Pub Date : 2021-12-28DOI: 10.21688/1681-3472-2021-4-85-96
D. Khelimskii, O. Krestyaninov, A. Badoian, A. A. Baranov, R. Utegenov, I. Bessonov, S. Sapozhnikov
Background. Atrial fibrillation is one of the most common types of cardiac arrhythmias. The frequent combination of atrial fibrillation and coronary artery disease in clinical practice can be attributed to common risk factors and relationships among pathogenetic mechanisms.Aim. This study aims to evaluate the impact of atrial fibrillation on immediate and long-term clinical outcomes in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions.Methods. This study included 709 patients who underwent percutaneous coronary intervention for coronary bifurcation lesions. All patients were divided into two groups: those with and without atrial fibrillation.Results. This multicentre registry showed that the incidence of atrial fibrillation was 11.7%. Compared to patients without a history of atrial fibrillation, those that did were older (66.8 ± 8.5 vs. 62.9 ± 9.0 years, p = 0.0002) and more often had cerebrovascular (22.9% vs. 10.4%, p = 0.003) and peripheral artery disease (18.1% vs. 7.2%, p = 0.002). The overall incidence of major adverse cardiovascular events at the hospital stage was 1.8%. The average follow-up duration was 476 ± 94 days. No difference in long-term major adverse cardiovascular events (15.0% vs. 13.1%, p = 0.6) was observed between patients with and without atrial fibrillation. Patients with atrial fibrillation were more likely to have adverse events, such as bleeding (13.8% vs. 9.3%, p = 0.22), stroke (2.5% vs. 1.0%, p = 0.23) and myocardial infarction (7.6% vs. 5.0%, p = 0.28), although differences between the groups were insignificant.Conclusion. Atrial fibrillation was not associated with mortality and major adverse cardiovascular events in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions.ClinicalTrials.gov Identifier: NCT03450577Received 4 August 2021. Revised 27 September 2021. Accepted 28 September 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors Conception and study design: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov Data collection and analysis: D.A. Khelimskii, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov Statistical analysis: D.A. Khelimskii, A.G. Badoian, I.S. Bessonov Drafting the article: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov Critical revision of the article: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov Final approval of the version to be published: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov
{"title":"Impact of atrial fibrillation on long-term outcomes in patients with coronary artery bifurcation lesions undergoing percutaneous coronary intervention","authors":"D. Khelimskii, O. Krestyaninov, A. Badoian, A. A. Baranov, R. Utegenov, I. Bessonov, S. Sapozhnikov","doi":"10.21688/1681-3472-2021-4-85-96","DOIUrl":"https://doi.org/10.21688/1681-3472-2021-4-85-96","url":null,"abstract":"Background. Atrial fibrillation is one of the most common types of cardiac arrhythmias. The frequent combination of atrial fibrillation and coronary artery disease in clinical practice can be attributed to common risk factors and relationships among pathogenetic mechanisms.Aim. This study aims to evaluate the impact of atrial fibrillation on immediate and long-term clinical outcomes in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions.Methods. This study included 709 patients who underwent percutaneous coronary intervention for coronary bifurcation lesions. All patients were divided into two groups: those with and without atrial fibrillation.Results. This multicentre registry showed that the incidence of atrial fibrillation was 11.7%. Compared to patients without a history of atrial fibrillation, those that did were older (66.8 ± 8.5 vs. 62.9 ± 9.0 years, p = 0.0002) and more often had cerebrovascular (22.9% vs. 10.4%, p = 0.003) and peripheral artery disease (18.1% vs. 7.2%, p = 0.002). The overall incidence of major adverse cardiovascular events at the hospital stage was 1.8%. The average follow-up duration was 476 ± 94 days. No difference in long-term major adverse cardiovascular events (15.0% vs. 13.1%, p = 0.6) was observed between patients with and without atrial fibrillation. Patients with atrial fibrillation were more likely to have adverse events, such as bleeding (13.8% vs. 9.3%, p = 0.22), stroke (2.5% vs. 1.0%, p = 0.23) and myocardial infarction (7.6% vs. 5.0%, p = 0.28), although differences between the groups were insignificant.Conclusion. Atrial fibrillation was not associated with mortality and major adverse cardiovascular events in patients undergoing percutaneous coronary intervention for coronary bifurcation lesions.ClinicalTrials.gov Identifier: NCT03450577Received 4 August 2021. Revised 27 September 2021. Accepted 28 September 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors Conception and study design: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov Data collection and analysis: D.A. Khelimskii, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov Statistical analysis: D.A. Khelimskii, A.G. Badoian, I.S. Bessonov Drafting the article: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov Critical revision of the article: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov Final approval of the version to be published: D.A. Khelimskii, O.V. Krestyaninov, A.G. Badoian, A.A. Baranov, R.B. Utegenov, I.S. Bessonov, S.S. Sapozhnikov","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89144065","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 : 2021-12-28DOI: 10.21688/1681-3472-2021-4-23-29
D. Belov, D. Garbuzenko, S. I. Andrievskikh, S. S. Anufrieva
