Objective: To evaluate hospital outcomes of isolated hepatic perfusion for metastases of uveal melanoma.Methods: In 2020-2022, 38 isolated hepatic perfusion procedures for unresectable metastases of uveal melanoma were performed in the Kostroma Regional Cancer Center. Our study included the following complications: death, bleeding, tumor lysis syndrome, abscess in the left lobe of the liver, peritonitis, asystole, lower extremity deep vein thrombosis, hydrothorax, acute liver failure, anasarca, polyserositis, ischemic cholangiopathy, common hepatic artery thrombosis, detachment of the common hepatic artery intima. We calculated a composite end point (the sum of all the complications).Results: In 2 cases, there was an accidental decannulation of the cannula placed in the proper hepatic artery in the 30th minute of perfusion. Due to hemodynamic instability, the procedure was terminated. Death from worsening liver failure was reported in 3 cases. Postoperative bleeding was diagnosed in 7 patients, and relaparotomy was performed to stop the bleeding. Subsequently, no concerns were reported. The combined end point was 42.11%.Conclusion: Isolated hepatic perfusion is an unsafe treatment option for patients with liver metastases of uveal melanoma. Received 12 May 2023. Revised 16 June 2023. Accepted 21 June 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.D. Kaprin, Yu.V. BelovData collection and analysis: A.N. Kazantsev, V.M. UnguryanStatistical analysis: A.N. Kazantsev, V.M. Unguryan, A.V. KorotkikhDrafting the article: A.N. Kazantsev, V.M. UnguryanCritical revision of the article: A.D. Kaprin, Yu.V. Belov, S.A. IvanovFinal approval of the version to be published: V.M. Unguryan, A.N. Kazantsev, A.V. Korotkikh, S.A. Ivanov, Yu.V. Belov, A.D. Kaprin
{"title":"Isolated hepatic perfusion for metastases of uveal melanoma: hospital outcomes","authors":"V.M. Unguryan, A.N. Kazantsev, A.V. Korotkikh, S.A. Ivanov, Yu.V. Belov, A.D. Kaprin","doi":"10.21688/1681-3472-2023-3-74-82","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-3-74-82","url":null,"abstract":"Objective: To evaluate hospital outcomes of isolated hepatic perfusion for metastases of uveal melanoma.Methods: In 2020-2022, 38 isolated hepatic perfusion procedures for unresectable metastases of uveal melanoma were performed in the Kostroma Regional Cancer Center. Our study included the following complications: death, bleeding, tumor lysis syndrome, abscess in the left lobe of the liver, peritonitis, asystole, lower extremity deep vein thrombosis, hydrothorax, acute liver failure, anasarca, polyserositis, ischemic cholangiopathy, common hepatic artery thrombosis, detachment of the common hepatic artery intima. We calculated a composite end point (the sum of all the complications).Results: In 2 cases, there was an accidental decannulation of the cannula placed in the proper hepatic artery in the 30th minute of perfusion. Due to hemodynamic instability, the procedure was terminated. Death from worsening liver failure was reported in 3 cases. Postoperative bleeding was diagnosed in 7 patients, and relaparotomy was performed to stop the bleeding. Subsequently, no concerns were reported. The combined end point was 42.11%.Conclusion: Isolated hepatic perfusion is an unsafe treatment option for patients with liver metastases of uveal melanoma. Received 12 May 2023. Revised 16 June 2023. Accepted 21 June 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.D. Kaprin, Yu.V. BelovData collection and analysis: A.N. Kazantsev, V.M. UnguryanStatistical analysis: A.N. Kazantsev, V.M. Unguryan, A.V. KorotkikhDrafting the article: A.N. Kazantsev, V.M. UnguryanCritical revision of the article: A.D. Kaprin, Yu.V. Belov, S.A. IvanovFinal approval of the version to be published: V.M. Unguryan, A.N. Kazantsev, A.V. Korotkikh, S.A. Ivanov, Yu.V. Belov, A.D. Kaprin","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135200471","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}
Background: There is strong evidence that stroke associated with atrial fibrillation (AF) has a cardioembolic origin. Given that the main source of thrombi in such patients is the left atrial appendage (LAA), there is a prospect of its closure becoming an adjunct or alternative to lifelong anticoagulant therapy.Objective: To evaluate the long-term effectiveness of routine LAA closure for ischemic stroke (IS) prevention in patients who underwent cardiac surgery with cardiopulmonary bypass (CPB).Methods: Our retrospective single-center study included patients who underwent cardiac surgery with CPB within 3 years. All participants were older than 18 years. The exclusion criteria: lack of information on the long-term outcomes; hemodynamically significant lesion of brachiocephalic vessels; porcelain aorta; infective endocarditis; history of malignant neoplasms, autoimmune diseases, and systemic vasculitis; acute coronary syndrome, repeated open heart surgery, and minimally invasive procedures. The selected patients were divided into 2 groups. Group 1 included patients who underwent concomitant LAA closure. Group 2 consisted of patients with intact LAA. We further divided patients based on whether they had preoperative AF or not. The primary end point was IS. The secondary end points were survival, perioperative myocardial infarction and AF, CPB and aortic cross-clamp time, number of resternotomies for bleeding, length of stay in the intensive care and cardiac surgery units.Results: After the primary analysis and use of exclusion criteria, we formed an LAA closure group (216 patients) and a group with intact LAA (179 patients). Among 129 patients with preoperative AF, concomitant LAA closure was performed in 69 patients and was not performed in 60 patients. Among 266 patients with no history of AF, this procedure was performed in 147 patients and was not performed in 119 patients. Multivariable Cox regression analysis included all the patients and showed that LAA closure was an independent predictor of decrease in IS incidence (hazard ratio, 0.20; 95% CI, 0.06-0.62; P = .006). At the same time, the procedure lost its benefits when patients with AF were excluded from the analysis. There were no differences in the secondary end points.Conclusion: LAA closure is an effective and safe method for long-term IS prevention in patients with AF operated on using CPB. The use of this procedure as a routine addition to the main cardiac surgery is not viable. Received 12 December 2022. Revised 4 September 2023. Accepted 5 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":"Routine left atrial appendage closure: a retrospective analysis of mid-term outcomes","authors":"R.N. Komarov, D.V. Shevyakin, Ye.B. Solovyev, N.V. Kulikov","doi":"10.21688/1681-3472-2023-3-53-61","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-3-53-61","url":null,"abstract":"Background: There is strong evidence that stroke associated with atrial fibrillation (AF) has a cardioembolic origin. Given that the main source of thrombi in such patients is the left atrial appendage (LAA), there is a prospect of its closure becoming an adjunct or alternative to lifelong anticoagulant therapy.Objective: To evaluate the long-term effectiveness of routine LAA closure for ischemic stroke (IS) prevention in patients who underwent cardiac surgery with cardiopulmonary bypass (CPB).Methods: Our retrospective single-center study included patients who underwent cardiac surgery with CPB within 3 years. All participants were