Pub Date : 2024-05-22DOI: 10.21688/1681-3472-2024-1-50-58
M. Gurianov, E. Kharitonova, P. Yablonskiy
Introduction: Ventricular fibrillation (VF) is a fatal arrhythmia that causes sudden cardiac death in the overwhelming majority of cases (> 80%).Objective: The study was aimed to examine frequency and amplitude structure of VF upon canine heart reperfusion after ischemia within 30–240 s. Methods: Six experiments were conducted on 12 dogs. In each experiment the isolated heart of the one dog was perfused with the blood of the other (supporting) dog. Nine episodes of heart ischemia, lasting 30, 60, 90, 120, 150, 180, 210 and 240 s, were examined in six experiments (72 episodes of heart ischemia at VF in total). Before and after each ischemia episode, ten-minute perfusion and reperfusion were performed at VF, and heart electrograms were recorded. Spectral analysis of electrograms was conducted using Fast Fourier Transform in the range of 0.5–15 Hz. The frequency and proportions of the 1st through the 3rd oscillations of the most powerful frequencies were determined during perfusion, ischemia and reperfusion of the heart at VF (frequency (Hz) — mode; proportions (%) — M±SD; n = 270). Results: The frequency and proportions of the dominant oscillations were stable at perfusion and amounted to 9–10 Hz and 39–41%, respectively, without significant changes after 30-second ischemia (P = 0.09; P = 0.07) and 10-minute reperfusion (from P = 0.07 to P = 0.23; from P = 0.09 to P = 0.21). At the 2nd min of ischemia, the frequency of dominant oscillations decreased to 8.5–9.0 Hz (P = 0.009) but their proportions did not change significantly (P = 0.06). At the 3-4th min of ischemia, the frequency of dominant oscillations decreased to 5.0-7.5 Hz (P = 0.002), and their proportions reduced to 32-33% (P = 0.001). During reperfusion, after 1–2-minute ischemia, the frequency of the dominant oscillations increased to 10.5–12.0 Hz (P = 0.03 and P = 0.002) at the 1st min and decreased to 9.5–10.5 Hz (P = 0.01 and P = 0.009) at the 2nd min of reperfusion processes. After 3–4 minute ischemia, the frequency of dominant oscillations increased to 12.5–14.0 Hz (P = 0.001) at the 1st min and decreased to 10–11 Hz (P = 0.005 and P = 0.007) at the 2nd min of reperfusion processes. Further, the proportions of dominant oscillations after 1–2-minute ischemia decreased to 33–36% (P = 0.003 and P = 0.002) at the 1st min and increased to 39% (P = 0.005 and P = 0.001) at the 2nd min of reperfusion. After 3–4-minute ischemia, the proportion of dominant oscillations remained reduced (32–34%) at the 1st min but increased to 36–40% (P = 0.005 and P = 0.007) at the 2nd min during reperfusion.Conclusion: The organized VF activity was more sensitive to reperfusion than to ischemia, as evidenced by more significant changes in the VF frequency and amplitude structure at reperfusion relative to ischemia. VF was specified by explosive (impulse) destabilization of the organized activity at reperfusion, which manifested itself by an increase in the frequency of dominant FV oscillations at the 1st min
{"title":"Frequency and amplitude structure of ventricular fibrillation of canine heart during ischemia and reperfusion: an experimental study","authors":"M. Gurianov, E. Kharitonova, P. Yablonskiy","doi":"10.21688/1681-3472-2024-1-50-58","DOIUrl":"https://doi.org/10.21688/1681-3472-2024-1-50-58","url":null,"abstract":"Introduction: Ventricular fibrillation (VF) is a fatal arrhythmia that causes sudden cardiac death in the overwhelming majority of cases (> 80%).Objective: The study was aimed to examine frequency and amplitude structure of VF upon canine heart reperfusion after ischemia within 30–240 s. Methods: Six experiments were conducted on 12 dogs. In each experiment the isolated heart of the one dog was perfused with the blood of the other (supporting) dog. Nine episodes of heart ischemia, lasting 30, 60, 90, 120, 150, 180, 210 and 240 s, were examined in six experiments (72 episodes of heart ischemia at VF in total). Before and after each ischemia episode, ten-minute perfusion and reperfusion were performed at VF, and heart electrograms were recorded. Spectral analysis of electrograms was conducted using Fast Fourier Transform in the range of 0.5–15 Hz. The frequency and proportions of the 1st through the 3rd oscillations of the most powerful frequencies were determined during perfusion, ischemia and reperfusion of the heart at VF (frequency (Hz) — mode; proportions (%) — M±SD; n = 270). Results: The frequency and proportions of the dominant oscillations were stable at perfusion and amounted to 9–10 Hz and 39–41%, respectively, without significant changes after 30-second ischemia (P = 0.09; P = 0.07) and 10-minute reperfusion (from P = 0.07 to P = 0.23; from P = 0.09 to P = 0.21). At the 2nd min of ischemia, the frequency of dominant oscillations decreased to 8.5–9.0 Hz (P = 0.009) but their proportions did not change significantly (P = 0.06). At the 3-4th min of ischemia, the frequency of dominant oscillations decreased to 5.0-7.5 Hz (P = 0.002), and their proportions reduced to 32-33% (P = 0.001). During reperfusion, after 1–2-minute ischemia, the frequency of the dominant oscillations increased to 10.5–12.0 Hz (P = 0.03 and P = 0.002) at the 1st min and decreased to 9.5–10.5 Hz (P = 0.01 and P = 0.009) at the 2nd min of reperfusion processes. After 3–4 minute ischemia, the frequency of dominant oscillations increased to 12.5–14.0 Hz (P = 0.001) at the 1st min and decreased to 10–11 Hz (P = 0.005 and P = 0.007) at the 2nd min of reperfusion processes. Further, the proportions of dominant oscillations after 1–2-minute ischemia decreased to 33–36% (P = 0.003 and P = 0.002) at the 1st min and increased to 39% (P = 0.005 and P = 0.001) at the 2nd min of reperfusion. After 3–4-minute ischemia, the proportion of dominant oscillations remained reduced (32–34%) at the 1st min but increased to 36–40% (P = 0.005 and P = 0.007) at the 2nd min during reperfusion.Conclusion: The organized VF activity was more sensitive to reperfusion than to ischemia, as evidenced by more significant changes in the VF frequency and amplitude structure at reperfusion relative to ischemia. VF was specified by explosive (impulse) destabilization of the organized activity at reperfusion, which manifested itself by an increase in the frequency of dominant FV oscillations at the 1st min","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"39 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141109102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-16DOI: 10.21688/1681-3472-2024-1-59-72
A. Romanov, V. Beloborodov, V. V. Shabanov, A. Filippenko, D.A. Elesin, V.A. Boboshko, S. Khrushchev, P. Ruzankin