Aorto-digestive fistulas are a rare but extremely dangerous cause of massive gastrointestinal bleeding with a high risk of death. The aim of the review was to examine the modern principles of aorto-digestive fistula diagnosis and optimal treatment modalities.Scientific publications and their reference lists were searched on PubMed database, Google Scholar and Russian Science Citation Index. Articles relevant to the topic, published over the past 25 years (1996-2021), were included and they were searched and categorised using the following key words: ‘gastrointestinal bleeding’, ‘aorto-digestive fistulas’, ‘diagnosis’ and ‘treatment’. Inclusion criteria were limited to gastrointestinal bleeding associated with aorto-digestive fistulas.Patients with aortic aneurysms or those who have undergone prosthetics should have increased alertness regarding the formation of aorto-digestive fistulas. With a presence of gastrointestinal bleeding and exclusion of other sources based on multispiral computed tomography data with intravenous bolus contrast enhancement, this will allow for quick verification of the diagnosis and also enable timely medical measures to be taken. In an emergency situation, to achieve rapid hemostasis in unstable patients, endovascular aortic replacement is most justified. Open reconstruction of the aorta in situ with simultaneous elimination of the hollow organ defect and sanitation of fistula-associated foci of infection should be considered as a radical intervention for aorto-digestive fistulas.Received 19 May 2021. Revised 7 July 2021. Accepted 9 July 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
{"title":"Aorto-digestive fistula: a rare cause of gastrointestinal bleeding","authors":"D. Belov, D. Garbuzenko, S. I. Andrievskikh, S. S. Anufrieva","doi":"10.21688/1681-3472-2021-4-23-29","DOIUrl":"https://doi.org/10.21688/1681-3472-2021-4-23-29","url":null,"abstract":"Aorto-digestive fistulas are a rare but extremely dangerous cause of massive gastrointestinal bleeding with a high risk of death. The aim of the review was to examine the modern principles of aorto-digestive fistula diagnosis and optimal treatment modalities.Scientific publications and their reference lists were searched on PubMed database, Google Scholar and Russian Science Citation Index. Articles relevant to the topic, published over the past 25 years (1996-2021), were included and they were searched and categorised using the following key words: ‘gastrointestinal bleeding’, ‘aorto-digestive fistulas’, ‘diagnosis’ and ‘treatment’. Inclusion criteria were limited to gastrointestinal bleeding associated with aorto-digestive fistulas.Patients with aortic aneurysms or those who have undergone prosthetics should have increased alertness regarding the formation of aorto-digestive fistulas. With a presence of gastrointestinal bleeding and exclusion of other sources based on multispiral computed tomography data with intravenous bolus contrast enhancement, this will allow for quick verification of the diagnosis and also enable timely medical measures to be taken. In an emergency situation, to achieve rapid hemostasis in unstable patients, endovascular aortic replacement is most justified. Open reconstruction of the aorta in situ with simultaneous elimination of the hollow organ defect and sanitation of fistula-associated foci of infection should be considered as a radical intervention for aorto-digestive fistulas.Received 19 May 2021. Revised 7 July 2021. Accepted 9 July 2021.Funding: The study did not have sponsorship.Conflict of interest: 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":"4 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72412391","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 : 2021-12-28DOI: 10.21688/1681-3472-2021-4-64-75
A. Klinkova, O. Kamenskaya, I. Loginova, A. Chernyavskiy, V. Lomivorotov
Aim. To study the quality of life and how it is influenced by different factors in the long term after myocardial re-vascularisation in patients with coronary artery disease who had acute coronary syndrome during the coronavirus disease 2019 (COVID-19) pandemic.Methods. We examined 658 patients with coronary artery disease and acute coronary syndrome (mean age 66.4 ± 4.3 years). Percutaneous coronary intervention (600 patients) and coronary artery bypass grafting with cardio-pulmonary bypass (58 patients) were performed. Six months after myocardial re-vascularisation, we assessed patients' quality of life using the SF-36 questionnaire. We identified factors that affect the quality of life using multivariate regression analysis.Results. After myocardial revascularisation, the patients had a reduced overall indicator of physical health (< 40 points). The overall indicator of psycho-emotional health was higher than physical (p < 0.002) but did not exceed 50 points. We noted the adverse effect of COVID-19 (regardless of disease severity) on the assessment. Also, COVID-19 was associated with increased anxiety. A history of concomitant diabetes mellitus, obesity, stroke and percutaneous coronary intervention had a negative effect on the overall indicators of physical and mental health.Conclusion. Patients with coronary artery disease who had acute coronary syndrome after myocardial re-vascularisation are characterised by reduced indicators of physical and average indicators of mental health in the long term. COVID-19, regardless of disease severity, has a negative impact on patients' general state of health, social activity and emotional background. A history of diabetes mellitus, obesity, stroke and percutaneous coronary intervention adversely affects the physical and mental health indicators.Received 4 August 2021. Revised 31 August 2021. Accepted 1 September 2021.Funding: This work was carried out within the framework of the state task of the Ministry of Health of the Russian Federation (No. 121031300225-8).Conflict of interest: Authors declare no conflict of interest.Contribution of the authors Conception and study design: O.V. Kamenskaya, V.V. Lomivorotov Data collection and analysis: A.S. Klinkova Statistical analysis: A.S. Klinkova Drafting the article: A.S. Klinkova, I.Yu. Loginova Critical revision of the article: O.V. Kamenskaya, A.M. Chernyavskiy Final approval of the version to be published: A.S. Klinkova, O.V. Kamenskaya, I.Yu. Loginova, A.M. Chernyavskiy, V.V. Lomivorotov