older than 18 years. The exclusion criteria: lack of information on the long-term outcomes; hemodynamically significant lesion of brachiocephalic vessels; porcelain aorta; infective endocarditis; history of malignant neoplasms, autoimmune diseases, and systemic vasculitis; acute coronary syndrome, repeated open heart surgery, and minimally invasive procedures. The selected patients were divided into 2 groups. Group 1 included patients who underwent concomitant LAA closure. Group 2 consisted of patients with intact LAA. We further divided patients based on whether they had preoperative AF or not. The primary end point was IS. The secondary end points were survival, perioperative myocardial infarction and AF, CPB and aortic cross-clamp time, number of resternotomies for bleeding, length of stay in the intensive care and cardiac surgery units.Results: After the primary analysis and use of exclusion criteria, we formed an LAA closure group (216 patients) and a group with intact LAA (179 patients). Among 129 patients with preoperative AF, concomitant LAA closure was performed in 69 patients and was not performed in 60 patients. Among 266 patients with no history of AF, this procedure was performed in 147 patients and was not performed in 119 patients. Multivariable Cox regression analysis included all the patients and showed that LAA closure was an independent predictor of decrease in IS incidence (hazard ratio, 0.20; 95% CI, 0.06-0.62; P = .006). At the same time, the procedure lost its benefits when patients with AF were excluded from the analysis. There were no differences in the secondary end points.Conclusion: LAA closure is an effective and safe method for long-term IS prevention in patients with AF operated on using CPB. The use of this procedure as a routine addition to the main cardiac surgery is not viable. Received 12 December 2022. Revised 4 September 2023. Accepted 5 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":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135199914","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}
Background: As the severity of comorbid diseases increases, risks of cardiopulmonary bypass (CPB) complications significantly increase. A complex of the procedure’s damaging factors provokes a systemic inflammatory response that in some cases is accompanied by the damage to target organs, transitioning from chronic organ dysfunctions into acute ones. Some studies on the use of minimal invasive extracorporeal circulation (MiECC) systems show their advantage over conventional extracorporeal circulation (CECC); however, the diversity of MiECC systems, patients, and outcomes precludes us from confidently extrapolating these data to older comorbid patients.Objective: To compare the severity of systemic inflammation and treatment outcomes in comorbid patients who underwent cardiac surgery with CECC and MiECC.Methods: We conducted a retrospective cohort study of 760 patients who consecutively underwent elective cardiac operations in 2019-2022. Inclusion criteria: comorbid status (age-adjusted Charlson Comorbidity Index score of ≥6); CPB time ≥90 min. Exclusion criteria: emergency surgery, refusal to participate in the study. A total of 68 patients met the inclusion criteria. We formed 2 study groups based on the extracorporeal circulation method: CECC group (n = 51) and MiECC group (n = 17). Control points: before CPB and 24 hours after the surgery (lactate; creatinine; oxygenation index, hemolysis level). For systemic inflammatory response markers: 1 hour after the CPB start and 24 hours after the CPB end (interleukin 6; interleukin 10; procalcitonin; C-reactive protein; soluble Triggering Receptor Expressed on Myeloid Cells-1 [sTREM-1]). We evaluated respiratory and renal complications, drainage-related hemorrhages, hemostatic disorders, the need for sympathomimetic drugs, and the length of stay in an intensive care unit and inpatient hospital.Results: Between the groups there were no statistically significant differences in gender and anthropometric characteristics, surgery types, and main perfusion parameters. In the CECC group, we observed significantly higher doses of vasoconstrictors (norepinephrine) as well as a decrease in urine output and lung injury and an increase in lactate and hemolysis. The systemic inflammatory response markers were also significantly higher.Conclusion: Compared with CECC, MiECC does not significantly affect the frequency of organ dysfunctions; however, it reduces the severity of the systemic inflammatory response and immune suppression that are trigger mechanisms for multiple organ dysfunction syndrome. It is particularly important for patients with chronic organ dysfunctions. A range of indications for MiECC systems should be defined given its high cost and off-target effect on pleiotropic factors of systemic inflammatory response development. Received 6 April 2023. Revised 17 August 2023. Accepted 18 August 2023. Funding: The study was conducted within the framework of the research project "Development of minimally in
{"title":"Minimal invasive extracorporeal circulation in comorbid patients","authors":"A.Sh. Revishvili, R.A. Kornelyuk, G.P. Plotnikov, L.B. Berikashvili, I.P. Komkov, E.S. Malyshenko, V.M. Zemskov, V.A. Popov","doi":"10.21688/1681-3472-2023-3-62-73","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-3-62-73","url":null,"abstract":"Background: As the severity of comorbid diseases increases, risks of cardiopulmonary bypass (CPB) complications significantly increase. A complex of the procedure’s damaging factors provokes a systemic inflammatory response that in some cases is accompanied by the damage to target organs, transitioning from chronic organ dysfunctions into acute ones. Some studies on the use of minimal invasive extracorporeal circulation (MiECC) systems show their advantage over conventional extracorporeal circulation (CECC); however, the diversity of MiECC systems, patients, and outcomes precludes us from confidently extrapolating these data to older comorbid patients.Objective: To compare the severity of systemic inflammation and treatment outcomes in comorbid patients who underwent cardiac surgery with CECC and MiECC.Methods: We conducted a retrospective cohort study of 760 patients who consecutively underwent elective cardiac operations in 2019-2022. Inclusion criteria: comorbid status (age-adjusted Charlson Comorbidity Index score of ≥6); CPB time ≥90 min. Exclusion criteria: emergency surgery, refusal to participate in the study. A total of 68 patients met the inclusion criteria. We formed 2 study groups based on the extracorporeal circulation method: CECC group (n = 51) and MiECC group (n = 17). Control points: before CPB and 24 hours after the surgery (lactate; creatinine; oxygenation index, hemolysis level). For systemic inflammatory response markers: 1 hour after the CPB start and 24 hours after the CPB end (interleukin 6; interleukin 10; procalcitonin; C-reactive protein; soluble Triggering Receptor Expressed on Myeloid Cells-1 [sTREM-1]). We evaluated respiratory and renal complications, drainage-related hemorrhages, hemostatic disorders, the need for sympathomimetic drugs, and the length of stay in an intensive care unit and inpatient hospital.Results: Between the groups there were no statistically significant differences in gender and anthropometric characteristics, surgery types, and main perfusion parameters. In the CECC group, we observed significantly higher doses of vasoconstrictors (norepinephrine) as well as a decrease in urine output and lung injury and an increase in lactate and hemolysis. The systemic inflammatory response markers were also significantly higher.Conclusion: Compared with CECC, MiECC does not significantly affect the frequency of organ dysfunctions; however, it reduces the severity of the systemic inflammatory response and immune suppression that are trigger mechanisms for multiple organ dysfunction syndrome. It is particularly important for patients with chronic organ dysfunctions. A range of indications for MiECC systems should be defined given its high cost and off-target effect on pleiotropic factors of systemic inflammatory response development. Received 6 April 2023. Revised 17 August 2023. Accepted 18 August 2023. Funding: The study was conducted within the framework of the research project \"Development of minimally in","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135199601","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 : 2023-09-29DOI: 10.21688/1681-3472-2023-3-89-98