Introduction: Pulmonary vein ostia isolation (PVI) is the main method for catheter ablation (CA) in patients with atrial fibrillation (AF) who are refractory to antiarrhythmic drug therapy (AAD). The data regarding comparison of the remote magnetic-guided navigation (RMN) and manual (MAN) radiofrequency ablation approaches for PVI in patients with AF and enlarged left atrium (LA) are limited.Objective: The study was aimed to comparison of the safety and long-term efficacy of the radiofrequency CA associated with RMN and MAN using in patients with AF and enlarged LA.Methods: The retrospective cohort included 534 patients (mean age 59.2 ± 8.7 years, 41.6% female) with different AF forms and LA >4.5 cm who underwent PVI between 2016 and 2019. The patients were divided into two groups: the RMN group (n = 267) and MAN group (n = 267). The primary safety objective was associated with preventing perisurgical complications, and the primary efficacy objective was disengagement from AF / atrial flutter (AFl) / AT (atrial tachycardia), lasting > 30 seconds, in the 3-month period after the index procedure without AAD. The comparison of the results with 1:1 propensity score matching (PSM) was applied on the basis of 11 covariates. After PSM, 235 patients were selected for each group. The entire cohort was additionally divided into the subgroups of paroxysmal AF (n = 355) and non-paroxysmal AF (n = 179) to increase efficacy assessment. After PSM, 310 and 136 patients with paroxysmal and non-paroxysmal AF were analyzed, respectively.Results: In the entire cohort after PSM (n = 470) patients were balanced completely according to AF forms. The mean values of LA diameter were 4.98 ± 0.61 cm and 4.94 ± 0.58 cm in the RMN and MAN groups, respectively. The long-term efficacy assessment was performed in 448 patients of the both groups excluding 22 (4.7%) patients due to failed contacts. The median follow-up period was 24 months (minimum 3 and maximum 72 months). In the matched cohorts, perisurgical complications were detected in 11 (4.7%) patients of the MAN group and 2 (0.9%) patients of the RMN group (Р = 0.021, OR = 5.7; 95% CI [1.22, 53.5]). The disengagement from AF/AFl/AT after 36 months of the follow up amounted to 62.6% in the RMN group and 47.9% in the MAN group (for entire follow up, P = 0.005, HR = 1.54; 95% CI [1.14, 2.08]). For paroxysmal AF subgroup (n = 310), the disengagement from AF/AFl/AT after 36 months of the follow was 67.1% in the RMN group and 60.6% in the MAN group (for entire follow up, P = 0.15, HR = 1.34; 95% CI [0.90, 1.98]). In the non-paroxysmal AF subgroup (n = 136), the disengagement from AF/AFl/AT after 36 months of the follow up was higher in the RMN group as compared to the MAN group (59.6% and 30.4%, respectively, for entire follow up, P = 0.005, HR = 2.01; 95% CI [1.23, 3.29]) predominantly due to persistent AF.Conclusion: The present propensity-score matching study evidentiated that RMN CA was superior over manual CA for the inter
{"title":"Remote magnetic-guided navigation versus manual radiofrequency ablation approach in the interventional treatment of patients with atrial fibrillation and enlarged left atrium: propensity-score matching assessment","authors":"A. Romanov, V. Beloborodov, V. V. Shabanov, A. Filippenko, D.A. Elesin, V.A. Boboshko, S. Khrushchev, P. Ruzankin","doi":"10.21688/1681-3472-2024-1-59-72","DOIUrl":"https://doi.org/10.21688/1681-3472-2024-1-59-72","url":null,"abstract":"Introduction: Pulmonary vein ostia isolation (PVI) is the main method for catheter ablation (CA) in patients with atrial fibrillation (AF) who are refractory to antiarrhythmic drug therapy (AAD). The data regarding comparison of the remote magnetic-guided navigation (RMN) and manual (MAN) radiofrequency ablation approaches for PVI in patients with AF and enlarged left atrium (LA) are limited.Objective: The study was aimed to comparison of the safety and long-term efficacy of the radiofrequency CA associated with RMN and MAN using in patients with AF and enlarged LA.Methods: The retrospective cohort included 534 patients (mean age 59.2 ± 8.7 years, 41.6% female) with different AF forms and LA >4.5 cm who underwent PVI between 2016 and 2019. The patients were divided into two groups: the RMN group (n = 267) and MAN group (n = 267). The primary safety objective was associated with preventing perisurgical complications, and the primary efficacy objective was disengagement from AF / atrial flutter (AFl) / AT (atrial tachycardia), lasting > 30 seconds, in the 3-month period after the index procedure without AAD. The comparison of the results with 1:1 propensity score matching (PSM) was applied on the basis of 11 covariates. After PSM, 235 patients were selected for each group. The entire cohort was additionally divided into the subgroups of paroxysmal AF (n = 355) and non-paroxysmal AF (n = 179) to increase efficacy assessment. After PSM, 310 and 136 patients with paroxysmal and non-paroxysmal AF were analyzed, respectively.Results: In the entire cohort after PSM (n = 470) patients were balanced completely according to AF forms. The mean values of LA diameter were 4.98 ± 0.61 cm and 4.94 ± 0.58 cm in the RMN and MAN groups, respectively. The long-term efficacy assessment was performed in 448 patients of the both groups excluding 22 (4.7%) patients due to failed contacts. The median follow-up period was 24 months (minimum 3 and maximum 72 months). In the matched cohorts, perisurgical complications were detected in 11 (4.7%) patients of the MAN group and 2 (0.9%) patients of the RMN group (Р = 0.021, OR = 5.7; 95% CI [1.22, 53.5]). The disengagement from AF/AFl/AT after 36 months of the follow up amounted to 62.6% in the RMN group and 47.9% in the MAN group (for entire follow up, P = 0.005, HR = 1.54; 95% CI [1.14, 2.08]). For paroxysmal AF subgroup (n = 310), the disengagement from AF/AFl/AT after 36 months of the follow was 67.1% in the RMN group and 60.6% in the MAN group (for entire follow up, P = 0.15, HR = 1.34; 95% CI [0.90, 1.98]). In the non-paroxysmal AF subgroup (n = 136), the disengagement from AF/AFl/AT after 36 months of the follow up was higher in the RMN group as compared to the MAN group (59.6% and 30.4%, respectively, for entire follow up, P = 0.005, HR = 2.01; 95% CI [1.23, 3.29]) predominantly due to persistent AF.Conclusion: The present propensity-score matching study evidentiated that RMN CA was superior over manual CA for the inter","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141127363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.21688/1681-3472-2024-1-41-49
A. Boyko, N.O. Kamenshchikov, A. G. Miroshnichenko, Y. Podoksenov, Y. Svirko, V. A. Lugovskiy, M. L. Diakova, I. V. Kravchenko, A. Mukhomedzyanov, L. N. Maslov, B. A. Bazarbekova, K. Petlin, D. Panfilov, B. N. Kozlov