{"title":"Quality of life after myocardial re-vascularisation in patients with acute coronary syndrome during the coronavirus disease 2019 pandemic: a prospective observational study","authors":"A. Klinkova, O. Kamenskaya, I. Loginova, A. Chernyavskiy, V. Lomivorotov","doi":"10.21688/1681-3472-2021-4-64-75","DOIUrl":"https://doi.org/10.21688/1681-3472-2021-4-64-75","url":null,"abstract":"Aim. To study the quality of life and how it is influenced by different factors in the long term after myocardial re-vascularisation in patients with coronary artery disease who had acute coronary syndrome during the coronavirus disease 2019 (COVID-19) pandemic.Methods. We examined 658 patients with coronary artery disease and acute coronary syndrome (mean age 66.4 ± 4.3 years). Percutaneous coronary intervention (600 patients) and coronary artery bypass grafting with cardio-pulmonary bypass (58 patients) were performed. Six months after myocardial re-vascularisation, we assessed patients' quality of life using the SF-36 questionnaire. We identified factors that affect the quality of life using multivariate regression analysis.Results. After myocardial revascularisation, the patients had a reduced overall indicator of physical health (< 40 points). The overall indicator of psycho-emotional health was higher than physical (p < 0.002) but did not exceed 50 points. We noted the adverse effect of COVID-19 (regardless of disease severity) on the assessment. Also, COVID-19 was associated with increased anxiety. A history of concomitant diabetes mellitus, obesity, stroke and percutaneous coronary intervention had a negative effect on the overall indicators of physical and mental health.Conclusion. Patients with coronary artery disease who had acute coronary syndrome after myocardial re-vascularisation are characterised by reduced indicators of physical and average indicators of mental health in the long term. COVID-19, regardless of disease severity, has a negative impact on patients' general state of health, social activity and emotional background. A history of diabetes mellitus, obesity, stroke and percutaneous coronary intervention adversely affects the physical and mental health indicators.Received 4 August 2021. Revised 31 August 2021. Accepted 1 September 2021.Funding: This work was carried out within the framework of the state task of the Ministry of Health of the Russian Federation (No. 121031300225-8).Conflict of interest: Authors declare no conflict of interest.Contribution of the authors Conception and study design: O.V. Kamenskaya, V.V. Lomivorotov Data collection and analysis: A.S. Klinkova Statistical analysis: A.S. Klinkova Drafting the article: A.S. Klinkova, I.Yu. Loginova Critical revision of the article: O.V. Kamenskaya, A.M. Chernyavskiy Final approval of the version to be published: A.S. Klinkova, O.V. Kamenskaya, I.Yu. Loginova, A.M. Chernyavskiy, V.V. Lomivorotov","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76075702","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 : 2021-12-28DOI: 10.21688/1681-3472-2021-4-41-52
M. Plotnikov, Y. Gorbatykh, A. Аrkhipov, M. Galstyan, A. Bogachev-Prokophiev, D. Tarasov, I. Soynov
Aim. To compare complications and outcomes in the postoperative period with two different methods for correcting total anomalous pulmonary venous connection.Methods. In this pilot, two-centre, simple, blind, prospective randomised study, the patients’ quality of life after correction of total anomalous pulmonary venous connection in infancy was evaluated using the sutureless (n = 20) and conventional repair methods (n = 20) in 40 patients. The overall mortality and complications in the mid-term were evaluated.Results. The average follow-up was 15 (13; 16) months. Mortality was noted only in the conventional repair group, amounting to 5 (25%) patients (p = 0.018). Severe obstruction of the pulmonary veins anastomosis was also noted only in the conventional repair group (n = 8, 40%; p = 0.0013). Infectious endocarditis was observed in one (6.6%) patient in the conventional repair group (p = 0.42). Arrhythmias were present in 4 (26.6%) patients in the conventional repair group (p = 0.02).Conclusion. The rates of obstruction of the pulmonary vein anastomosis, arrhythmias and death depend on the method of total anomalous pulmonary venous connection correction. The sutureless repair reduces the incidence of early and mid-term postoperative complications compared to conventional repair.Received 16 March 2021. Revised 8 June 2021. Accepted 11 June 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Contribution of the authors Conception and study design: Yu.N. Gorbatykh, A.V. Bogachev-Prokophiev, M.V. Plotnikov Data collection and analysis: M.V. Plotnikov, M.G. Galstyan, D.G. Tarasov Statistical analysis: M.V. Plotnikov Drafting the article: M.V. Plotnikov, Yu.N. Gorbatykh Critical revision of the article: I.A. Soynov Final approval of the version to be published: M.V. Plotnikov, Yu.N. Gorbatykh, A.N. Аrkhipov, M.G. Galstyan, A.V. Bogachev-Prokophiev, D.G. Tarasov, I.A. Soynov
