Objective. To investigate the connection between application of solutions for infusion and parameters of the hemostasis system while the elective operations performance of coronary shunting on the working heart. Materials and methods. The results of examination and surgical treatment were analyzed in 80 patients, in whom coronary shunting on the working heart was conducted. The patients were divided into three groups: the Investigation Group I (IG I) – 20 patients, in whom colloidal solution of hydroxyethyl starch (HES) 130/0.4 was applied intraoperatively, the Investigation Group II (IG II) - 20 patients, in whom colloidal 4% solution of gelatin was used intraoperatively, and a Control Group, consisted of 40 patients, in whom only crystalloidal solutions were included in the infusion therapy program. The coagulation hemostasis indices, the blood loss volume and the need for hemotransfusion were compared. Results. In the IG I patients the volume of perioperative blood loss was more than in the IG II patients – (615 ± 191) and (438 ± 62) ml, accordingly (p=0.0003), and the coagulation hemostasis indices were trustworthily lower at the operation ending, demanding the erythrocytic mass transfusion doing in 3 (15%) patients. The IG II patients, comparing with the Control Group, suffered more volume of the blood loss - (560 ± 164) and (438 ± 62) ml, accordingly (p=0,02), and the changes in the coagulation indices, similar to changes in patients of the IG I, comparing with the Control Group patients. Any patient from the IG II needed hemotransfusion perioperatively. Conclusion. Application of colloidal solutions while doing elective operations of CSH on the  working heart leads to disorder of coagulation hemostasis, the intraoperative blood loss and the need for hemotransfusion enhancement.

The heart transplantation in early period after ending of a COVID-19-associated pneumonia

The results of the use of colloidal and crystalloid solutions during surgical intervention of patients with coronary heart disease are presented. The effect of colloidal solutions on the coagulation hemostasis system and the associated perioperative complications were studied. The study included 60 patients operated in the NIST named after O.O. Shalimov on coronary heart disease who underwent off-pump coronary bypass grafting surgery: 40 patients (in the intraoperative period solutions of hydroxyethyl starch 130/0.4 were used (20 patients) and 4% gelatin (20 patients) were used in the intraoperative period); the comparison group included 20 patients (only crystalloid solutions were used in the intraoperative period). The results of general and biochemical analysis of blood, electrolyte, acid-base and gas composition of blood were analyzed, prothrombin time was determined, prothrombin index, international normalized ratio, activated partial thromboplastin time, thromboelastometry. The statistical analysis of the material was carried out using standard methods using the application package “MS Excel” and “StatPlus 2007 Professional”. Evaluated the average, standard errors, the authenticity of the differences. To estimate the intergroup difference, the parametric t-criterion of the Student was used, while the links between the indicators were determined - a correlation analysis by Pierson. The results obtained showed a negative effect on the coagulation hemostasis system of colloidal solutions (changes in the thromboelastometry, prothrombin time and index) and an increase in the frequency of postoperative complications (blood loss, the need for blood transfusion, prolonged stay in the intensive care unit and hospital). The results of the study provide a perspective in the further study of the effect of colloidal solutions on coagulation hemostasis during other surgical interventions (thoracic, abdominal, etc.), as well as the use of the thromboelastometry method in clinical practice for early diagnosis of coagulation hemostasis disorders.

Introduction. Heart transplantation remains the only radical treatment for end-stage heart failure (HF). Liver and / or renal dysfunction is common in patients with HF, which is also exacerbated by the use of artificial circulation and immunosuppressive therapy, and leads to postoperative complications and mortality. Case description. Patient P., 49 years old, after orthotopic heart transplantation was admitted to the intensive care unit (ICU) with signs of multiple organ failure. Graft rejection syndrome was suspected, but was not confirmed after the detailed clinical and laboratory examinations and according to the myocardial biopsy. Because of severe renal and hepatic insufficiency, patient at the ICU started to receive hemodiaultrafiltration with a flow of 190 ml/min; ultrafiltration – 100 ml/h. The condition, that developed was due to the direct effect of tacrolimus as the patient had a critically high plasma concentration of this drug (> 30 ng / ml) after the standard recommended postoperative dose (0.2 mg / kg per day). According to the literature, the elimination of the tacrolimus is provided by the liver, with microsomal cytochrome P450 3A4. Thus, the patient most likely had a failure of hepatic metabolism. Conclusion: Because of the systemic toxicity of tacrolimus, it is important to monitor its concentration after the first dose. Diagnosis of metabolic disorders at an early stage will prevent further systemic toxicity of tacrolimus. Efferent methods at ICU are the important tools for the correction of hepatic and renal insufficiency throughout toxic effects of tacrolimus.

Вивчені зміни гемодинаміки, які виникають на етапах коронарного шунтування (КШ) на працюючому серці. На основі змін серцевого індексу (СІ), тиску в легеневій артерії, артеріального тиску (АТ) та сатурації змішаної венозної крові, що виникали під час операції, розроблено алгоритм прийняття рішень, який дозволив оптимізувати анестезіологічне забезпечення у цієї категорії пацієнтів. У дослідження включено 75 пацієнтів, оперованих у НІХТ імені О. О. Шалімова з приводу ішемічної хвороби серця (ІХС), яким було виконано КШ на працюючому серці. У групу дослідження увійшло 40 пацієнтів, у яких в інтраопераційному періоді застосовували оптимізований алгоритм прийняття рішень на основі комплексного аналізу факторів, що призводили до порушень гемодинаміки на етапах КШ. Групу порівняння становили 35 пацієнтів, у яких корекцію гемодинаміки проводили, переважно орієнтуючись на показники АТ. Отримані результати продемонстрували, що при застосуванні оптимізованого алгоритму прийняття рішень у разі гемодинамічних порушень зменшується потреба в симпатоміметичній та полемічній підтримці, скорочується час перебування у відділенні інтенсивної терапії та стаціонарі.