Introduction: Surgical interventions under cardiopulmonary bypass and circulatory arrest are complicated by impaired microcirculation in tissues; during hypoxic period the mitochondria dysfunction becomes the leading pathogenetic factor of ischemia-reperfusion injuries. In this regard, the search for methods of organ protection seems to be an extremely urgent task. The using of nitric oxide can be a promising technique given its pluripotent properties.Objective: The study was aimed to examining of mitochondria injuries in kidney biopsies stipulated by cardiopulmonary bypass and circulatory arrest when simulating cardiac surgery, as well as to assessing the potentials of organ protection with nitric oxide in the experiment.Methods: The study was carried out on Altai breed sheep and included simulating of cardiopulmonary bypass and circulatory arrest. The first group (n = 6) was provided with intraoperative nitric oxide donation. The second group (n = 6) served as a control (without nitric oxide donation). Mitochondria injuries were assessed in kidney biopsies by measuring transmembrane potential and Ca2+-binding capacity of organelles, as well as by determining ATP and lactate concentrations.Results: Nitric oxide therapy was associated with less mitochondria dysfunction in kidney biopsies compared with the control group. There was a steady trend to the amelioration of the energy maintenance in the renal parenchyma in the nitric oxide donation group.Conclusion: A steady trend towards optimizing the energy supply of tissues under cardiopulmonary bypass and circulatory arrest was revealed in an experiment against the background of NO donation at a concentration of 80 ppm. Received 11 February 2024. Revised 28 March 2024. Accepted 29 March 2024. Funding: The The study was carried out within the framework of the state assignment “Protection of organs by nitric oxide in cardiovascular surgery: technological support (synthesis and delivery devices), mechanisms for implementing protective effects and impact on clinical outcomes” (topic No. 122123000017-3). Conflict of interest: The authors declare no conflict of interest. Contribution of the authors Conception and study design: A.M. Boyko, N.O. Kamenshchikov, Yu.K. Podoksenov, L.N. Maslov, B.N. Kozlov Data collection and analysis: A.M. Boyko, Yu.S. Svirko, V.A. Lugovskiy, A.V. Mukhomedzyanov, B.A. BazarbekovaStatistical analysis: I.V. KravchenkoDrafting the article: A.M. Boyko Critical revision of the article: N.O. Kamenshchikov, A.G. Miroshnichenko, Yu.K. Podoksenov, M.L. Diakova, K.A. Petlin, D.S. Panfilov, B.N. KozlovFinal approval of the version to be published: A.M. Boyko, N.O. Kamenshchikov, A.G. Miroshnichenko, Yu.K. Podoksenov, Yu.S. Svirko, V.A. Lugovskiy, M.L. Diakova, I.V. Kravchenko, A.V. Mukhomedzyanov, L.N. Maslov, B.A. Bazarbekova, K.A. Petlin, D.S. Panfilov, B.N. Kozlov
导言：在心肺旁路和循环停止状态下进行的外科手术会因组织微循环受损而变得复杂；在缺氧期间，线粒体功能障碍成为缺血再灌注损伤的主要致病因素。因此，寻找器官保护方法似乎是一项极为紧迫的任务。鉴于一氧化氮的多能特性，使用一氧化氮可能是一种很有前景的技术：本研究的目的是在模拟心脏手术时，检查心肺旁路和循环停止对肾活检组织线粒体造成的损伤，并在实验中评估一氧化氮保护器官的潜力：研究在阿尔泰种羊身上进行，包括模拟心肺旁路和循环停止。第一组（n = 6）在术中捐献一氧化氮。第二组（n = 6）为对照组（无一氧化氮捐献）。通过测量细胞器的跨膜电位和 Ca2+ 结合能力，以及测定 ATP 和乳酸浓度，评估肾活检组织中线粒体的损伤情况：结果：与对照组相比，一氧化氮疗法可减少肾活检中线粒体的功能障碍。一氧化氮捐赠组肾脏实质的能量维持呈稳定改善趋势：结论：以浓度为 80 ppm 的一氧化氮捐献为背景的实验显示，在心肺旁路和循环停止状态下，组织的能量供应有稳定的优化趋势。2024年3月28日修订。2024 年 3 月 29 日接受：本研究在国家任务 "一氧化氮在心血管手术中对器官的保护：技术支持（合成和输送装置）、保护作用的实现机制以及对临床结果的影响"（课题编号：122123000017-3）的框架内进行：作者声明无利益冲突：A.M. Boyko、N.O. Kamenshchikov、Yu.K. Podoksenov、L.N. Maslov、B.N. Kozlov 数据收集和分析：A.M. Boyko、Yu.S. Svirko、V.A. Lugovskiy、A.V. Mukhomedzyanov、B.A. Bazarbekova统计分析：I.V. Kravchenko文章起草：A.M. BoykoA.M. Boyko Critical revision of the article：N.O. Kamenshchikov, A.G. Miroshnichenko, Yu.K. Podoksenov, M.L. Diakova, K.A. Petlin, D.S. Panfilov, B.N. KozlovFinal approval of the version to be published：A.M. Boyko、N.O. Kamenshchikov、A.G. Miroshnichenko、Yu.K. Podoksenov、Yu.S. Svirko、V.A. Lugovskiy、M.L. Diakova、I.V. Kravchenko、A.V. Mukhomedzyanov、L.N. Maslov、B.A. Bazarbekova、K.A. Petlin、D.S. Panfilov、B.N. Kozlov
{"title":"Nitric oxide and mitochondria injuries in kidney tissue upon a simulation of cardiopulmonary bypass and circulatory arrest: an experimental study","authors":"A. Boyko, N.O. Kamenshchikov, A. G. Miroshnichenko, Y. Podoksenov, Y. Svirko, V. A. Lugovskiy, M. L. Diakova, I. V. Kravchenko, A. Mukhomedzyanov, L. N. Maslov, B. A. Bazarbekova, K. Petlin, D. Panfilov, B. N. Kozlov","doi":"10.21688/1681-3472-2024-1-41-49","DOIUrl":"https://doi.org/10.21688/1681-3472-2024-1-41-49","url":null,"abstract":"Introduction: Surgical interventions under cardiopulmonary bypass and circulatory arrest are complicated by impaired microcirculation in tissues; during hypoxic period the mitochondria dysfunction becomes the leading pathogenetic factor of ischemia-reperfusion injuries. In this regard, the search for methods of organ protection seems to be an extremely urgent task. The using of nitric oxide can be a promising technique given its pluripotent properties.Objective: The study was aimed to examining of mitochondria injuries in kidney biopsies stipulated by cardiopulmonary bypass and circulatory arrest when simulating cardiac surgery, as well as to assessing the potentials of organ protection with nitric oxide in the experiment.Methods: The study was carried out on Altai breed sheep and included simulating of cardiopulmonary bypass and circulatory arrest. The first group (n = 6) was provided with intraoperative nitric oxide donation. The second group (n = 6) served as a control (without nitric oxide donation). Mitochondria injuries were assessed in kidney biopsies by measuring transmembrane potential and Ca2+-binding capacity of organelles, as well as by determining ATP and lactate concentrations.Results: Nitric oxide therapy was associated with less mitochondria dysfunction in kidney biopsies compared with the control group. There was a steady trend to the amelioration of the energy maintenance in the renal parenchyma in the nitric oxide donation group.Conclusion: A steady trend towards optimizing the energy supply of tissues under cardiopulmonary bypass and circulatory arrest was revealed in an experiment against the background of NO donation at a concentration of 80 ppm.\u0000Received 11 February 2024. Revised 28 March 2024. Accepted 29 March 2024.\u0000Funding: The The study was carried out within the framework of the state assignment “Protection of organs by nitric oxide in cardiovascular surgery: technological support (synthesis and delivery devices), mechanisms for implementing protective effects and impact on clinical outcomes” (topic No. 122123000017-3).\u0000Conflict of interest: The authors declare no conflict of interest.\u0000Contribution of the authors Conception and study design: A.M. Boyko, N.O. Kamenshchikov, Yu.K. Podoksenov, L.N. Maslov, B.N. Kozlov Data collection and analysis: A.M. Boyko, Yu.S. Svirko, V.A. Lugovskiy, A.V. Mukhomedzyanov, B.A. BazarbekovaStatistical analysis: I.V. KravchenkoDrafting the article: A.M. Boyko Critical revision of the article: N.O. Kamenshchikov, A.G. Miroshnichenko, Yu.K. Podoksenov, M.L. Diakova, K.A. Petlin, D.S. Panfilov, B.N. KozlovFinal approval of the version to be published: A.M. Boyko, N.O. Kamenshchikov, A.G. Miroshnichenko, Yu.K. Podoksenov, Yu.S. Svirko, V.A. Lugovskiy, M.L. Diakova, I.V. Kravchenko, A.V. Mukhomedzyanov, L.N. Maslov, B.A. Bazarbekova, K.A. Petlin, D.S. Panfilov, B.N. Kozlov","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"58 46","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140701392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.21688/1681-3472-2024-1-26-40
