cases of resternotomy performed due to hypocoagulable bleeding. A statistically significant association was found between preoperative anemia and resternotomy (x2, p = 0.039, RR = 2.03, 95% CI: 1-4).Conclusions:1) intraoperative hypofibrinogenemia increases the risk of resternotomy 11 times (x2 = 63.375, p = 0, df = 1, RR = 11.686, 95% CI: 5.61-24.33);2) preoperative anemia doubles the risk of resternotomy (p = 0,039, ОR = 2.03, 95% CI: 1-4);3) when using the bleeding prevention protocol, intraoperative hypofibrinogenemia occurs 5 times less often;4) when using the bleeding prevention protocol, complications associated with bleeding are 2.5 times less common: Х2 = 10,6; р = 0,001, Х2Yates = 9,693; р = 0,002, RR = 2,453, 95% CI: 1,39-4,34;5) when using a bleeding prevention protocol, the risk of resternotomy is reduced by 7 times: Х2 = 15,859; р = 0 (Х2Yates = 14,397, р = 0; р (F) = 0; RR = 7,286, 95% CI: 2,25-23,59).

An outstanding surgeon and scientist, a talented teacher, one of the pioneers of world cardiac surgery, Honored Scientist of the RSFSR (1964), laureate of the USSR State Prize (1988), Colonel of the Medical Service, Doctor of Medical Sciences, Professor Vasily Ivanovich Kolesov was born on September 24, 1904 in the village Martyanovskaya (now Ust-Kubinsky district) Vologda province. In 1931, he graduated from the 2nd Leningrad Medical Institute and worked as a therapist in the village of Chusovoy, Perm Region. From 1934 to 1938, he taught at the Department of Faculty Surgery of the Perm Medical Institute, where he prepared his Ph.D. thesis, which he defended at the Leningrad State Institute for Advanced Medical Training in 1938 and moved to Leningrad. In 1953–1955, V. I. Kolesov headed the Department of General Surgery, and in 1955–1976 – Department and Clinic of Faculty Surgery of the 1st Leningrad Medical Institute named after Academician I. P. Pavlov. On February 25, 1964, for the first time in the world, Vasily Ivanovich sewed the distal end of the transected mammary artery into the end of the circumflex artery of the heart in a seriously ill man without coronary artery perfusion. At the end of the 1960s, V. I. Kolesov began performing anastomoses using the ASC-4 vascular stapling device, as well as devices designed by his son, E. V. Kolesov (ASC-UV and ASC-VAK), which significantly reduced the time of formation of a vascular anastomosis on a beating heart. On February 5, 1968, V. I. Kolesov for the first time operated on a patient 7 hours after her ECG registered myocardial infarction, and on May 17 of the same year, he restored the blood supply to the heart of a patient with unstable angina, proving for the first time in the world the possibility of surgically preventing the development of myocardial infarction. V. I. Kolesov published about 200 scientific papers, including 8 monographs on general, thoracic and cardiac surgery. Vasily Ivanovich and Evgeny Vasilyevich Kolesov were the authors of more than ten global and domestic priorities. V. I. Kolesov was awarded two Orders of the Patriotic War, I and II degrees, the Order of the Red Banner of Labor, medals «For the Defense of Leningrad», «For Military Merit», «For Victory over Germany», as well as many honorary insignia. Professor Vasily Ivanovich Kolesov died on August 2, 1992 and was buried at the Bogoslovskoye cemetery in Saint Petersburg.

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.

The OBJECTIVE was to estimate the left ventricular stroke volume calculated using the Reuleaux triangle formula, and compare with the parameters obtained from measurements in the left ventricle outflow tract. METHODS AND MATERIALS. A prospective cross-sectional study of the dimensions of the left ventricular outflow tract (LVOT), the aortic valve, and the velocity-time integral (VTI) was carried out, followed by calculation of the left ventricular stroke volume in the LVOT and aortic valve in 36 patients receiving renal replacement therapy. RESULTS. The sizes of anatomical structures were determined in 36 patients. The average value of the LVOT area was calculated – 3.8 cm2, the average value of the area of the aortic valve (AV) opening was 2.8 cm2, the AV area according to the circle formula – 3.14 cm2, the AV area according to the Reuleaux triangle formula – 2.8 cm2. The mean value of the VTI in the LVOT was 21 cm; the VTI on the AV was 26.9 cm. The stroke volume (SV) in the LVOT was 70.85 ml, the SV on the AV by the area of the AV opening was 70.9 ml, the SV on the AV according to the circle formula – 76.5 ml, SV for AV according to the Reuleaux triangle formula – 68.72 ml. In a comparative analysis of the results of mathematical calculations, it was revealed that, in comparison with the SV in LVOT, the discrepancy between the results was more than 30 % when using the circle formula (χ2=4.1, p=0.04), in comparison with the Reuleaux triangle formula (13.8 % versus 4.1 %, respectively). CONCLUSION. Parameters of the left ventricular stroke volume calculated with the Reuleaux triangle formula matches to the reference values selected in the study, calculated for the left ventricular outflow tract.