M.V. Zozulya, A.V. Sotnikov, A.I. Lenkin
Background: Fluid overload is an independent risk factor for acute kidney injury after cardiac surgery. An objective volume status assessment remains an unsolved clinical problem.Objective: To analyze the relationship between the dynamic changes in splanchnic blood flow patterns (portal, hepatic, and interlobar renal veins), reflecting the venous congestion severity, and severity of renal dysfunction in the studied patients.Methods: From February to May 2023, 3 patients after open heart surgery developed acute kidney injury in the postoperative period: 2 of them required renal replacement therapy. In the perioperative period, all patients underwent Doppler ultrasonographic assessment of the splanchnic blood flow according to the venous excess ultrasound (VExUS) score.Results: The most distinct changes in blood flow patterns were observed in portal and interlobar renal veins. Two anuric patients requiring renal replacement therapy had a pulsatile portal venous flow with systolic flow reversal that indicated severe venous congestion and biphasic renal venous flow. After restoration of urine output in 1 patient, the blood flow pattern in the portal vein returned to the normal pattern. In another patient, the blood flow remained pulsatile, which manifested itself by persisting clinical signs of overhydration. In the third patient, the portal blood flow also was pulsatile but had no systolic flow reversal. The renal blood flow was biphasic, although it was initially continuous. After restoration of urine output and overhydration improvement, the blood flow pattern returned to the preoperative pattern.Conclusion: In the studied patients, the dynamic assessment of splanchnic blood flow using the VExUS score allowed to objectively assess the venous congestion severity and served as an additional criterion for initiating renal replacement therapy in case of acute kidney injury progression. Further research could validate this type of monitoring because its interpretation requires a comprehensive assessment due to moderate specificity. Received 21 June 2023. Revised 17 July 2023. Accepted 24 July 2023. Informed consent: The patients’ 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 conflicts of interests. Contribution of the authors: The authors contributed equally to this article.
{"title":"Dynamic volume status assessment with the VExUS score after heart valve surgery complicated by acute kidney injury: a case series","authors":"M.V. Zozulya, A.V. Sotnikov, A.I. Lenkin","doi":"10.21688/1681-3472-2023-3-89-98","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-3-89-98","url":null,"abstract":"Background: Fluid overload is an independent risk factor for acute kidney injury after cardiac surgery. An objective volume status assessment remains an unsolved clinical problem.Objective: To analyze the relationship between the dynamic changes in splanchnic blood flow patterns (portal, hepatic, and interlobar renal veins), reflecting the venous congestion severity, and severity of renal dysfunction in the studied patients.Methods: From February to May 2023, 3 patients after open heart surgery developed acute kidney injury in the postoperative period: 2 of them required renal replacement therapy. In the perioperative period, all patients underwent Doppler ultrasonographic assessment of the splanchnic blood flow according to the venous excess ultrasound (VExUS) score.Results: The most distinct changes in blood flow patterns were observed in portal and interlobar renal veins. Two anuric patients requiring renal replacement therapy had a pulsatile portal venous flow with systolic flow reversal that indicated severe venous congestion and biphasic renal venous flow. After restoration of urine output in 1 patient, the blood flow pattern in the portal vein returned to the normal pattern. In another patient, the blood flow remained pulsatile, which manifested itself by persisting clinical signs of overhydration. In the third patient, the portal blood flow also was pulsatile but had no systolic flow reversal. The renal blood flow was biphasic, although it was initially continuous. After restoration of urine output and overhydration improvement, the blood flow pattern returned to the preoperative pattern.Conclusion: In the studied patients, the dynamic assessment of splanchnic blood flow using the VExUS score allowed to objectively assess the venous congestion severity and served as an additional criterion for initiating renal replacement therapy in case of acute kidney injury progression. Further research could validate this type of monitoring because its interpretation requires a comprehensive assessment due to moderate specificity. Received 21 June 2023. Revised 17 July 2023. Accepted 24 July 2023. Informed consent: The patients’ 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 conflicts of interests. Contribution of the authors: The authors contributed equally to this article.","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135199425","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}
Background: Refractory angina pectoris significantly reduces the length and quality of life. One of the methods to control symptoms and improve the quality of life of patients with refractory angina pectoris is spinal cord stimulation.Objective: To evaluate the effectiveness of spinal cord stimulation in controlling anginal pain in the long-term period over a long follow-up (>7 years).Methods: We retrospectively studied treatment results of 9 patients (6 men and 3 women) in the long-term follow-up from October 2012 to November 2022. Anginal pain and patients' quality of life were assessed using the visual analog scale and the Seattle Angina Questionnaire, respectively.Results: The mean follow-up was 7.33 ± 1.11 years. In the long-term postoperative period, regression of pain according to the visual analog scale was 52.3% (P = .0025). The Seattle Angina Questionnaire showed an improvement of the quality of life by 52.2% (P = .0993).Conclusion: Spinal cord stimulation allows to make control of chronic anginal pain more efficient, improve patients’ length and quality of life, and reduce the frequency and severity of disability. Received 8 December 2022. Revised 17 July 2023. Accepted 18 July 2023. 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 authors: The authors contributed equally to this article.