M. Yadgarov, L. Berikashvili, P. Polyakov, K. Kadantseva, A. Smirnova, I. Kuznetsov, A. Yakovlev, V. Likhvantsev
Introduction: The reliability of statistical analysis and its results is becoming a focal point in scientific discourse, overshadowing concerns about statistical significance. Systematic reviews and meta-analyses are characterized by a range of serious statistical and methodological limitations, including insufficient statistical power, clinical and statistical heterogeneity, systematic errors, potential low quality of included examinations, limited data availability, and publication bias. In this context, “Trial Sequential Analysis” (TSA) emerges as a promising methodological tool used in combination with meta-analyses to enhance the precision and robustness of scientific conclusions. Objective: The study is aimed to demonstrating potential scenarios for the using TSA and its role in improving the reliability of scientific conclusions through meta-analyses published in Russian journals on anesthesiology-resuscitation, as well as the authors’ own meta-analyses.Methods: This study is a systematic review without a detailed description of the case studies. The search for meta-analyses was conducted using the keywords “meta-analysis”, “mortality”, “delirium”, “sedation”. Two researchers independently reviewed the titles and abstracts of the selected meta-analyses and extracted data. TSA was conducted for all meta-analyses using “TSA software” (Copenhagen, Denmark). Results: 6 studies were considered, and 7 TSA evaluations were performed. Six out of the seven TSA evaluations confirmed the conclusions of the pertinent meta-analyses. In one TSA, the cumulative Z-line did not reach the required sample size, highlighting the need for additional studies to definitively confirm the result. In two TSAs, the sample size in the meta-analysis was insufficient to draw definitive conclusions. The application of TSA in these cases could provide more substantiated and cautious conclusions.Conclusion: This study explores various scenarios for the application of TSA in meta-analyses published in both Russian and international journals in the fields of anesthesiology and resuscitation. The significance of TSA for enhancing the validity and clinical relevance of research findings was substantiated. Received 3 February 2024. Revised 18 March 2024. Accepted 20 March 2024. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: M.Ya. YadgarovData collection and analysis: M.Ya. Yadgarov, L.B. Berikashvili, P.A. PolyakovStatistical analysis: M.Ya. Yadgarov, P.A. PolyakovDrafting the article: M.Ya. Yadgarov, L.B. Berikashvili, K.K. Kadantseva, A.V. Smirnova, I.V. Kuznetsov, A.A. YakovlevCritical revision of the article: V.V. LikhvantsevFinal approval of the version to be published: M.Ya. Yadgarov, L.B. Berikashvili, P.A. Polyakov, K.K. Kadantseva, A.V. Smirnova, I.V. Kuznetsov, A.A. Yakovlev, V.V. Likhvantsev
导言：统计分析及其结果的可靠性正成为科学界讨论的焦点，其重要性超过了对统计显著性的关注。系统综述和荟萃分析在统计和方法上存在一系列严重的局限性，包括统计能力不足、临床和统计异质性、系统误差、所纳入研究的潜在低质量、数据可用性有限以及发表偏倚。在这种情况下，"试验序列分析"（TSA）作为一种有前途的方法学工具出现了，它与荟萃分析相结合，可提高科学结论的精确性和稳健性。研究目的本研究旨在通过俄罗斯麻醉学-复苏学期刊上发表的荟萃分析以及作者自己的荟萃分析，展示使用 TSA 的潜在方案及其在提高科学结论可靠性方面的作用：本研究为系统性综述，未对案例研究进行详细描述。使用关键词 "荟萃分析"、"死亡率"、"谵妄"、"镇静 "搜索荟萃分析。两名研究人员独立审阅了所选荟萃分析的标题和摘要，并提取了数据。使用 "TSA 软件"（丹麦哥本哈根）对所有荟萃分析进行 TSA 分析。结果：共考虑了 6 项研究，并进行了 7 次 TSA 评估。七项 TSA 评估中有六项证实了相关荟萃分析的结论。在一项 TSA 中，累积 Z 线没有达到所需的样本量，这说明需要进行更多的研究来最终确认结果。在两项 TSA 中，荟萃分析的样本量不足以得出明确结论。在这些病例中应用 TSA 可以得出更有依据、更谨慎的结论：本研究探讨了在麻醉学和复苏领域的俄罗斯和国际期刊上发表的荟萃分析中应用 TSA 的各种情况。TSA对于提高研究结果的有效性和临床相关性的意义得到了证实。2024年3月18日修订。2024年3月20日接受：本研究未获得赞助：作者声明无利益冲突：M.Ya.Yadgarov数据收集和分析：M.Ya：数据收集和分析：M.Ya.Yadgarov, L.B. Berikashvili, P.A. Polyakov统计分析：统计分析：M.Ya.Yadgarov, P.A. Polyakov起草文章：文章起草：M.Ya.Yadgarov, L.B. Berikashvili, K.K. Kadantseva, A.V. Smirnova, I.V. Kuznetsov, A.A. YakovlevCritical revision of the article：V.V. LikhvantsevFinal approval of the version to be published：M.Ya.Yadgarov, L.B. Berikashvili, P.A. Polyakov, K.K. Kadantseva, A.V. Smirnova, I.V. Kuznetsov, A.A. Yakovlev, V.V. Likhvantsev
{"title":"Trial sequential analysis in anesthesiology and intensive care: a systematic review","authors":"M. Yadgarov, L. Berikashvili, P. Polyakov, K. Kadantseva, A. Smirnova, I. Kuznetsov, A. Yakovlev, V. Likhvantsev","doi":"10.21688/1681-3472-2024-1-26-40","DOIUrl":"https://doi.org/10.21688/1681-3472-2024-1-26-40","url":null,"abstract":"Introduction: The reliability of statistical analysis and its results is becoming a focal point in scientific discourse, overshadowing concerns about statistical significance. Systematic reviews and meta-analyses are characterized by a range of serious statistical and methodological limitations, including insufficient statistical power, clinical and statistical heterogeneity, systematic errors, potential low quality of included examinations, limited data availability, and publication bias. In this context, “Trial Sequential Analysis” (TSA) emerges as a promising methodological tool used in combination with meta-analyses to enhance the precision and robustness of scientific conclusions. Objective: The study is aimed to demonstrating potential scenarios for the using TSA and its role in improving the reliability of scientific conclusions through meta-analyses published in Russian journals on anesthesiology-resuscitation, as well as the authors’ own meta-analyses.Methods: This study is a systematic review without a detailed description of the case studies. The search for meta-analyses was conducted using the keywords “meta-analysis”, “mortality”, “delirium”, “sedation”. Two researchers independently reviewed the titles and abstracts of the selected meta-analyses and extracted data. TSA was conducted for all meta-analyses using “TSA software” (Copenhagen, Denmark). Results: 6 studies were considered, and 7 TSA evaluations were performed. Six out of the seven TSA evaluations confirmed the conclusions of the pertinent meta-analyses. In one TSA, the cumulative Z-line did not reach the required sample size, highlighting the need for additional studies to definitively confirm the result. In two TSAs, the sample size in the meta-analysis was insufficient to draw definitive conclusions. The application of TSA in these cases could provide more substantiated and cautious conclusions.Conclusion: This study explores various scenarios for the application of TSA in meta-analyses published in both Russian and international journals in the fields of anesthesiology and resuscitation. The significance of TSA for enhancing the validity and clinical relevance of research findings was substantiated.\u0000Received 3 February 2024. Revised 18 March 2024. Accepted 20 March 2024.\u0000Funding: The study did not have sponsorship.\u0000Conflict of interest: The authors declare no conflict of interest.\u0000Contribution of the authorsConception and study design: M.Ya. YadgarovData collection and analysis: M.Ya. Yadgarov, L.B. Berikashvili, P.A. PolyakovStatistical analysis: M.Ya. Yadgarov, P.A. PolyakovDrafting the article: M.Ya. Yadgarov, L.B. Berikashvili, K.K. Kadantseva, A.V. Smirnova, I.V. Kuznetsov, A.A. YakovlevCritical revision of the article: V.V. LikhvantsevFinal approval of the version to be published: M.Ya. Yadgarov, L.B. Berikashvili, P.A. Polyakov, K.K. Kadantseva, A.V. Smirnova, I.V. Kuznetsov, A.A. Yakovlev, V.V. Likhvantsev","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"7 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.21688/1681-3472-2024-1-19-25
