In the first year of the COVID-19 pandemic, there was a significant reduction in the number of cardiac surgeries, but recently, with the vaccination campaign, the former surgical activity is gradually recovering. Among cardiac surgery patients, many have had COVID-19. The effects of SARS-CoV-2 on the human body in general and vascular endothelium in particular cause multisystem damage, which is associated with a high risk of pulmonary, cardiac, neurological and thrombotic complications not only in the acute period but also in the long term. The issue of the timing of operations in cardiac surgery patients after COVID-19, among whom patients with complicated forms of coronary artery disease are the most severe, is very acute. Case description. Patient H., 42 y.o, was hospitalized to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with thrombosed postinfarction aneurysm of the left ventricle, polymorbidity, severe COVID-19 with 60% lung damage 2 months ago. According to the results of diagnostic study, the on-pump surgical intervention was indicated: coronary artery bypass grafting, left ventricular aneurysm resection with thrombectomy. The predicted mortality risk was 11.5% by the EuroSCORE II scale and 8.08% by the Society of Thoracic Surgery Score (STS). The heart team decided to perform the life-saving surgery. After stabilization of the condition and compensation of concomitant diseases, the patient was successfully operated and discharged from the Institute without complications on the 9th day after surgery. Conclusions. High-risk patients with complicated coronary artery disease require careful preparation for cardiac surgery and compensation of comorbidity. Preoperative risk stratification allows the heart team to make decisions, predict perioperative complications and take measures to prevent them, as well as plan the volume of operation. Polysegmental bilateral COVID-19-associated pneumonia within the last 2 months is not a contraindication to cardiac surgery in the conditions of artificial circulation, provided adequate training, stability of the radiological picture. An important point of the positive result of cardiac surgery is intraoperative reduction of ischemic time with the performance of the main stage of the operation in conditions of parallel perfusion.

The current problem of modern medicine is the lack of public awareness about personal health, late diagnosis of diseases, untimely prehospital care and treatment of existing complications. This applies to all branches of medicine, especially cardiology and cardiac surgery. Coronary heart disease occupies one of the leading places in the structure of mortality due to cardiovascular diseases. This is mainly due to the fact that patients seek medical care with complicated forms of coronary heart disease like sudden cardiac death, cardiac arrhythmia (ventricular fibrillation, AV blockade, sinus bradycardia and tachycardia), formation of left ventricular (LV) aneurysm, LV free wall rupture and LV false aneurysm, mitral regurgitation. In such cases, all actions must be early, staged, well established, and concordant with clear algorithm. The aim. To demonstrate our clinical case as an example of proper logistics, rapid response and timely surgical treatment of complicated forms of coronary heart disease. Clinical case. Patient F., born in 1964, was admitted to the clinic on March 24, 2021 with a diagnosis of coronary heart disease: acute non-Q-wave myocardial infarction of the posterolateral LV since March 22, 2021. Clinical death with successful resuscitation at the prehospital stage (03/22/2021). Ventricular fibrillation (03/22/2021). Multivessel coronary artery disease. Mitral valve regurgitation grade II-III. Tricuspid valve regurgitation grade I-II. Pulmonary hypertension grade I. Hypertensive disease grade III, degree 3, risk 4 (very high). Heart failure II A with a moderately reduced LV ejection fraction (47%). NYHA3. Closed chest injury (03/22/2021): fracture of the ribs without displacement: ribs 4-8 on the left, ribs 4-8 on the right. He considers himself ill since March 22, 2021, when he suddenly felt severe pain in his chest and fell unconscious. According to witnesses, the man got out of the subway and fell unconscious, without breathing and pulse. Due to the presence of defibrillators at the subway station, successful resuscitation was conducted by police officers before the ambulance crew arrival. Clinical and instrumental studies were performed after hospitalization. The patient was taken to the operating room on 03/24/2021 at 5:30 PM, 50 minutes after admission to the National Amosov Institute, Kyiv. Urgent off-pump coronary artery bypass grafting of 3 coronary arteries was performed. A cardioverter-defibrillator was implanted due to the history of clinical death and the conclusion of daily ECG monitoring. The intra- and postoperative period was uneventful, the patient was discharged in satisfactory condition for rehabilitation. Conclusions. Our clinical experience shows that timely prehospital care, proper logistics and surgical correction of coronary heart disease not only saves but also significantly improves the quality of life of the patient in the future.

The aim. The aim of our study was to establish the expression levels of long non-coding RNA H19 and hypoxiainducible factor-1α (HIF-1α) in the myocardium and leukocyte fraction as a possible mechanism of adaptation to remote ischemic preconditioning (RIPC) in patients with ischemic heart disease during off-pump isolated coronary artery bypass grafting. Methods. To assess hemodynamic parameters, data from 31 patients (14 in the RIPC group, 17 in control group) were analyzed. The RIPC procedure was performed in patients before surgery by applying a blood pressure cuff to the right forearm. The cuff was inflated to a pressure of 200 mmHg and left for 5 minutes. This was followed by a reperfusion step which lasted 5 minutes. Periods of ischemia and reperfusion lasting 5 minutes were repeated three times. The expression level of long non-coding RNA H19 and HIF-1α was determined in the myocardium and leukocyte fraction by real-time polymerase chain reaction. Results. At the stage of formation of distal anastomoses in patients with RIPC cardiac index (CI) was 24% higher, and stroke volume index (SVI) was 18% higher. Systemic vascular resistance index (SVRI) was significantly lower in patients of the RIPC group (p <0.05). At the end of the operation the CI and SVI levels were significantly higher in the RIPC group, and the rate of SVRI in the RIPC group was significantly lower. In patients with RIPC the expression of H19 in the leukocyte fraction increased by a factor of 3 and in myocardial tissues the level of H19 expression decreased by a factor of 6.7 (p <0.05). The expression of HIF-1α in the myocardium after ischemic preconditioning significantly decreased by a factor of 7.5 (p <0.05), but in the leukocyte fraction there was an insignificant decrease in HIF-1α expression by 20% (p > 0.05). Conclusions. Based on hemodynamic parameters, it can be concluded that patients with RIPC were more hemodynamically stable. Significant changes in the expression of long non-coding RNA H19 and hypoxia-inducible factor-1α demonstrate the importance of these molecules in adaptation to ischemic preconditioning. However, the mechanisms of RIPC involving H19 and HIF-1α need further study.