{"title":"Spinal cord stimulation for refractory angina pectoris: a case series","authors":"D.D. Duse, V.Ya. Babchenko, R.S. Kiselev, V.I. Murtazin","doi":"10.21688/1681-3472-2023-3-83-88","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-3-83-88","url":null,"abstract":"Background: Refractory angina pectoris significantly reduces the length and quality of life. One of the methods to control symptoms and improve the quality of life of patients with refractory angina pectoris is spinal cord stimulation.Objective: To evaluate the effectiveness of spinal cord stimulation in controlling anginal pain in the long-term period over a long follow-up (>7 years).Methods: We retrospectively studied treatment results of 9 patients (6 men and 3 women) in the long-term follow-up from October 2012 to November 2022. Anginal pain and patients' quality of life were assessed using the visual analog scale and the Seattle Angina Questionnaire, respectively.Results: The mean follow-up was 7.33 ± 1.11 years. In the long-term postoperative period, regression of pain according to the visual analog scale was 52.3% (P = .0025). The Seattle Angina Questionnaire showed an improvement of the quality of life by 52.2% (P = .0993).Conclusion: Spinal cord stimulation allows to make control of chronic anginal pain more efficient, improve patients’ length and quality of life, and reduce the frequency and severity of disability. Received 8 December 2022. Revised 17 July 2023. Accepted 18 July 2023. 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 authors: The authors contributed equally to this article.","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135199752","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}
Background: In recent years, a typical candidate for coronary artery bypass grafting (CABG) has become a patient with complex, multivessel coronary artery disease (CAD), often with an unsatisfactory and small distal bed. The prevalence of diffuse CAD is 4.2%-46.0%, and the CABG refusal rate due to this disease accounts for 1.3%-15.0%. Diffuse CAD is an independent predictor of mortality and poor prognosis after CABG. Due to a lack of uniform criteria for diffuse CAD and randomized trials, there is no preferred surgical treatment option for such patients.Objective: To evaluate immediate and mid-term results of microscope-assisted CABG in patients with ischemic heart disease and diffuse CAD.Methods: We calculated a diffuseness score and determined whether the criterion of diffuse lesion by SYNTAX score was met. For our retrospective study we selected 187 ischemic heart disease patients with 3-vessel CAD who underwent microscope-assisted CABG. A coronary lesion with a diffuseness score of >18 was considered diffuse if the SYNTAX score criterion was met for each of the main coronary arteries. The patients were divided into 2 groups: group 1 for patients with diffuse CAD (n = 60) and group 2 for patients with CAD that did not meet the criterion to be considered diffused (n = 127). The propensity score matching was used to reduce differences between the groups. The primary end point was death from any cause; the secondary end points were adverse cardiovascular events (death from cardiac causes, myocardial infarction, repeated revascularization, acute cerebrovascular accident) and angina.Results: No significant differences in the frequency of in-hospital specific and nonspecific complications were found. The frequency of achieved complete revascularization was comparable between the groups. There were no significant differences in the long-term survival, adverse cardiovascular events, and freedom from angina during the median follow-up of 39 months (min 1 month; max 60 months). The univariate analysis after the propensity score matching showed that diffuse CAD was not a significant predictor of death from any cause [hazard ratio (HR), 1.141; 95% CI, 0.348-3.742; P = .83], adverse cardiovascular events [HR, 0.940; 95% CI, 0.425-2.078; P = .88], and angina [HR, 0.817; 95% CI, 0.394-1.696; P = .59]. The multivariate analysis revealed no significant association between diffuse CAD and death from any cause both before [HR, 1.382; 95% CI, 0.396-4.815; P = .61] and after propensity score matching [HR, 2.079; 95% CI, 0.158-27.422; P = .58]. We found that within 60 months after CABG, the risk of death from any cause was increased: by patient’s age [HR, 1.166; 95% CI, 1.043-1.303; P = .007], male sex [HR, 5.583; 95% CI, 1.062-29.344; P = .042], and diabetes mellitus [HR, 3.673; 95% CI, 1.143-11.805; P = .029] before the propensity score matching and by patient’s age [HR, 2.055; 95% CI, 1.028-4.104; P = .041] and cardiopulmonary bypass time [HR, 1.190; 95% CI,
{"title":"Microscope-assisted coronary artery bypass grafting in diffuse coronary artery disease: immediate and mid-term results","authors":"A.N. Semchenko, A.M. Shevchenko, I.V. Zaicev, A.V. Semchenko, T.B. Vnukova","doi":"10.21688/1681-3472-2023-3-31-43","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-3-31-43","url":null,"abstract":"Background: In recent years, a typical candidate for coronary artery bypass grafting (CABG) has become a patient with complex, multivessel coronary artery disease (CAD), often with an unsatisfactory and small distal bed. The prevalence of diffuse CAD is 4.2%-46.0%, and the CABG refusal rate due to this disease accounts for 1.3%-15.0%. Diffuse CAD is an independent predictor of mortality and poor prognosis after CABG. Due to a lack of uniform criteria for diffuse CAD and randomized trials, there is no preferred surgical treatment option for such patients.Objective: To evaluate immediate and mid-term results of microscope-assisted CABG in patients with ischemic heart disease and diffuse CAD.Methods: We calculated a diffuseness score and determined whether the criterion of diffuse lesion by SYNTAX score was met. For our retrospective study we selected 187 ischemic heart disease patients with 3-vessel CAD who underwent microscope-assisted CABG. A coronary lesion with a diffuseness score of >18 was considered diffuse if the SYNTAX score criterion was met for each of the main coronary arteries. The patients were