V. Bazylev, A. Mikulyak, M. Shmatkov, I.Ya. Senzhapov, M.A. Denisov
Mitral defects are the most common acquired heart disturbances. The only radical treatment for severe valve stenosis or its insufficiency is surgical correction of the defects. The main challenge of implanting a mechanical mitral prosthesis is associated to its thrombosis complication that demands repeated surgical intervention on re-replacement of the mitral prosthesis. Herein, a clinical case of patient P. (58 years old) is presented, who was admitted to the Federal Center for Cardiovascular Surgery (Penza, Russia) with thrombosis of the mitral valve prosthesis and its dysfunction. The patient has already been undergone repeated surgery to replace the mitral valve. The purpose of the clinical case description is to demonstrate the using of open mitral valve replacement method based on the valve-in-valve technique with a transcatheter balloon-expandable prosthesis, its efficacy and safety.The considered method of treatment can simplify the main stage of the surgical intervention; reduce the time of artificial circulation and aortic clamping as well as the number of intraoperative complications. This type of surgical treatment can be considered as an option for re-prosthesis in patients at high surgical risk who are indicated for re-intervention due to impaired function of previously implanted heart valve prosthesis. A clinical case attests the possibility, efficacy and safety of using a balloon-expandable prosthesis for mitral valve replacement with the valve-in-valve technique upon repeated surgical interventions. Received 12 January 2024. Revised 16 February 2024. Accepted 19 February 2024. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsLiterature review: M.A. DenisovDrafting the article: I.Ya. SenzhapovCritical revision of the article: A.I. MikulyakSurgical treatment: V.V. Bazylev, M.G. ShmatkovFinal approval of the version to be published: V.V. Bazylev, A.I. Mikulyak, M.G. Shmatkov, I.Ya. Senzhapov, M.A. Denisov
二尖瓣缺损是最常见的后天性心脏障碍。对于严重的瓣膜狭窄或瓣膜功能不全，唯一的根治方法就是手术矫正缺损。植入机械性二尖瓣假体的主要挑战在于其血栓形成并发症，需要反复进行手术干预，重新更换二尖瓣假体。本文介绍了患者 P.（58 岁）的临床病例，他因二尖瓣假体血栓形成和功能障碍而入住联邦心血管外科中心（俄罗斯奔萨）。患者已多次接受二尖瓣置换手术。临床病例描述的目的是展示基于瓣中瓣技术的开放式二尖瓣置换术与经导管球囊扩张假体的使用方法、其有效性和安全性。对于因先前植入的心脏瓣膜功能受损而需要重新介入治疗的高手术风险患者，这种手术治疗方法可作为重新植入假体的一种选择。一个临床病例证明了在反复手术干预的情况下，采用瓣中瓣技术将球囊扩张型人工瓣膜用于二尖瓣置换术的可能性、有效性和安全性。2024年2月16日修订。2024年2月19日接受。知情同意书：知情同意：获得患者知情同意将记录用于医疗目的：本研究没有赞助：作者声明无利益冲突：M.A. Denisov起草文章：I.Ya.SenzhapovCritical revision of the article：A.I. Mikulyak手术治疗：V.V. Bazylev, M.G. Shmatkov最终批准出版版本：V.V. Bazylev、A.I. Mikulyak、M.G. Shmatkov、I.Ya.Senzhapov, M.A. Denisov
{"title":"Open mitral valve replacement with a balloon-expandable prosthesis using the valve-in-valve technique: a case report","authors":"V. Bazylev, A. Mikulyak, M. Shmatkov, I.Ya. Senzhapov, M.A. Denisov","doi":"10.21688/1681-3472-2024-1-19-25","DOIUrl":"https://doi.org/10.21688/1681-3472-2024-1-19-25","url":null,"abstract":"Mitral defects are the most common acquired heart disturbances. The only radical treatment for severe valve stenosis or its insufficiency is surgical correction of the defects. The main challenge of implanting a mechanical mitral prosthesis is associated to its thrombosis complication that demands repeated surgical intervention on re-replacement of the mitral prosthesis. Herein, a clinical case of patient P. (58 years old) is presented, who was admitted to the Federal Center for Cardiovascular Surgery (Penza, Russia) with thrombosis of the mitral valve prosthesis and its dysfunction. The patient has already been undergone repeated surgery to replace the mitral valve. The purpose of the clinical case description is to demonstrate the using of open mitral valve replacement method based on the valve-in-valve technique with a transcatheter balloon-expandable prosthesis, its efficacy and safety.The considered method of treatment can simplify the main stage of the surgical intervention; reduce the time of artificial circulation and aortic clamping as well as the number of intraoperative complications. This type of surgical treatment can be considered as an option for re-prosthesis in patients at high surgical risk who are indicated for re-intervention due to impaired function of previously implanted heart valve prosthesis. A clinical case attests the possibility, efficacy and safety of using a balloon-expandable prosthesis for mitral valve replacement with the valve-in-valve technique upon repeated surgical interventions.\u0000Received 12 January 2024. Revised 16 February 2024. Accepted 19 February 2024.\u0000Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.\u0000Funding: The study did not have sponsorship.\u0000Conflict of interest: The authors declare no conflict of interest.\u0000Contribution of the authorsLiterature review: M.A. DenisovDrafting the article: I.Ya. SenzhapovCritical revision of the article: A.I. MikulyakSurgical treatment: V.V. Bazylev, M.G. ShmatkovFinal approval of the version to be published: V.V. Bazylev, A.I. Mikulyak, M.G. Shmatkov, I.Ya. Senzhapov, M.A. Denisov","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"6 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140720217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.21688/1681-3472-2024-1-7-18
I. Pchelina, A. M. Chernyavskiy
Igor N. Meshalkin (1913–1996) was Soviet cardiac surgeon, Dr. Sci. (Medicine). He was a graduate of the 2nd Moscow State Medical Institute (2nd MSMI, now the N.I. Pirogov Russian National Research Medical University). He was a participant in the Great Patriotic War. Igor N. Meshalkin began his professional career as a medical resident and an assistant of the clinic of faculty surgery in the 2nd MSMI since 1947; then as a medical resident of the Main Military Hospital of the Armed Forces of the USSR since 1951 and an assistant of the general surgery department of the pediatric faculty in the 2nd MSMI since 1954. In 1958–1963, he headed the Department of Acquired Heart Diseases in the Institute of Experimental Biology and Medicine (now the E.N. Meshalkin National Medical Research Center). In 1963–1977, Igor N. Meshalkin was the head of the department in the Central Clinical Hospital of the 4th Main Directorate of the USSR Ministry of Health. His research interests were focused on urgent abdominal surgery, thoracic surgery, mitral stenosis surgery. Igor N. Meshalkin was the author of 55 scientific works including two monographs. Received 8 November 2023. Accepted 14 November 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article. Acknowledgment: The authors would like to thank Marina, daughter of Igor N. Meshalkin, for providing personal documents and photographs.
