The main structural event in the development of heart failure is the myocardial remodeling. The extracellular matrix, that was knows as, considered an inert framework of cardiomyocytes, plays an important role in cardiac remodeling. The enzyme system, primarily responsible for the degradation of the extracellular matrix, is a matrix metalloproteinases (MMP). This review examines the evidence for the participation of MMP in the myocardial remodeling and recent studies of MMP as prognostic markers. Regulation of induction and/or activation of MMP are potential therapeutic targets.

Aim. To evaluate long-term quality of life (QOL) of patients after surgical treatment of mitral valve disease depending on the types of surgical intervention, to identify predictors of a lower QOL after surgery. Material and methods. A single-center retrospective study involved 107 patients after isolated correction of primary non-ischemic mitral valve (MV) pathology, who were operated on from 2009 to 2016, and analyzed their long-term QOL. The follow-up period was from 2 to 6 years. 2 groups of patients were formed: the 1st group (n=60) patients who underwent mitral valve replacement (MVR); the 2nd group (n=47) patients who underwent mitral valve repair (MVRep). There were no statistically significant differences between the main clinical and demographic characteristics in reference to the groups. The SF-36 questionnaire was used for studying QOL. Results. The indicators of QOL approach the average population levels in both groups. In group MVRep Physical Functioning PF (p=0.02 and 0.01), Bodily Pain BP (p=0.04), Vitality VT (p=0.01) and Social Functioning SF (p=0.001) are higher. There are improvements in physical and mental health components after surgery. Mental and physical components are lower than in the normal population but they dont go beyond average populations indicators. Mental health in the MVRep group is better than in the MVR group (p=0.01). Female gender, dilatation of the left atrium (every 1 mm before surgery), older age (every year) increased the probability of lower QOL in the long term by 84, 11 and 8% respectively. Conclusion. Long-term QOL of patients after surgical treatment of mitral valve disease improves both after valve repair and after valve replacement. After MVRep Physical Functioning, Bodily Pain, Vitality and Social Functioning indicators are higher. There are improvements in physical and mental health components. Psychological component of health is higher in patients in the MVRep-group. Female gender, dilatation of the left atrium, older age increase the probability of lower QOL in the long term after mitral valve surgery.

The goal is to reveal the relationship between the score SYNTAX score and the development of postoperative atrial fibrillation (AF). Materials and methods. Retrospective study included 156 patients (mean age 59±7 years) undergoing an isolated coronary bypass (CB). Exclusion criteria were: AF in the anamnesis, lesions of the valvular heart apparatus, diameter of the left atrium more than 50 mm, repeated surgical interventions on the heart. SYNTAX score, clinical, laboratory and echocardiographic parameters were evaluated. Results. The average score of the SYNTAX score was 26.7; postoperative AF was detected in 23 (14.7%) patients. Statistically significant differences were revealed during the time of mechanical ventilation (10.6±5.9 in comparison with 21.6±33.5, p=0.001) and SYNTAX score (25.7±8.7 vs 32.7±11.4, p=0.001). SYNTAX score and time of artificial ventilation are independent predictors of postoperative AF. Conclusion: a high score SYNTAX score is associated with a more frequent postoperative rhythm disturbance in the type of AF in patients undergoing an isolated CB.

Aim. To assess the afficiency of using different shcemes of the antiarrythmic therapy (AAT) after the surgical treatment of the atrial fibrillation (AF).Material and methods. This retrospective study included 279 patients: 141 (49%) females and 168 (51%) males, aged 59±7.9 years who had got Сox-Maze IV procedure at Federal cardiovascular center (Penza). 27 patient (9.7%) had the paroxysmal AF, 252 (90.3%) - the persistent one. The AF’s duration was 36 months (from 1 to 180). The size of the left atrium was average 52.4±8.4 mm (from 40 to 82 mm). The medium functional class (FC) of heart failure (HF) (NYHA) was 2.8±0.4: II FC-63 (22.6%), III FC - 213 (76.3%), IV FC - 3 (1.1%). There were 3 groups of patients:1 group had 57 patients who had got amiodaron over 6 months; 2 group - 126 patients who had got b-blocker (b-B) (bisoprolol) long monotherapy; 3 group - 96 patients who had got amiodaron during 3-6 months then had got bisoprolol long therapy. All patiens got Cox-Maze IV procedure.Results. Remote results assessed after 6 months-3 years period after the operation. In all groups the number of patients with I and II FC HF increased; there was significant difference at 2 group (p1-2=0.01; p2-3=0.01; p1- 3=0.73). And there were more patients with sinus rhythm at 2 group than at 3 group significantly. The freedom from AF at 1 group was 77%±0.89, at 2 group - 68%±0.98, at 3 group - 85%±0.95 with the significant difference between 2 and 3 groups (р1-2=0.61; p1-3=0.13; p2-3=0.01).Conclusions. AAT by amiodaron during 3-6 months and then by beta-blocker (bisoprolol) longly after Cox-Maze IV procedure allows to keep sinus rhythm to 85% patiens at the distant period of time and comparing with the b-blocker-monotherapy allows to keep sinus rhythm more effectively. The difference of efficiency by long amiodaron-monotherapy and amiodaron-therapy during 3-6 months is not got statistical significant after Cox-Maze IV procedure.