divided into 2 groups: group 1 for patients with diffuse CAD (n = 60) and group 2 for patients with CAD that did not meet the criterion to be considered diffused (n = 127). The propensity score matching was used to reduce differences between the groups. The primary end point was death from any cause; the secondary end points were adverse cardiovascular events (death from cardiac causes, myocardial infarction, repeated revascularization, acute cerebrovascular accident) and angina.Results: No significant differences in the frequency of in-hospital specific and nonspecific complications were found. The frequency of achieved complete revascularization was comparable between the groups. There were no significant differences in the long-term survival, adverse cardiovascular events, and freedom from angina during the median follow-up of 39 months (min 1 month; max 60 months). The univariate analysis after the propensity score matching showed that diffuse CAD was not a significant predictor of death from any cause [hazard ratio (HR), 1.141; 95% CI, 0.348-3.742; P = .83], adverse cardiovascular events [HR, 0.940; 95% CI, 0.425-2.078; P = .88], and angina [HR, 0.817; 95% CI, 0.394-1.696; P = .59]. The multivariate analysis revealed no significant association between diffuse CAD and death from any cause both before [HR, 1.382; 95% CI, 0.396-4.815; P = .61] and after propensity score matching [HR, 2.079; 95% CI, 0.158-27.422; P = .58]. We found that within 60 months after CABG, the risk of death from any cause was increased: by patient’s age [HR, 1.166; 95% CI, 1.043-1.303; P = .007], male sex [HR, 5.583; 95% CI, 1.062-29.344; P = .042], and diabetes mellitus [HR, 3.673; 95% CI, 1.143-11.805; P = .029] before the propensity score matching and by patient’s age [HR, 2.055; 95% CI, 1.028-4.104; P = .041] and cardiopulmonary bypass time [HR, 1.190; 95% CI, ","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135199912","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 : 2023-06-30DOI: 10.21688/1681-3472-2023-2-87-93
I. S. Sem’in, A. N. Ivanenko, G. A. Sobolev, A. Kiselev, A. Kazantsev, A. Korotkikh, I. V. Chernikova, V. Unguryan
Objective: To evaluate the effectiveness of endovascular stent thrombectomy for acute upper limb ischemia caused by thrombosis or thromboembolism of the major arteries of the upper limb.Methods: We evaluated the effectiveness and safety of this technique in 18 patients with acute upper limb ischemia. The mean age was 72 (38‐93) years; 66.7% of the patients were women. Arterial hypertension was observed in 94.4% of the patients, and 38.9% of the patients had confirmed atrial fibrillation.Results: The primary success rate (complete revascularization according to angiography findings) was 83.3% (15 of 18 cases). We used this technique as a stand-alone procedure in 15 cases. Two patients received self-expanding stents, and 1 patient had selective thrombolytic therapy. In 3 cases we did not relieve symptoms of acute ischemia and perform any upper limb amputations during hospitalization, nor did we have any conversions to open surgery. Two patients died during hospitalization: one patient died of acute myocardial infarction, and another died of multiple organ dysfunction syndrome in the postoperative period.Conclusion: This endovascular thrombectomy technique in combination with other endovascular techniques is highly effective and has a number of benefits, such as low trauma, no need for general anesthesia, accurate intra- and postoperative patency control, timely detection of emboli with the possibility of their removal from arteries comparable in diameter to a stent delivery system (up to 1.8 mm). Received 15 February 2023. Revised 29 March 2023. Accepted 6 April 2023. 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: A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan, A.D. KiselevDrafting the article: A.N. Kazantsev, A.N. Ivanenko, G.A. SobolevCritical revision of the article: I.S. SeminSurgical treatment: A.N. Ivanenko, G.A. SobolevFinal approval of the version to be published: I.S. Semin, A.N. Ivanenko, G.A. Sobolev, A.D. Kiselev, A.N. Kazantsev, A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan
目的:评价血管内支架取栓术治疗上肢大动脉血栓形成或血栓栓塞引起的急性上肢缺血的疗效。方法:对18例急性上肢缺血患者的临床疗效和安全性进行评价。平均年龄为72岁(38‐93岁);66.7%的患者为女性。94.4%的患者出现动脉高血压,38.9%的患者确诊房颤。结果:18例患者中15例首次成功(血管造影显示完全血运重建)83.3%。我们在15例病例中使用该技术作为独立手术。2例患者接受自扩张支架,1例患者接受选择性溶栓治疗。在3例患者中,我们在住院期间没有缓解急性缺血症状,也没有进行任何上肢截肢手术,也没有进行任何转开腹手术。2例患者在住院期间死亡:1例患者死于急性心肌梗死,1例患者死于术后多器官功能障碍综合征。结论:这种血管内取栓技术与其他血管内技术联合使用是非常有效的,并且具有许多优点,如创伤小、不需要全身麻醉、准确的术中和术后通畅控制、及时发现栓塞并有可能将其从直径与支架输送系统相当的动脉中取出(最大1.8 mm)。2023年2月15日收到。2023年3月29日修订。2023年4月6日录用。知情同意:已取得患者知情同意将病历用于医疗目的。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者贡献文献综述:A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan, A.D. kiselevv文章起草:A.N. Kazantsev, A.N. Ivanenko, G.A. sobolev文章关键修改:I.S. Semin手术治疗:A.N. Ivanenko, G.A. Sobolev, A.N. Kiselev, A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan最终批准出版:I.S. Semin, A.N. Ivanenko, G.A. Sobolev, A.V. Kiselev, A.V. Chernikova
{"title":"Stent thrombectomy for acute upper limb ischemia associated with thrombosis or thromboembolism: a case series","authors":"I. S. Sem’in, A. N. Ivanenko, G. A. Sobolev, A. Kiselev, A. Kazantsev, A. Korotkikh, I. V. Chernikova, V. Unguryan","doi":"10.21688/1681-3472-2023-2-87-93","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-2-87-93","url":null,"abstract":"Objective: To evaluate the effectiveness of endovascular stent thrombectomy for acute upper limb ischemia caused by thrombosis or thromboembolism of the major arteries of the upper limb.Methods: We evaluated the effectiveness and safety of this technique in 18 patients with acute upper limb ischemia. The mean age was 72 (38‐93) years; 66.7% of the patients were women. Arterial hypertension was observed in 94.4% of the patients, and 38.9% of the patients had confirmed atrial fibrillation.Results: The primary success rate (complete revascularization according to angiography findings) was 83.3% (15 of 18 cases). We used this technique as a stand-alone procedure in 15 cases. Two patients received self-expanding stents, and 1 patient had selective thrombolytic therapy. In 3 cases we did not relieve symptoms of acute ischemia and perform any upper limb amputations during hospitalization, nor did we have any conversions to open surgery. Two patients died during hospitalization: one patient died of acute myocardial infarction, and another died of multiple organ dysfunction syndrome in the postoperative period.Conclusion: This endovascular thrombectomy technique in combination with other endovascular techniques is highly effective and has a number of benefits, such as low trauma, no need for general anesthesia, accurate intra- and postoperative patency control, timely detection of emboli with the possibility of their removal from arteries comparable in diameter to a stent delivery system (up to 1.8 mm).