{"title":"Results of the early and mid-term postoperative period after correction of total anomalous pulmonary venous connection","authors":"M. Plotnikov, Y. Gorbatykh, A. Аrkhipov, M. Galstyan, A. Bogachev-Prokophiev, D. Tarasov, I. Soynov","doi":"10.21688/1681-3472-2021-4-41-52","DOIUrl":"https://doi.org/10.21688/1681-3472-2021-4-41-52","url":null,"abstract":"Aim. To compare complications and outcomes in the postoperative period with two different methods for correcting total anomalous pulmonary venous connection.Methods. In this pilot, two-centre, simple, blind, prospective randomised study, the patients’ quality of life after correction of total anomalous pulmonary venous connection in infancy was evaluated using the sutureless (n = 20) and conventional repair methods (n = 20) in 40 patients. The overall mortality and complications in the mid-term were evaluated.Results. The average follow-up was 15 (13; 16) months. Mortality was noted only in the conventional repair group, amounting to 5 (25%) patients (p = 0.018). Severe obstruction of the pulmonary veins anastomosis was also noted only in the conventional repair group (n = 8, 40%; p = 0.0013). Infectious endocarditis was observed in one (6.6%) patient in the conventional repair group (p = 0.42). Arrhythmias were present in 4 (26.6%) patients in the conventional repair group (p = 0.02).Conclusion. The rates of obstruction of the pulmonary vein anastomosis, arrhythmias and death depend on the method of total anomalous pulmonary venous connection correction. The sutureless repair reduces the incidence of early and mid-term postoperative complications compared to conventional repair.Received 16 March 2021. Revised 8 June 2021. Accepted 11 June 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Contribution of the authors Conception and study design: Yu.N. Gorbatykh, A.V. Bogachev-Prokophiev, M.V. Plotnikov Data collection and analysis: M.V. Plotnikov, M.G. Galstyan, D.G. Tarasov Statistical analysis: M.V. Plotnikov Drafting the article: M.V. Plotnikov, Yu.N. Gorbatykh Critical revision of the article: I.A. Soynov Final approval of the version to be published: M.V. Plotnikov, Yu.N. Gorbatykh, A.N. Аrkhipov, M.G. Galstyan, A.V. Bogachev-Prokophiev, D.G. Tarasov, I.A. Soynov","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72537402","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 : 2021-12-28DOI: 10.21688/1681-3472-2021-4-118-123
T. Simonyan, I. Scopin, I. M. Tsiskaridze, I. Farulova, E. A. Babajanyan
Heart tumours account for approximately 0.2 % of all tumours: of these, approximately 75 % of all primary heart tumours are benign and 50 % of them are myxomas. Further, myxomas make up 0.0017 % of the general population of patients with cardiovascular disease. Biatrial myxomas, i.e. tumours in both the left and right atria, can be in the form of a ‘butterfly’ or a ‘dumbbell’, and account for < 1 % of all cardiac myxomas. Here we describe the successful surgical management of a rare case of a large biatrial myxoma and concomitant atrioventricular valve insufficiency. Briefly, 2D transthoracic echocardiography findings included an end-diastolic volume of 90 ml, an end-systolic volume of 40 ml and a left ventricular ejection fraction of 55 % (according to Simpson). The fibrous ring of the mitral valve measured 36 mm with a regurgitation degree of 2 while the fibrous ring of the tricuspid valve was 42 mm in size and the regurgitation grade was 3. Lesion size in the cavity of the left and right atrium were 73 × 38 mm and 80 × 42 mm, respectively. These neoplasia were surgically removed under peripheral cardiopulmonary bypass, hypothermia and cold cardioplegia (Custodiol). The myxomas were accessed through the right atrium, according to Giradon and were resected without defragmentation. Next, mitral valve plasty using a soft support ring and annuloplasty of the tricuspid valve were performed according to de Vega. The duration of artificial circulation was 150 minutes and that of myocardial ischaemia was 100 minutes. The patient was extubated 11 hours after surgery, spent 22 hours in the intensive care unit and was discharged on the 14th day after surgery. Surgical resection of biatrial myxomas before the development of serious irreversible or life-threatening complications can provide rapid symptomatic relief in congestive heart failure.Received 30 May 2021. Revised 22 August 2021. Accepted 23 August 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors Literature review: T.A. Simonyan Drafting the article: T.A. Simonyan, I.M. Tsiskaridze Critical revision of the article: T.A. Simonyan, I.Yu. Farulova, E.A. Babajanyan Surgical treatment: I.I. Scopin, I.M. Tsiskaridze Final approval of the version to be published: T.A. Simonyan, I.I. Scopin, I.M. Tsiskaridze, I.Yu. Farulova, E.A. Babajanyan
{"title":"Surgical management of biatrial myxoma: case report","authors":"T. Simonyan, I. Scopin, I. M. Tsiskaridze, I. Farulova, E. A. Babajanyan","doi":"10.21688/1681-3472-2021-4-118-123","DOIUrl":"https://doi.org/10.21688/1681-3472-2021-4-118-123","url":null,"abstract":"Heart tumours account for approximately 0.2 % of all tumours: of these, approximately 75 % of all primary heart tumours are benign and 50 % of them are myxomas. Further, myxomas make up 0.0017 % of the general population of patients with cardiovascular disease. Biatrial myxomas, i.e. tumours in both the left and right atria, can be in the form of a ‘butterfly’ or a ‘dumbbell’, and account for < 1 % of all cardiac myxomas. Here we describe the successful surgical management of a rare case of a large biatrial myxoma and concomitant atrioventricular valve insufficiency. Briefly, 2D transthoracic echocardiography findings included an end-diastolic volume of 90 ml, an end-systolic volume of 40 ml and a left ventricular ejection fraction of 55 % (according to Simpson). The fibrous ring of the mitral valve measured 36 mm with a regurgitation degree of 2 while the fibrous ring of the tricuspid valve was 42 mm in size and the regurgitation grade was 3. Lesion size in the cavity of the left and right atrium were 73 × 38 mm and 80 × 42 mm, respectively. These neoplasia were surgically removed under peripheral cardiopulmonary bypass, hypothermia and cold cardioplegia (Custodiol). The myxomas were accessed through the right atrium, according to Giradon and were resected without defragmentation. Next, mitral valve plasty using a soft support ring and annuloplasty of the tricuspid valve were performed according to de Vega. The duration of artificial circulation was 150 minutes and that of myocardial ischaemia was 100 minutes. The patient was extubated 11 hours after surgery, spent 