伊戈尔-梅沙尔金（Igor N. Meshalkin，1913-1996 年）是苏联心脏外科医生，理学博士（医学）。他毕业于莫斯科国立第二医学院（现为俄罗斯国立皮罗戈夫研究医科大学）。他参加过伟大的卫国战争。伊戈尔-梅沙尔金的职业生涯始于 1947 年，当时他是莫斯科国立第二医学院外科教研室的住院医师和助理医师；1951 年，他成为苏联武装部队总医院的住院医师；1954 年，成为莫斯科国立第二医学院儿科教研室普外科的助理医师。1958-1963 年，他担任实验生物学和医学研究所（现为 E.N. Meshalkin 国家医学研究中心）后天性心脏病系主任。1963-1977 年，伊戈尔-梅沙尔金担任苏联卫生部第四总局中央临床医院科室主任。他的研究兴趣主要集中在紧急腹部手术、胸腔手术、二尖瓣狭窄手术。伊戈尔-梅沙尔金（Igor N. Meshalkin）著有 55 部学术著作，其中包括两部专著。2023年11月8日收到，2023年11月14日接受：本研究没有赞助：作者声明无利益冲突：作者对本文的贡献相同：作者感谢伊戈尔-梅沙尔金（Igor N. Meshalkin）的女儿玛丽娜提供个人资料和照片。
{"title":"To 110th anniversary of cardiac surgeon and researcher Igor N. Meshalkin","authors":"I. Pchelina, A. M. Chernyavskiy","doi":"10.21688/1681-3472-2024-1-7-18","DOIUrl":"https://doi.org/10.21688/1681-3472-2024-1-7-18","url":null,"abstract":"Igor N. Meshalkin (1913–1996) was Soviet cardiac surgeon, Dr. Sci. (Medicine). He was a graduate of the 2nd Moscow State Medical Institute (2nd MSMI, now the N.I. Pirogov Russian National Research Medical University). He was a participant in the Great Patriotic War. Igor N. Meshalkin began his professional career as a medical resident and an assistant of the clinic of faculty surgery in the 2nd MSMI since 1947; then as a medical resident of the Main Military Hospital of the Armed Forces of the USSR since 1951 and an assistant of the general surgery department of the pediatric faculty in the 2nd MSMI since 1954. In 1958–1963, he headed the Department of Acquired Heart Diseases in the Institute of Experimental Biology and Medicine (now the E.N. Meshalkin National Medical Research Center). In 1963–1977, Igor N. Meshalkin was the head of the department in the Central Clinical Hospital of the 4th Main Directorate of the USSR Ministry of Health. His research interests were focused on urgent abdominal surgery, thoracic surgery, mitral stenosis surgery. Igor N. Meshalkin was the author of 55 scientific works including two monographs.\u0000Received 8 November 2023. Accepted 14 November 2023.\u0000Funding: The study did not have sponsorship.\u0000Conflict of interest: The authors declare no conflict of interest.\u0000Contribution of the authors: The authors contributed equally to this article.\u0000Acknowledgment: The authors would like to thank Marina, daughter of Igor N. Meshalkin, for providing personal documents and photographs.","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"1979 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140718880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-26DOI: 10.21688/1681-3472-2023-4-77-88
D. Belov, O.S. Abramovskikh, M.A. Zotova, Y. Loginova, A.A. Fokin
Introduction: The prediction of postoperative abdominal complications is a continuing concern in the cardiac surgery. Identifying genetic predictors will allow a better understanding of the pathophysiological mechanisms underlying postoperative disorders and their prevention.Objective: To identify genetic predictors of abdominal complications after heart surgery.Methods: A prospective study was carried out at the Federal Center for Cardiovascular Surgery (Chelyabinsk) involving 72 patients with abdominal complications and 102 controls without such complications. The distribution of genotypes was assessed for adherence to the Hardy-Weinberg distribution using the exact method according to the SNP-HWE algorithm in the PLINK package (version 1.9). To identify marker genes associated with the risk of abdominal complications, 6 models were evaluated for each polymorphic gene: allelic, codominant, dominant, recessive, overdominant, and log-additive. To analyze the SNPs of the IL6 (rs1800795), TNF (rs1800629), and SERPINE1 (rs1799768) genes, real-time polymerase chain reaction (PCR) was performed on a Rotor-Gene 6000 detecting cycler (Corbett Research Pty Ltd., Mortlake, Australia) using primers and probes manufactured by Syntol CJSC (Moscow, Russia) according to the manufacturer's instructions. To analyze the SNPs of the IL1B (rs1143634), CXCL8 (rs4073), IL10 (rs1800872), APOE (rs429358), FABP2 (rs1799883), NOS3 (rs1799983), VEGFA (rs699947) genes, real-time PCR was performed on a DTprime 4 analyzer (DNA-Technology, Moscow, Russia) using primers and probes manufactured by TestGene LLC (Ulyanovsk, Russia) according to the manufacturer's instructions. The determination of the SNP of the TLR3 gene (rs3775291) relied on real-time PCR according to melting curves using TestGene LLC reagent kits on a DTprime 4 device.Results: Two genes, IL1B rs1143634 and FABP2 rs1799883, were found to be associated with the risk of abdominal complications. Following the adjustment for multiple comparisons, only FABP2 rs1799883 remained statistically significant. The rs1799883 polymorphism of the FABP2 gene can be considered a predictor of the risk of abdominal complications and can be evaluated within the codominant and dominant models, which exhibit similar p-values (0.003 and 0.002, respectively). Overall, the analysis of the obtained data suggests that the risk of abdominal complications is associated with the presence of the mutant allele C in the genome, likely due to its dominance. Specifically, in the dominant model, the odds ratio was 3.53 (95% CI 1.62 to 7.70).Conclusion: The most significant markers of the risk of abdominal complications were the IL1B (rs1143634) and FABP2 (rs1799883) genes, of which FABP2 (rs1799883) remained statistically significant after adjusting for multiple comparisons. Its polymorphism as a predictor of abdominal complications can be evaluated within the codominant and dominant models. Received 13 June 2023. Revised 28 November 2023. Accept
导言：预测术后腹部并发症是心脏外科一直关注的问题。确定遗传预测因子将有助于更好地了解术后并发症的病理生理机制及其预防：确定心脏手术后腹部并发症的遗传预测因素：方法：在联邦心血管外科中心（车里雅宾斯克）进行了一项前瞻性研究，涉及 72 名腹部并发症患者和 102 名无腹部并发症的对照组。根据 PLINK 软件包（1.9 版）中的 SNP-HWE 算法，使用精确法评估了基因型分布是否符合 Hardy-Weinberg 分布。为了确定与腹部并发症风险相关的标记基因，对每个多态性基因评估了 6 种模型：等位基因、共显性基因、显性基因、隐性基因、过显性基因和对数加性基因。为了分析 IL6（rs1800795）、TNF（rs1800629）和 SERPINE1（rs1799768）基因的 SNPs，使用 Syntol CJSC（俄罗斯莫斯科）生产的引物和探针，按照生产商的说明，在 Rotor-Gene 6000 检测循环器（Corbett Research Pty Ltd., Mortlake, Australia）上进行了实时聚合酶链反应（PCR）。分析 IL1B (rs1143634), CXCL8 (rs4073), IL10 (rs1800872), APOE (rs429358), FABP2 (rs1799883), NOS3 (rs1799983), VEGFA (rs699947) 基因的 SNPs、使用 TestGene LLC（俄罗斯乌里扬诺夫斯克）生产的引物和探针，按照生产商的说明在 DTprime 4 分析仪（DNA-Technology，俄罗斯莫斯科）上进行了实时 PCR 检测。TLR3基因SNP（rs3775291）的测定是在DTprime 4设备上使用TestGene LLC试剂盒，根据熔解曲线进行实时PCR测定：结果：发现IL1B rs1143634和FABP2 rs1799883这两个基因与腹部并发症的风险有关。经多重比较调整后，只有 FABP2 rs1799883 仍具有统计学意义。FABP2 基因的 rs1799883 多态性可被视为腹部并发症风险的预测因子，并可在共显模型和显性模型中进行评估，其 p 值相似（分别为 0.003 和 0.002）。总之，对所获数据的分析表明，腹部并发症的风险与基因组中突变等位基因 C 的存在有关，这可能是由于其显性作用。具体而言，在显性模型中，几率比为 3.53（95% CI 1.62 至 7.70）：结论：腹部并发症风险最重要的标记是IL1B（rs1143634）和FABP2（rs1799883）基因，其中FABP2（rs1799883）在调整多重比较后仍具有统计学意义。其多态性作为腹部并发症的预测因子，可在共显模型和显性模型中进行评估。2023年6月13日收到。2023 年 11 月 28 日修订。2023年11月29日接受。资助：本研究由俄罗斯科学基金会资助，项目编号：22-25-20016，https://rscf.ru/project/22-25-20016/ 利益冲突：作者声明无利益冲突。作者贡献构思和研究设计：O.S. Abramovskikh, A.A. Fokin, D.V. Belov数据收集和分析：Yu.V. Loginova数据收集和分析：Yu.V. Loginova 统计分析：M.A. ZotovaM.A. Zotova撰写文章：D.V. Belov文章的严格修订：Yu.V. LoginovaFinal revision of the article：Yu.V. LoginovaFinal approval of the version to be published：D.V. Belov, O.S. Abramovskikh, M.A. Zotova, Yu.V. Loginova, A.A. Fokin