\u0000Received 15 February 2023. Revised 29 March 2023. Accepted 6 April 2023.\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: A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan, A.D. KiselevDrafting the article: A.N. Kazantsev, A.N. Ivanenko, G.A. SobolevCritical revision of the article: I.S. SeminSurgical treatment: A.N. Ivanenko, G.A. SobolevFinal approval of the version to be published: I.S. Semin, A.N. Ivanenko, G.A. Sobolev, A.D. Kiselev, A.N. Kazantsev, A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90550607","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 : 2023-06-30DOI: 10.21688/1681-3472-2023-2-54-65
A. A. Baranov, O. Krestyaninov, A. Badoian, D. Khelimskii, S. Manukian, A. Tsydenova, M.A. Makhmudov
Background: Transcatheter aortic valve implantation (TAVI) is an effective and safe procedure for severe aortic stenosis. Increased aortic root angulation is an important anatomical feature that may cause technical difficulties and negatively affect immediate and long-term outcomes.Objective: To evaluate immediate outcomes of TAVI in patients with increased aortic root angulation.Methods: Our retrospective single-center study included 412 patients with severe aortic stenosis who underwent TAVI using self-expanding bioprostheses from 2015 to 2022. Patients with aortic root angulation ≥ 49° were included in group 1 (n = 200), and those with aortic root angulation < 49° comprised group 2 (n = 212).Results: The mean age of the patients was 75.2 ± 7.2 years. In a subgroup with the first-generation CoreValve prosthesis and a ≥ 49° angle, we observed moderate aortic regurgitation significantly more often (7.4% vs 0.0%, P = .010) and technical success significantly less often (90.1% vs 98.9%, P = .010) compared with a similar subgroup with a < 49° angle. In subgroups with CoreValve Evolute R and ACURATE neo prostheses, there were no significant differences in terms of the mentioned parameters. Independent predictors of technical failure were the aortic root angle [OR for each degree increase: 0.44, 95% CI: 0.30-0.63, P < .001], no postdilation [OR: 5.0, 95% CI: 1.33-20.00, P = .074], indexed mass of the left ventricular myocardium [OR: 1.02, 95% CI: 1.01-1.03, P = .003], and higher implantation relative to the aortic annulus [OR for every 1 mm decrease in implantation depth: 0.44, 95% CI: 0.30-0.63, P < .001].Conclusion: Increased aortic angulation ≥ 49° negatively affected the technical success of TAVI only in patients with the first-generation CoreValve prostheses. Independent predictors of technical failure in TAVI were the aortic root angle, no postdilation, indexed mass of the left ventricular myocardium, and higher implantation relative to the aortic annulus. Received 9 January 2023. Revised 10 May 2023. Accepted 30 May 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianData collection and analysis: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianStatistical analysis: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianDrafting the article: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, A.Yu. Tsydenova, M.A. MakhmudovCritical revision of the article: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, A.Yu. Tsydenova, M.A. MakhmudovFinal approval of the version to be published: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, A.Yu. Tsydenova, M.A. Makhmudov
{"title":"Immediate outcomes of transcatheter aortic valve implantation in patients with horizontal aorta","authors":"A. A. Baranov, O. Krestyaninov, A. Badoian, D. Khelimskii, S. Manukian, A. Tsydenova, M.A. Makhmudov","doi":"10.21688/1681-3472-2023-2-54-65","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-2-54-65","url":null,"abstract":"Background: Transcatheter aortic valve implantation (TAVI) is an effective and safe procedure for severe aortic stenosis. Increased aortic root angulation is an important anatomical feature that may cause technical difficulties and negatively affect immediate and long-term outcomes.Objective: To evaluate immediate outcomes of TAVI in patients with increased aortic root angulation.Methods: Our retrospective single-center study included 412 patients with severe aortic stenosis who underwent TAVI using self-expanding bioprostheses from 2015 to 2022. Patients with aortic root angulation ≥ 49° were included in group 1 (n = 200), and those with aortic root angulation < 49° comprised group 2 (n = 212).Results: The mean age of the patients was 75.2 ± 7.2 years. In a subgroup with the first-generation CoreValve prosthesis and a ≥ 49° angle, we observed moderate aortic regurgitation significantly more often (7.4% vs 0.0%, P = .010) and technical success significantly less often (90.1% vs 98.9%, P = .010) compared with a similar subgroup with a < 49° angle. In subgroups with CoreValve Evolute R and ACURATE neo prostheses, there were no significant differences in terms of the mentioned parameters. Independent predictors of technical failure were the aortic root angle [OR for each degree increase: 0.44, 95% CI: 0.30-0.63, P < .001], no postdilation [OR: 5.0, 95% CI: 1.33-20.00, P = .074], indexed mass of the left ventricular myocardium [OR: 1.02, 95% CI: 1.01-1.03, P = .003], and higher implantation relative to the aortic annulus [OR for every 1 mm decrease in implantation depth: 0.44, 95% CI: 0.30-0.63, P < .001].Conclusion: Increased aortic angulation ≥ 49° negatively affected the technical success of TAVI only in patients with the first-generation CoreValve prostheses. Independent predictors of technical failure in TAVI were the aortic root angle, no postdilation, indexed mass of the left ventricular myocardium, and higher implantation relative to the aortic annulus.