22 hours in the intensive care unit and was discharged on the 14th day after surgery. Surgical resection of biatrial myxomas before the development of serious irreversible or life-threatening complications can provide rapid symptomatic relief in congestive heart failure.Received 30 May 2021. Revised 22 August 2021. Accepted 23 August 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors Literature review: T.A. Simonyan Drafting the article: T.A. Simonyan, I.M. Tsiskaridze Critical revision of the article: T.A. Simonyan, I.Yu. Farulova, E.A. Babajanyan Surgical treatment: I.I. Scopin, I.M. Tsiskaridze Final approval of the version to be published: T.A. Simonyan, I.I. Scopin, I.M. Tsiskaridze, I.Yu. Farulova, E.A. Babajanyan","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75859354","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 : 2021-12-28DOI: 10.21688/1681-3472-2021-4-97-105
V. Bazylev, P. Batrakov, D. M. Khadiev, A. Egorov, N. Eremin
Aim. The study aimed to compare the hydrodynamic characteristics and durability of the aortic root prosthesis with pericardial cusps with various options for the formation of commissures.Methods. Nine conduits with pericardial valves were formed according to the technique described by Ozaki. The prostheses were divided into 3 groups of 3 specimens each: group 1 — without additional reinforcing seams on the top of the commissure; group 2 — with an additional U-shaped seam without gasket; and group 3 — with an additional suture with an opposite pericardial gasket. The prostheses were fixed on a stand for hydrodynamic testing of artificial heart valves. The hydrodynamic characteristics of the prostheses were evaluated. The hydrodynamics of the frame biological prosthesis was used for comparison. After assessing the hydrodynamic parameters of the aortic root prostheses, their work durability was tested. Defects of the pericardial cusps were studied macroscopically.Results. Two samples from group 2 were withdrawn from testing ahead of schedule at around 11 × 106 cycles, which is approximately 3.5 months of normal heart function. The other prostheses remained competent and were removed for an examination at 32 × 106 cycles, which is approximately 9.6 months of normal heart function.Conclusion. The hydrodynamics of the aortic root prosthesis with pericardial valves was comparable to the hydrodynamics of the frame biological prosthesis. Additional U-shaped sutures in the commissure area of the pericardial cusps did not increase the functional durability of the aortic root prosthesis with pericardial leaflets and served as additional risk factors for leaflet perforation. Implantation of pericardial leaflets into a vascular graft resulted in a different distribution of dynamic stress compared to the original aortic valve neocuspidisation, which preserved the aortic root.Received 8 July 2021. Revised 30 August 2021. Accepted 7 September 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors Conception and study design: V.V. Bazylev, P.A. Batrakov Data collection and analysis: P.A. Batrakov, D.M. Khadiev, A.A. Egorov, N.A. Eremin Drafting the article: P.A. Batrakov Critical revision of the article: V.V. Bazylev, P.A. Batrakov Final approval of the version to be published: V.V. Bazylev, P.A. Batrakov, D.M. Khadiev, A.A. Egorov, N.A. Eremin
{"title":"Aortic root prosthesis with pericardial cusps \"Russian conduit\": A hydrodynamic experiment","authors":"V. Bazylev, P. Batrakov, D. M. Khadiev, A. Egorov, N. Eremin","doi":"10.21688/1681-3472-2021-4-97-105","DOIUrl":"https://doi.org/10.21688/1681-3472-2021-4-97-105","url":null,"abstract":"Aim. The study aimed to compare the hydrodynamic characteristics and durability of the aortic root prosthesis with pericardial cusps with various options for the formation of commissures.Methods. Nine conduits with pericardial valves were formed according to the technique described by Ozaki. The prostheses were divided into 3 groups of 3 specimens each: group 1 — without additional reinforcing seams on the top of the commissure; group 2 — with an additional U-shaped seam without gasket; and group 3 — with an additional suture with an opposite pericardial gasket. The prostheses were fixed on a stand for hydrodynamic testing of artificial heart valves. The hydrodynamic characteristics of the prostheses were evaluated. The hydrodynamics of the frame biological prosthesis was used for comparison. After assessing the hydrodynamic parameters of the aortic root prostheses, their work durability was tested. Defects of the pericardial cusps were studied macroscopically.Results. Two samples from group 2 were withdrawn from testing ahead of schedule at around 11 × 106 cycles, which is approximately 3.5 months of normal heart function. The other prostheses remained competent and were removed for an examination at 32 × 106 cycles, which is approximately 9.6 months of normal heart function.Conclusion. The hydrodynamics of the aortic root prosthesis with pericardial valves was comparable to the hydrodynamics of the frame biological prosthesis. Additional U-shaped sutures in the commissure area of the pericardial cusps did not increase the functional durability of the aortic root prosthesis with pericardial leaflets and served as additional risk factors for leaflet perforation. Implantation of pericardial leaflets into a vascular graft resulted in a different distribution of dynamic stress compared to the original aortic valve neocuspidisation, which preserved the aortic root.Received 8 July 2021. Revised 30 August 2021. Accepted 7 September 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors Conception and study design: V.V. Bazylev, P.A. Batrakov Data collection and analysis: P.A. Batrakov, D.M. Khadiev, A.A. Egorov, N.A. Eremin Drafting the article: P.A. Batrakov Critical revision of the article: V.V. Bazylev, P.A. Batrakov Final approval of the version to be published: V.V. Bazylev, P.A. Batrakov, D.M. Khadiev, A.A. Egorov, N.A. Eremin ","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78471017","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 : 2021-12-28DOI: 10.21688/1681-3472-2021-4-11-22