{"title":"Genetic predictors of abdominal complications after cardiac surgery: a prospective study","authors":"D. Belov, O.S. Abramovskikh, M.A. Zotova, Y. Loginova, A.A. Fokin","doi":"10.21688/1681-3472-2023-4-77-88","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-4-77-88","url":null,"abstract":"Introduction: The prediction of postoperative abdominal complications is a continuing concern in the cardiac surgery. Identifying genetic predictors will allow a better understanding of the pathophysiological mechanisms underlying postoperative disorders and their prevention.Objective: To identify genetic predictors of abdominal complications after heart surgery.Methods: A prospective study was carried out at the Federal Center for Cardiovascular Surgery (Chelyabinsk) involving 72 patients with abdominal complications and 102 controls without such complications. The distribution of genotypes was assessed for adherence to the Hardy-Weinberg distribution using the exact method according to the SNP-HWE algorithm in the PLINK package (version 1.9). To identify marker genes associated with the risk of abdominal complications, 6 models were evaluated for each polymorphic gene: allelic, codominant, dominant, recessive, overdominant, and log-additive. To analyze the SNPs of the IL6 (rs1800795), TNF (rs1800629), and SERPINE1 (rs1799768) genes, real-time polymerase chain reaction (PCR) was performed on a Rotor-Gene 6000 detecting cycler (Corbett Research Pty Ltd., Mortlake, Australia) using primers and probes manufactured by Syntol CJSC (Moscow, Russia) according to the manufacturer's instructions. To analyze the SNPs of the IL1B (rs1143634), CXCL8 (rs4073), IL10 (rs1800872), APOE (rs429358), FABP2 (rs1799883), NOS3 (rs1799983), VEGFA (rs699947) genes, real-time PCR was performed on a DTprime 4 analyzer (DNA-Technology, Moscow, Russia) using primers and probes manufactured by TestGene LLC (Ulyanovsk, Russia) according to the manufacturer's instructions. The determination of the SNP of the TLR3 gene (rs3775291) relied on real-time PCR according to melting curves using TestGene LLC reagent kits on a DTprime 4 device.Results: Two genes, IL1B rs1143634 and FABP2 rs1799883, were found to be associated with the risk of abdominal complications. Following the adjustment for multiple comparisons, only FABP2 rs1799883 remained statistically significant. The rs1799883 polymorphism of the FABP2 gene can be considered a predictor of the risk of abdominal complications and can be evaluated within the codominant and dominant models, which exhibit similar p-values (0.003 and 0.002, respectively). Overall, the analysis of the obtained data suggests that the risk of abdominal complications is associated with the presence of the mutant allele C in the genome, likely due to its dominance. Specifically, in the dominant model, the odds ratio was 3.53 (95% CI 1.62 to 7.70).Conclusion: The most significant markers of the risk of abdominal complications were the IL1B (rs1143634) and FABP2 (rs1799883) genes, of which FABP2 (rs1799883) remained statistically significant after adjusting for multiple comparisons. Its polymorphism as a predictor of abdominal complications can be evaluated within the codominant and dominant models. Received 13 June 2023. Revised 28 November 2023. Accept","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"2 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139156746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-26DOI: 10.21688/1681-3472-2023-4-98-108
I. V. Pchelina, A. M. Chernyavskiy
This article presents historical milestones for E.N. Meshalkin scientific school of cardiac surgery. E.N. Meshalkin was corresponding member of the USSR Academy of Sciences and first director of Meshalkin National Medical Research Center. Publications by E.N. Meshalkin and his followers reflect the study of circulatory organ pathology, physiology, and regeneration, as well as the diagnosis and surgical treatment of heart defects and diseases, including hypothermia and cardiopulmonary bypass. Additionally, they cover methods of anesthesia in cardiac surgery, organ transplantation, and the creation of new equipment, as well as improvements in methods of hemodynamics research. Successors of E.N. Meshalkin scientific school combine high-tech medical care with fundamental research, development, and implementation of innovative diagnostic and treatment methods in cardiac surgery, oncology, neurosurgery, and related fields of medicine. Received 12 December 2023. Accepted 18 December 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.
{"title":"E.N. Meshalkin scientific school of cardiac surgery in Siberia (To the 300th anniversary of the Russian Academy of Sciences)","authors":"I. V. Pchelina, A. M. Chernyavskiy","doi":"10.21688/1681-3472-2023-4-98-108","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-4-98-108","url":null,"abstract":"This article presents historical milestones for E.N. Meshalkin scientific school of cardiac surgery. E.N. Meshalkin was corresponding member of the USSR Academy of Sciences and first director of Meshalkin National Medical Research Center. Publications by E.N. Meshalkin and his followers reflect the study of circulatory organ pathology, physiology, and regeneration, as well as the diagnosis and surgical treatment of heart defects and diseases, including hypothermia and cardiopulmonary bypass. Additionally, they cover methods of anesthesia in cardiac surgery, organ transplantation, and the creation of new equipment, as well as improvements in methods of hemodynamics research. Successors of E.N. Meshalkin scientific school combine high-tech medical care with fundamental research, development, and implementation of innovative diagnostic and treatment methods in cardiac surgery, oncology, neurosurgery, and related fields of medicine. Received 12 December 2023. Accepted 18 December 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"97 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139154986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-26DOI: 10.21688/1681-3472-2023-4-43-51
V. V. Shabanov, A. Filippenko, V. Beloborodov, T.U. Khalkhoghaev, V. Murtazin
Introduction: Despite the advancement interventional methods for treating atrial fibrillation, the effectiveness of catheter ablation remains poor, especially in patients with persistent and long-persistent atrial fibrillation. Thus, experts continue to explore new treatments for this arrhythmia. The issue of experimental studies investigating the association between spinal cord stimulation and atrial fibrillation is mainly attributed to the lack of optimal algorithms for spinal cord stimulation in animal experiments. Therefore, it is important to develop adequate algorithms for spinal cord stimulation in the chronic model of atrial fibrillation.Objective: To evaluate the impact of spinal cord stimulation on the model of atrial fibrillation in mini-pigs.Methods: In a series of experiments, 6 (100%) successful implantations of electrodes and pacemakers, and spinal cord stimulation electrodes were performed. The electrodes were used to stimulate the atria, creating a model of atrial fibrillation, while the spinal cord stimulation was carried out using an electrode implanted into the spinal canal. During the experiment, an electrophysiological study was performed using an implanted pacemaker. The inducibility of atrial fibrillation was assessed before and after the experiment using various spinal cord stimulation algorithms.Results: There were no complications associated with surgery or stimulation of the atria and spinal cord. Spinal stimulation had a modeling effect on the autonomic nervous system, significantly changing the average heart rate, Wenckebach point, and effective refractory period. When comparing spinal stimulation algorithms, algorithm 1 was found to significantly reduce the atrial fibrillation inducibility.Conclusion: Spinal cord stimulation had a modeling effect on the autonomic nervous system, significantly changing the average heart rate, Wenckebach point, and effective refractory period. Inducibility of atrial fibrillation decreases with changes in the spinal pacing algorithm. Received 15 September 2023. Revised 30 October 2023. Accepted 31 October 2023. Funding: The study was supported by Russian Science Foundation (project No. 22-25-00672). Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.G. Filippenko, V.V. Shabanov, V.I. MurtazinData collection and analysis: A.G. Filippenko, T.U. Khalkhoghaev, V.V. BeloborodovStatistical analysis: A.G. Filippenko, V.V. ShabanovDrafting the article: A.G. Filippenko, V.V. BeloborodovCritical revision of the article: V.V. ShabanovFinal approval of the version to be published: V.V. Shabanov, A.G. Filippenko, V.V. Beloborodov, T.U. Khalkhoghaev, V.I. Murtazin