\u0000Received 9 January 2023. Revised 10 May 2023. Accepted 30 May 2023.\u0000Funding: The study did not have sponsorship.\u0000Conflict of interest: The authors declare no conflict of interest.\u0000Contribution of the authorsConception and study design: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianData collection and analysis: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianStatistical analysis: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianDrafting the article: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, A.Yu. Tsydenova, M.A. MakhmudovCritical revision of the article: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, A.Yu. Tsydenova, M.A. MakhmudovFinal approval of the version to be published: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, A.Yu. Tsydenova, M.A. Makhmudov","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80687253","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 : 2023-06-30DOI: 10.21688/1681-3472-2023-2-19-26
E. Kushnareva, O. E. Astafurova, E. Zorina, O. Moiseeva
Background: Various methods of breast cancer treatment are potentially cardiotoxic: anthracycline chemotherapy, HER2-targeted therapy, and radiation therapy to the left side of the chest. In clinical practice, cardiologists deal with a wide range of complications caused by the mentioned methods.Objective: To analyze the reasons for and timing of seeking healthcare in cardiac clinics by women with a history of successfully treated breast cancer.Methods: Our single-center retrospective observational study included 125 women (mean age at the time of seeking healthcare was 68.1 ± 8.6 years).Results: Patients with a history of radiation therapy had higher peak velocity (P = .015) and peak gradient (P = .017) across the aortic valve. As part of their examination and treatment 71 patients underwent coronary angiography. Of them, 21 patients (29.6%) had coronary artery stenting, and 23 patients (32.4%) underwent coronary artery bypass grafting. Forty-two patients (33.6%) underwent heart valve replacement: aortic valve replacement in 92.9% of the cases (n = 39) and mitral valve replacement in 7.1% of the cases (n = 3). We found a strong negative correlation between the age at the time of radiation therapy and the time to onset of valvular heart disease (r = −0.748; P = .000004) and an average negative correlation between the age and the time to surgical treatment (r = −0.695; P = .00003).Conclusion: We studied the main reasons for seeking healthcare in cardiac clinics by women with a history of breast cancer, analyzed cardiac operations in terms of antitumor therapy types, and found a strong correlation between the age at the time of antitumor therapy and the time to onset of valvular heart disease, as well as the time to cardiac surgery. Received 20 November 2022. Revised 21 May 2023. Accepted 31 May 2023. Funding: The study was supported by Ministry of Science and Higher Education of Russian Federation (No. 075-15-2022-301). Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.
{"title":"Reasons for and time to seeking healthcare in cardiac clinics by women with a history of successfully treated breast cancer","authors":"E. Kushnareva, O. E. Astafurova, E. Zorina, O. Moiseeva","doi":"10.21688/1681-3472-2023-2-19-26","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-2-19-26","url":null,"abstract":"Background: Various methods of breast cancer treatment are potentially cardiotoxic: anthracycline chemotherapy, HER2-targeted therapy, and radiation therapy to the left side of the chest. In clinical practice, cardiologists deal with a wide range of complications caused by the mentioned methods.Objective: To analyze the reasons for and timing of seeking healthcare in cardiac clinics by women with a history of successfully treated breast cancer.Methods: Our single-center retrospective observational study included 125 women (mean age at the time of seeking healthcare was 68.1 ± 8.6 years).Results: Patients with a history of radiation therapy had higher peak velocity (P = .015) and peak gradient (P = .017) across the aortic valve. As part of their examination and treatment 71 patients underwent coronary angiography. Of them, 21 patients (29.6%) had coronary artery stenting, and 23 patients (32.4%) underwent coronary artery bypass grafting. Forty-two patients (33.6%) underwent heart valve replacement: aortic valve replacement in 92.9% of the cases (n = 39) and mitral valve replacement in 7.1% of the cases (n = 3). We found a strong negative correlation between the age at the time of radiation therapy and the time to onset of valvular heart disease (r = −0.748; P = .000004) and an average negative correlation between the age and the time to surgical treatment (r = −0.695; P = .00003).Conclusion: We studied the main reasons for seeking healthcare in cardiac clinics by women with a history of breast cancer, analyzed cardiac operations in terms of antitumor therapy types, and found a strong correlation between the age at the time of antitumor therapy and the time to onset of valvular heart disease, as well as the time to cardiac surgery.\u0000Received 20 November 2022. Revised 21 May 2023. Accepted 31 May 2023.\u0000Funding: The study was supported by Ministry of Science and Higher Education of Russian Federation (No. 075-15-2022-301).\u0000Conflict of interest: The authors declare no conflict of interest.\u0000Contribution of the authors: The authors contributed equally to this article.","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87643225","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 : 2023-06-30DOI: 10.21688/1681-3472-2023-2-66-73
S. Korolev, E. Artyukhina, V. Shabanov, O. Sapelnikov, A. Tsyganov, A. Revishvili, A. Romanov