S. A. Sergeev, V. Lomivorotov
Acute kidney injury (AKI) after cardiac surgery in children remains a common clinical concern. The approaches developed recently and applied in clinical practice have sufficiently helped in clarifying the epidemiology, risk factors and pathophysiology of AKI in paediatric cardiac surgery. Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease criteria (pRIFLE), Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO), which are based on changes in serum creatinine levels and urine output rate, enable the identification and ranking of AKI according to severity. However, the diagnostic strategies for AKI have developed beyond creatinine levels and recommend the use of markers of renal tissue damage. Currently, two markers, neutrophil gelatinase-associated lipocalin and TIMP-2/IGFBP-7 (tissue inhibitor of metalloproteinase 2 and protein that binds insulin-like growth factor-7), can be used for the early diagnosis of AKI in paediatric cardiac surgery.Various risk factors, both renal and extrarenal, can predict AKI after cardiac surgery, among which age, the duration of cardiopulmonary bypass and the need for mechanical ventilation and inotropic support before surgery, are the most significant. Strategies for addressing modifiable risk factors (maintaining appropriate perfusion pressure during cardiopulmonary bypass and avoiding nephrotoxic drugs and fluid overload) will reduce the risk of developing AKI. There has been a significant increase in survival rates due to the introduction of ultrafiltration techniques and the early initiation of renal replacement therapy in the postoperative period.The purpose of this review is to analyse the current literature data on AKI in paediatric cardiac surgery. The review results demonstrate the differences in the incidence of AKI associated with cardiac surgery and the effectiveness of certain methods for prevention and treatment of this complication. Further comprehensive research on the issue of AKI in children, creation of medical electronic databases on patients, minimisation of the influence of possible risk factors and timely prevention and treatment of complications would prevent the development of AKI and reduce the possibility of complication progression to a more severe stage.Received 12 April 2021. Revised 24 June 2021. Accepted 25 June 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
{"title":"Acute kidney injury after cardiac surgery in children","authors":"S. A. Sergeev, V. Lomivorotov","doi":"10.21688/1681-3472-2021-4-11-22","DOIUrl":"https://doi.org/10.21688/1681-3472-2021-4-11-22","url":null,"abstract":"Acute kidney injury (AKI) after cardiac surgery in children remains a common clinical concern. The approaches developed recently and applied in clinical practice have sufficiently helped in clarifying the epidemiology, risk factors and pathophysiology of AKI in paediatric cardiac surgery. Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease criteria (pRIFLE), Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO), which are based on changes in serum creatinine levels and urine output rate, enable the identification and ranking of AKI according to severity. However, the diagnostic strategies for AKI have developed beyond creatinine levels and recommend the use of markers of renal tissue damage. Currently, two markers, neutrophil gelatinase-associated lipocalin and TIMP-2/IGFBP-7 (tissue inhibitor of metalloproteinase 2 and protein that binds insulin-like growth factor-7), can be used for the early diagnosis of AKI in paediatric cardiac surgery.Various risk factors, both renal and extrarenal, can predict AKI after cardiac surgery, among which age, the duration of cardiopulmonary bypass and the need for mechanical ventilation and inotropic support before surgery, are the most significant. Strategies for addressing modifiable risk factors (maintaining appropriate perfusion pressure during cardiopulmonary bypass and avoiding nephrotoxic drugs and fluid overload) will reduce the risk of developing AKI. There has been a significant increase in survival rates due to the introduction of ultrafiltration techniques and the early initiation of renal replacement therapy in the postoperative period.The purpose of this review is to analyse the current literature data on AKI in paediatric cardiac surgery. The review results demonstrate the differences in the incidence of AKI associated with cardiac surgery and the effectiveness of certain methods for prevention and treatment of this complication. Further comprehensive research on the issue of AKI in children, creation of medical electronic databases on patients, minimisation of the influence of possible risk factors and timely prevention and treatment of complications would prevent the development of AKI and reduce the possibility of complication progression to a more severe stage.Received 12 April 2021. Revised 24 June 2021. Accepted 25 June 2021.Funding: The study did not have sponsorship.Conflict of interest: 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":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86880580","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 : 2021-12-28DOI: 10.21688/1681-3472-2021-4-30-40
G. Pushkarev, S. Matskeplishvili