导言：尽管治疗心房颤动的介入方法在不断进步，但导管消融术的效果仍然不佳，尤其是对持续性和长期持续性心房颤动患者而言。因此，专家们继续探索治疗这种心律失常的新方法。调查脊髓刺激与心房颤动之间关联的实验研究之所以存在问题，主要是因为在动物实验中缺乏脊髓刺激的最佳算法。因此，在心房颤动慢性模型中开发适当的脊髓刺激算法非常重要：评估脊髓刺激对迷你猪心房颤动模型的影响：在一系列实验中，成功植入电极、心脏起搏器和脊髓刺激电极 6 次（100%）。电极用于刺激心房，创建心房颤动模型，而脊髓刺激则通过植入椎管的电极进行。在实验过程中，还使用植入的心脏起搏器进行了电生理研究。实验前后使用不同的脊髓刺激算法对心房颤动的诱导性进行了评估：结果：手术或刺激心房和脊髓均无并发症。脊髓刺激对自律神经系统有建模作用，显著改变了平均心率、温克巴赫点和有效折返期。在比较脊髓刺激算法时，发现算法1能明显降低心房颤动的诱发率：结论：脊髓刺激对自律神经系统有建模作用，能显著改变平均心率、温克巴赫点和有效折返期。心房颤动的诱发率会随着脊髓起搏算法的改变而降低。2023 年 9 月 15 日收到。2023 年 10 月 30 日修订。2023年10月31日接受。资助：本研究由俄罗斯科学基金会（项目编号：22-25-00672）资助。利益冲突：作者声明无利益冲突。作者贡献构思和研究设计：A.G. Filippenko、V.V. Shabanov、V.I. Murtazin数据收集和分析：数据收集和分析：A.G. Filippenko, T.U. Khalkhoghaev, V.V. Beloborodov统计分析：A.G. Filippenko, T.U. Khalkhoghaev, V.V. Beloborodov文章起草：A.G. Filippenko, V.V. ShabanovA.G. Filippenko, V.V. BeloborodovCritical revision of the article：V.V. ShabanovFinal approval of the version to be published：V.V. Shabanov, A.G. Filippenko, V.V. Beloborodov, T.U. Khalkhoghaev, V.I. Murtazin
{"title":"The impact of spinal cord stimulation on a chronic model of atrial fibrillation in a mini-pig experiment","authors":"V. V. Shabanov, A. Filippenko, V. Beloborodov, T.U. Khalkhoghaev, V. Murtazin","doi":"10.21688/1681-3472-2023-4-43-51","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-4-43-51","url":null,"abstract":"Introduction: Despite the advancement interventional methods for treating atrial fibrillation, the effectiveness of catheter ablation remains poor, especially in patients with persistent and long-persistent atrial fibrillation. Thus, experts continue to explore new treatments for this arrhythmia. The issue of experimental studies investigating the association between spinal cord stimulation and atrial fibrillation is mainly attributed to the lack of optimal algorithms for spinal cord stimulation in animal experiments. Therefore, it is important to develop adequate algorithms for spinal cord stimulation in the chronic model of atrial fibrillation.Objective: To evaluate the impact of spinal cord stimulation on the model of atrial fibrillation in mini-pigs.Methods: In a series of experiments, 6 (100%) successful implantations of electrodes and pacemakers, and spinal cord stimulation electrodes were performed. The electrodes were used to stimulate the atria, creating a model of atrial fibrillation, while the spinal cord stimulation was carried out using an electrode implanted into the spinal canal. During the experiment, an electrophysiological study was performed using an implanted pacemaker. The inducibility of atrial fibrillation was assessed before and after the experiment using various spinal cord stimulation algorithms.Results: There were no complications associated with surgery or stimulation of the atria and spinal cord. Spinal stimulation had a modeling effect on the autonomic nervous system, significantly changing the average heart rate, Wenckebach point, and effective refractory period. When comparing spinal stimulation algorithms, algorithm 1 was found to significantly reduce the atrial fibrillation inducibility.Conclusion: Spinal cord stimulation had a modeling effect on the autonomic nervous system, significantly changing the average heart rate, Wenckebach point, and effective refractory period. Inducibility of atrial fibrillation decreases with changes in the spinal pacing algorithm. Received 15 September 2023. Revised 30 October 2023. Accepted 31 October 2023. Funding: The study was supported by Russian Science Foundation (project No. 22-25-00672). Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.G. Filippenko, V.V. Shabanov, V.I. MurtazinData collection and analysis: A.G. Filippenko, T.U. Khalkhoghaev, V.V. BeloborodovStatistical analysis: A.G. Filippenko, V.V. ShabanovDrafting the article: A.G. Filippenko, V.V. BeloborodovCritical revision of the article: V.V. ShabanovFinal approval of the version to be published: V.V. Shabanov, A.G. Filippenko, V.V. Beloborodov, T.U. Khalkhoghaev, V.I. Murtazin","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"79 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139155023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-26DOI: 10.21688/1681-3472-2023-4-7-24
I. I. Skopin, M. Latyshev, D.V. Britikov
Introduction: In severe recurrent infectious lesions in the right heart, one of the alternative options for bioprosthetics is to implant mitral allografts (donor heart valves) in the tricuspid valve position. Allografts offer numerous benefits, including a configuration that closely resembles a native valve, adaptability to high systemic pressure, absence of foreign elements that can could act as entry points for infections, and antibacterial treatment without lifelong anticoagulant therapy.Objective: To study the feasibility of using a mitral allograft in the tricuspid position based on the analysis of literature data and our own experience.Methods: Searches were conducted in Medline (PubMed), Google Scholar, and Russian Science Citation Index databases using search queries, keywords, and logical operators. The last session was conducted on December 21, 2022. In the initial selection of aforementioned search queries, a total of 4,446 results were obtained (Google Scholar — 3,080, Medline — 1,050, Russian Science Citation Index — 316). After analyzing titles and abstracts, 4,390 studies were excluded due to the insufficient data. Of the remaining studies, 25 scientific papers were excluded due to their duplication. The final group included 31 studies.Results: Based on a systematic literature review, the article presents aspects of the explantation, preparation, and implantation of the mitral allograft in the tricuspid position at the present stage of biotechnology development. The article highlights the main complications, rare clinical observations, and immediate and long-term postoperative results of mitral allograft implantation in the tricuspid position.Conclusion: This technique presents an interesting solution for patients with severe structural changes in the tricuspid valve, but further research is necessary at this stage of biotechnology development. Received 9 March 2023. Revised 7 September 2023. Accepted 11 September 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.
{"title":"Mitral allografts in tricuspid valve position in modern surgery of acquired heart defects: a systematic review","authors":"I. I. Skopin, M. Latyshev, D.V. Britikov","doi":"10.21688/1681-3472-2023-4-7-24","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-4-7-24","url":null,"abstract":"Introduction: In severe recurrent infectious lesions in the right heart, one of the alternative options for bioprosthetics is to implant mitral allografts (donor heart valves) in the tricuspid valve position. Allografts offer numerous benefits, including a configuration that closely resembles a native valve, adaptability to high systemic pressure, absence of foreign elements that can could act as entry points for infections, and antibacterial treatment without lifelong anticoagulant therapy.Objective: To study the feasibility of using a mitral allograft in the tricuspid position based on the analysis of literature data and our own experience.Methods: Searches were conducted in Medline (PubMed), Google Scholar, and Russian Science Citation Index databases using search queries, keywords, and logical operators. The last session was conducted on December 21, 2022. In the initial selection of aforementioned search queries, a total of 4,446 results were obtained (Google Scholar — 3,080, Medline — 1,050, Russian Science Citation Index — 316). After analyzing titles and abstracts, 4,390 studies were excluded due to the insufficient data. Of the remaining studies, 25 scientific papers were excluded due to their duplication. The final group included 31 studies.Results: Based on a systematic literature review, the article presents aspects of the explantation, preparation, and implantation of the mitral allograft in the tricuspid position at the present stage of biotechnology development. The article highlights the main complications, rare clinical observations, and immediate and long-term postoperative results of mitral allograft implantation in the tricuspid position.Conclusion: This technique presents an interesting solution for patients with severe structural changes in the tricuspid valve, but further research is necessary at this stage of biotechnology development. Received 9 March 2023. Revised 7 September 2023. Accepted 11 September 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"69 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139155049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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