BackgroundAlthough remote ischaemic preconditioning (RIP) provides protection against myocardial ischaemia and reperfusion injury during cardiac surgery, it is not widely used. Systemic intermittent hypoxic–hyperoxic training (IHHT) may be a suitable alternative.MethodsThis is a prospective, single-centre, randomised controlled trial. 127 patients with ischaemic heart disease and indication for coronary artery bypass graft (CABG) surgery from the Cardiology Clinic IM Sechenov First Moscow State Medical University were randomly assigned to IHHT, IHHT-control or RIP. Primary endpoint was serum concentration of troponin I and lactate 2 and 24 hours after surgery.ResultsMedian value for troponin I 24 hours after surgery was 1.068 (0.388–1.397) ng/mL in the IHHT group and was significantly lower compared with IHHT-controls with 1.980 (1.068–3.239) ng/mL (p=0.012) and to the RIP group with 1.762 (1.288–2.186) ng/mL (p=0.029), while there was no significant difference between RIP and the IHHT-control. Serum lactate after surgery was 1.74 (1.23–2.04) mmol/L in the IHHT group and was also significantly lower compared with IHHT-controls with 2.10 (1.80–2.29) mmol/L (p=0.045) and RIP with 2.12 (1.91–2.33) mmol/L (p=0.032). No significant complications or serious adverse events were observed during IHHT. Intraoperative and early postoperative complications did not differ significantly between groups.ConclusionsThe results of this first trial using IHHT for myocardial protection against perioperative ischaemic myocardial injury in patients undergoing CABG surgery are promising and further larger trials should be done with adequate power to detect clinical rather than surrogate marker benefits.

отделение кардиохирургии клиники аортальной и сердечно-сосудистой хирургии (дир.-д.м.н. р.н. Комаров) ФППоВ Первого Московского государственного медицинского университета им. и.М. сеченова, Москва, россия Ключевые слова: ложная аневризма, аутовенозное протезирование, внутренняя сонная артерия.

No abstract

<p>Heart valve surgery, including aortic valve surgery, began to develop in the first half of the 20th century with the advancement of reconstructive procedures. Thereafter, the progress of science and technology led to the development of mechanical and biological prostheses, homografts and plastic materials, which continue to improve and transform. This review focuses on the historical aspects of the development of aortic root and aortic valve surgery, mentions the initial interventions and presents the contributions of Soviet and Russian surgeons to global surgery. The article will be interesting to cardiovascular surgery specialists as well as a wide range of readers who intend to learn more regarding the history of medicine and cardiovascular surgery.</p><p>Received 8 November 2019. Revised 10 December 2019. Accepted 12 December 2019.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

It was analyzed the results of treatment of 152 patients who underwent heart valve surgery. Depending on cardiopulmonary bypass (CPB) duration patients were divided into 4 groups: the 1st--up to 90 min, the 2nd--90-120 min, the 3rd--120-180 min, the 4th--more than 180 min. Severity of initial comorbidities was comparable in all groups. It was revealed that CPB duration effects on intraoperative blood loss, incidence of acute renal failure, encephalopathy, use of inotropic and angiotonic support (p<0.05). Accession of CPB duration was associated with increased number of postoperative complications in all groups (p<0.05). "Critical periods" of CPB for every type of postoperative complications are defined.