Cardiovascular diseases (CVD) remain the leading cause of death in Russia. Apart from conventional modified risk factors, population health, including CVD progression and related death, is influenced by psychosocial risk factors (PS RF). In theory, the role of PS RF can be explained by the significant changes in death rates within the Russian population during social and economic alterations. However, the significance of primary CVD RF has remained unchanged since the Soviet times. Nonetheless, PS RF does not receive much attention in our country. Thus, the current review aimed to introduce specialists focusing primarily on PS RF, such as low socioeconomic status, social isolation and low levels of social support, depressive disorders and personality traits (hostility and type D personality), which are now undoubtedly closely associated with unfavourable prognosis in patients with CVD. This summary also discusses the main pathophysiological mechanisms that may facilitate the progression of CVD, which include the activation of the hypothalamic–pituitary–adrenal axis, sympathoadrenal system with increased cardiovascular reactivity, endothelial function, inflammatory markers, platelets, coagulation factors, fibrinogen and lifestyle-associated factors. Thus, PS RF have considerable practical significance, not only for individual risk estimation but also in primary and secondary interventions for the prevention of CVD.Received 4 May 2021. Revised 6 June 2021. Accepted 11 June 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
{"title":"Psychosocial risk factors in cardiac practice","authors":"G. Pushkarev, S. Matskeplishvili","doi":"10.21688/1681-3472-2021-4-30-40","DOIUrl":"https://doi.org/10.21688/1681-3472-2021-4-30-40","url":null,"abstract":"Cardiovascular diseases (CVD) remain the leading cause of death in Russia. Apart from conventional modified risk factors, population health, including CVD progression and related death, is influenced by psychosocial risk factors (PS RF). In theory, the role of PS RF can be explained by the significant changes in death rates within the Russian population during social and economic alterations. However, the significance of primary CVD RF has remained unchanged since the Soviet times. Nonetheless, PS RF does not receive much attention in our country. Thus, the current review aimed to introduce specialists focusing primarily on PS RF, such as low socioeconomic status, social isolation and low levels of social support, depressive disorders and personality traits (hostility and type D personality), which are now undoubtedly closely associated with unfavourable prognosis in patients with CVD. This summary also discusses the main pathophysiological mechanisms that may facilitate the progression of CVD, which include the activation of the hypothalamic–pituitary–adrenal axis, sympathoadrenal system with increased cardiovascular reactivity, endothelial function, inflammatory markers, platelets, coagulation factors, fibrinogen and lifestyle-associated factors. Thus, PS RF have considerable practical significance, not only for individual risk estimation but also in primary and secondary interventions for the prevention of CVD.Received 4 May 2021. Revised 6 June 2021. Accepted 11 June 2021.Funding: The study did not have sponsorship.Conflict of interest: 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":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80579654","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 : 2021-12-28DOI: 10.21688/1681-3472-2021-4-112-117
A. D. Gorovaya, D. D. Zubarev, V. Krasnov, M. Chernyavskiy, A. Prokhorikhin
We report the successful endovascular correction of the migration of a transcatheter aortic valve prosthesis in the left ventricle outflow tract (LVOT). A 72-old man was underwent transcatheter aortic valve implantation (TAVI) at Almazov National Medical Research Centre for severe aortic stenosis. During the procedure, the self-expanding prosthesis dislocated 10–12 mm into the LVOT. The frame was optimised with the use of a balloon catheter, and aortic regurgitation I-II degree was achieved. However, on day 17 of hospitalisation, acute heart failure with episodes of asystole occurred as a result of severe paravalvular regurgitation; cardiopulmonary resuscitation was necessary. The prosthesis malpositioning was corrected by traction with endovascular snare devices. The patient was stable during the postprocedural period and discharged on day 31. Dislocation of self-expanding prostheses into the LVOT is a complication specific to TAVI that may quickly aggravate a patient’s condition; therefore, correction of valve malpositioning should be performed as soon as possible. The case reported here in an illustration of successful endovascular correction of dislocation performed with the snare traction technique. This bail-out approach can be used by interventional cardiologists in similar situations.Received 27 May 2021. Revised 29 July 2021. Accepted 30 July 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors Literature review: A.D. Gorovaya, D.D. Zubarev, A.A. Prokhorikhin Drafting the article: A.D. Gorovaya, V.S. Krasnov, A.A. Prokhorikhin Critical revision of the article: A.D. Gorovaya, M.A. Chernyavskiy, A.A. Prokhorikhin Surgical treatment: D.D. Zubarev, V.S. Krasnov, A.A. Prokhorikhin Final approval of the version to be published: A.D. Gorovaya, D.D. Zubarev, V.S. Krasnov, M.A. Chernyavskiy, A.A. Prokhorikhin
{"title":"Successful delayed endovascular correction of migration of transcatheter aortic valve prosthesis in left ventricle outflow tract: case report","authors":"A. D. Gorovaya, D. D. Zubarev, V. Krasnov, M. Chernyavskiy, A. Prokhorikhin","doi":"10.21688/1681-3472-2021-4-112-117","DOIUrl":"https://doi.org/10.21688/1681-3472-2021-4-112-117","url":null,"abstract":"We report the successful endovascular correction of the migration of a transcatheter aortic valve prosthesis in the left ventricle outflow tract (LVOT). A 72-old man was underwent transcatheter aortic valve implantation (TAVI) at Almazov National Medical Research Centre for severe aortic stenosis. During the procedure, the self-expanding prosthesis dislocated 10–12 mm into the LVOT. The frame was optimised with the use of a balloon catheter, and aortic regurgitation I-II degree was achieved. However, on day 17 of hospitalisation, acute heart failure with episodes of asystole occurred as a result of severe paravalvular