Background: The outcomes of ventricular tachycardia (VT) ablation in patients with structural heart disease (SHD) are not ideal. High-power radiofrequency ablation (RFA) may have a long-term beneficial effect in this patient cohort.Objective: To evaluate the safety, early and long-term efficacy of high-power RFA for VT and concomitant SHD in a multicenter prospective registry.Methods: Our study included a total of 63 patients (66,7% of them were men; median age was 61.0 [51.0-66.5] years) with ischemic heart disease and drug-resistant VT who were scheduled for RFA (50 W). Non-fluoroscopic 3D mapping systems were used for bipolar and activation mapping with standard settings. The safety end point included perioperative complications, such as death, hemopericardium, stroke, myocardial infarction, electrical storm, and vascular complications. The efficacy end points included VT non-inducibility at the end of ablation and freedom from VT at 12 months of the follow-up. The secondary end points were changes in implantable cardioverter-defibrillator (ICD) therapy, sonographic findings, and number of hospital admissions.Results: All patients underwent VT ablation under general sedation. One clinical VT was induced in 96.8% of the patients before ablation. After ablation no clinical VTs were induced (P < .0001 vs baseline). No perioperative complications were observed. Freedom from VT without antiarrhythmic drugs was 82.6% at 12 months of the follow-up. The number of ICD therapies significantly decreased at 12 months of the follow-up compared with baseline (3.2% vs 31.7%, respectively; P = .0001). The left ventricular ejection fraction increased from 48.7% ± 14.7% at baseline to 50.3% ± 11.9% at 12 months of the follow-up (P = .038). There was a statistically significant decrease in hospital admission rate before and after ablation (from 2 [range: 0-12] to 0 [range: 0-3], P < .0001).Conclusion: High-power RFA for VT in patients with ischemia demonstrated its safety and high perioperative and long-term efficacy, which were linked to clinical improvement. Further randomized studies will help introduce this VT ablation approach into routine clinical practice. Received 5 September 2022. Revised 16 February 2023. Accepted 31 May 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: S.V. Korolev, A.Sh. Revishvili, A.B. Romanov Data collection and analysis: S.V. Korolev, E.A. Artyukhina, V.V. Shabanov, O.V. Sapelnikov, A.V. Tsyganov, A.Sh. Revishvili, A.B. RomanovStatistical analysis: S.V. Korolev Drafting the article: S.V. Korolev Critical revision of the article: A.B. Romanov, A.Sh. Revishvili Final approval of the version to be published: S.V. Korolev, E.A. Artyukhina, V.V. Shabanov, O.V. Sapelnikov, A.V. Tsyganov, A.Sh. Revishvili, A.B. Romanov
{"title":"High-power radiofrequency ablation for ventricular tachycardia in patients with structural heart disease: one-year follow-up data from the multicenter prospective registry","authors":"S. Korolev, E. Artyukhina, V. Shabanov, O. Sapelnikov, A. Tsyganov, A. Revishvili, A. Romanov","doi":"10.21688/1681-3472-2023-2-66-73","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-2-66-73","url":null,"abstract":"Background: The outcomes of ventricular tachycardia (VT) ablation in patients with structural heart disease (SHD) are not ideal. High-power radiofrequency ablation (RFA) may have a long-term beneficial effect in this patient cohort.Objective: To evaluate the safety, early and long-term efficacy of high-power RFA for VT and concomitant SHD in a multicenter prospective registry.Methods: Our study included a total of 63 patients (66,7% of them were men; median age was 61.0 [51.0-66.5] years) with ischemic heart disease and drug-resistant VT who were scheduled for RFA (50 W). Non-fluoroscopic 3D mapping systems were used for bipolar and activation mapping with standard settings. The safety end point included perioperative complications, such as death, hemopericardium, stroke, myocardial infarction, electrical storm, and vascular complications. The efficacy end points included VT non-inducibility at the end of ablation and freedom from VT at 12 months of the follow-up. The secondary end points were changes in implantable cardioverter-defibrillator (ICD) therapy, sonographic findings, and number of hospital admissions.Results: All patients underwent VT ablation under general sedation. One clinical VT was induced in 96.8% of the patients before ablation. After ablation no clinical VTs were induced (P < .0001 vs baseline). No perioperative complications were observed. Freedom from VT without antiarrhythmic drugs was 82.6% at 12 months of the follow-up. The number of ICD therapies significantly decreased at 12 months of the follow-up compared with baseline (3.2% vs 31.7%, respectively; P = .0001). The left ventricular ejection fraction increased from 48.7% ± 14.7% at baseline to 50.3% ± 11.9% at 12 months of the follow-up (P = .038). There was a statistically significant decrease in hospital admission rate before and after ablation (from 2 [range: 0-12] to 0 [range: 0-3], P < .0001).Conclusion: High-power RFA for VT in patients with ischemia demonstrated its safety and high perioperative and long-term efficacy, which were linked to clinical improvement. Further randomized studies will help introduce this VT ablation approach into routine clinical practice.\u0000Received 5 September 2022. Revised 16 February 2023. Accepted 31 May 2023.\u0000Funding: The study did not have sponsorship.\u0000Conflict of interest: The authors declare no conflict of interest.\u0000Contribution of the authorsConception and study design: S.V. Korolev, A.Sh. Revishvili, A.B. Romanov Data collection and analysis: S.V. Korolev, E.A. Artyukhina, V.V. Shabanov, O.V. Sapelnikov, A.V. Tsyganov, A.Sh. Revishvili, A.B. RomanovStatistical analysis: S.V. Korolev Drafting the article: S.V. Korolev Critical revision of the article: A.B. Romanov, A.Sh. Revishvili Final approval of the version to be published: S.V. Korolev, E.A. Artyukhina, V.V. Shabanov, O.V. Sapelnikov, A.V. Tsyganov, A.Sh. Revishvili, A.B. Romanov","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"49 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83213708","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}