regurgitation; cardiopulmonary resuscitation was necessary. The prosthesis malpositioning was corrected by traction with endovascular snare devices. The patient was stable during the postprocedural period and discharged on day 31. Dislocation of self-expanding prostheses into the LVOT is a complication specific to TAVI that may quickly aggravate a patient’s condition; therefore, correction of valve malpositioning should be performed as soon as possible. The case reported here in an illustration of successful endovascular correction of dislocation performed with the snare traction technique. This bail-out approach can be used by interventional cardiologists in similar situations.Received 27 May 2021. Revised 29 July 2021. Accepted 30 July 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors Literature review: A.D. Gorovaya, D.D. Zubarev, A.A. Prokhorikhin Drafting the article: A.D. Gorovaya, V.S. Krasnov, A.A. Prokhorikhin Critical revision of the article: A.D. Gorovaya, M.A. Chernyavskiy, A.A. Prokhorikhin Surgical treatment: D.D. Zubarev, V.S. Krasnov, A.A. Prokhorikhin Final approval of the version to be published: A.D. Gorovaya, D.D. Zubarev, V.S. Krasnov, M.A. Chernyavskiy, A.A. Prokhorikhin","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81522137","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 : 2021-12-28DOI: 10.21688/1681-3472-2021-4-76-84
I. Muchamadeev, A. Oborin
Aim. To analyse perioperative and long-term results of carotid endarterectomy for occlusion or stenosis of the contralateral internal carotid artery.Methods. This study included 184 patients who underwent carotid endarterectomy for either occlusion (group 1, n = 74) or stenosis (group 2, n = 110) of the contralateral internal carotid artery. Carotid endarterectomy with eversion was performed in 97% of the patients while the conventional procedure with a patch was used in the remaining 3%.Results. The incidence of perioperative stroke / transient ischemic attack (TIA) in groups 1 and 2 was 1.35% and 1.82%, respectively (p = 0.806). Stroke / TIA within 30 days after surgery occurred in 2 patients in group 1 and in 1 patient in group 2 (p = 0.346); however, none were associated with death. In contrast, 3 cases of myocardial infarction (MI) were seen in group 1, two of which resulted in death. No instances of MI were seen in group 2. Long-term freedom from stroke and myocardial infarction, estimated using the Kaplan-Meier method, was not significantly different between the groups (p = 0.240 and p = 0.657, respectively). Long-term survival was similar in both groups (p = 0.281). An analysis of the risk factors for major cardiovascular events, both immediate and in the long-term, showed that plaque instability was the most significant (p = 0.004), followed by lesions in the arteries of the lower extremities (p = 0.002).Conclusion. Short-term and long-term cerebral complications were not significantly different between patients with occlusion or stenosis of the contralateral internal carotid artery. However, patients with occlusion were significantly more likely to experience MI, necessitating a detailed diagnosis of coronary artery disease. Instability of the atherosclerotic substrate and multifocal atherosclerosis were identified as independent risk factors for major cardiovascular events.Received 18 May 2021. Revised 30 July 2021. Accepted 11 August 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
{"title":"Carotid endarterectomy for atherosclerotic occlusion of the contralateral internal carotid artery","authors":"I. Muchamadeev, A. Oborin","doi":"10.21688/1681-3472-2021-4-76-84","DOIUrl":"https://doi.org/10.21688/1681-3472-2021-4-76-84","url":null,"abstract":"Aim. To analyse perioperative and long-term results of carotid endarterectomy for occlusion or stenosis of the contralateral internal carotid artery.Methods. This study included 184 patients who underwent carotid endarterectomy for either occlusion (group 1, n = 74) or stenosis (group 2, n = 110) of the contralateral internal carotid artery. Carotid endarterectomy with eversion was performed in 97% of the patients while the conventional procedure with a patch was used in the remaining 3%.Results. The incidence of perioperative stroke / transient ischemic attack (TIA) in groups 1 and 2 was 1.35% and 1.82%, respectively (p = 0.806). Stroke / TIA within 30 days after surgery occurred in 2 patients in group 1 and in 1 patient in group 2 (p = 0.346); however, none were associated with death. In contrast, 3 cases of myocardial infarction (MI) were seen in group 1, two of which resulted in death. No instances of MI were seen in group 2. Long-term freedom from stroke and myocardial infarction, estimated using the Kaplan-Meier method, was not significantly different between the groups (p = 0.240 and p = 0.657, respectively). Long-term survival was similar in both groups (p = 0.281). An analysis of the risk factors for major cardiovascular events, both immediate and in the long-term, showed that plaque instability was the most significant (p = 0.004), followed by lesions in the arteries of the lower extremities (p = 0.002).Conclusion. Short-term and long-term cerebral complications were not significantly different between patients with occlusion or stenosis of the contralateral internal carotid artery. However, patients with occlusion were significantly more likely to experience MI, necessitating a detailed diagnosis of coronary artery disease. Instability of the atherosclerotic substrate and multifocal atherosclerosis were identified as independent risk factors for major cardiovascular events.Received 18 May 2021. Revised 30 July 2021. Accepted 11 August 2021.Funding: The study did not have sponsorship.Conflict of interest: 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":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75718899","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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