Introduction. The number of patients with severe ischemic left ventricular dysfunction (ILVD), who undergo coronary artery bypass, increasing each year. ILVD is an established risk factor for mortality in patients after myocardial revascularization during the early and late postoperative periods.Aim of study. To evaluate the early results of surgical myocardial revascularization in patients with coronary artery disease (CAD) and severe ILVD.Material and methods. The study included 149 patients with coronary artery disease with severe left ventricular dysfunction (ejection fraction (EF) ≤39%), operated from January 2002 to December 2018. different variables were assessed (pre- and postoperative), including LV ejection fraction and end systolic volume index (ESVI).Results. The average age of the patients was 59.36±8.97 years (from 30 to 78 years), 93% of the patients were men. In 28 patients (19%), ILVD developed against the background of myocardial infarction (MI) and in 121 (81%) due to ischemic cardiomyopathy (ICMP) with a history of myocardial infarction. The mean EF before surgery was 36.64±3.17 (from 21 to 39%). In the postoperative period, there was an increase in EF, which averaged 44.92±4.92 (from 36 to 59%) (p value <0.001). The mean LV ESVI before surgery was 60.23±11.52 ml/m2. In the immediate postoperative period ESVI decreased to 46.26±12.40 ml/m2 (the value of p<0.001). The average number of bypass coronary arteries in one patient was 3.9±0.87. There was also a decrease in the degree of mitral regurgitation in most patients after coronary artery bypass grafting (CABG) (p value <0.001). Hospital mortality was 2% (3 patients).Conclusion. Coronary artery bypass grafting in patients with severe ischemic left ventricular dysfunction can be performed with low mortality. Surgical myocardial revascularization can be considered a safe and effective operation for patients with coronary artery disease with a satisfactory condition of the distal coronary arteries, low ejection fraction, and with a predominance of viable myocardium.

BackgroundAs life expectancy and quality of health improve, more and more people reach old age, and so does the number of heart diseases. One of the most urgent problems among elderly patients is degenerative stenosis of the aortic valve (AV). The conservative treatment of symptoms of chronic heart failure with AV stenosis improves the patient’s condition only for a while, whereas surgical treatment such as replacement of AV is recognized as the main effective method of treating a defect. Recently, alternative technologies for prosthetic AV have been developed, aimed at reducing adverse effects of artificial circulation (AC) in high-risk patients and minimizing the scope of surgical intervention.Aim of studyThe aim of the study was to evaluate the immediate results of surgical treatment of aortic stenosis using different methods in patients over 70.Material and methodsThe article presents the results of treatment of 64 patients over 70 with isolated AV stenosis, operated with different surgical techniques from July, 2016 to January, 2018. All patients were divided into three groups, differing in the severity of the initial condition and the method treatment. Group 1 (transcatheter implantation of the prosthetic AV, EuroSCORE II — 21.81%) consisted of 19 patients, Group 2 (non-suture implantation of a Perceval prosthetic valce under the AC, EuroSCORE II — 13.81%) consisted of 13 patients and Group 3 (“standard” prosthetics, EuroSCORE II — 9.89%) consisted of 32 patients.ResultsIn Group 1, two patients died, the hospital mortality was 10.5%. In Group 2 and Group 3, one patient died, the hospital mortality was 7.6 and 3.1%, respectively. Implantation of a permanent pacemaker was required in three patients (15.7%) from the TAVI group after installation of Medtronic Core Valve and two patients (15.3%) from the Perceval group.ConclusionThe obtained results of AV replacement by various methods allowed to expand indications for the management of AV stenosis in patients of the older age group with a high surgical risk of operation under AC conditions who had not previously been considered candidates for surgical treatment of aortic malformation due to the age and severity of the concomitant pathology.

Introduction.The total number of patients with chronic heart failure in Russia had reached 15 million by 2016, including 6 million of those with the end-stage heart failure. Currently, heart transplantation (HT) provides the only possible method of a definite treatment of the disease, which allows a significant steady and long-term improvement of patient's quality of life.  The purpose of this article was to review the experience of heart transplantation in a multidisciplinary medical institution over an 8-year period.Material and methods. Since September 2009, more than 300 patients have been studied for the presence of indications for heart transplantation in the Department of Urgent Cardiology, Assisted Circulation and Heart Transplantation of the Sklifosovsky Research Institute for Emergency Medicine. Eighty of all the screened potential recipients were included in the waiting list, and by the end of 2017, heart transplantations had been performed in 70 of them; the mean waiting time for transplantation was 93 ± 79 days.Results.The graft ischemia time averaged 174 ± 28 minutes (97 to 250 minutes). The graft ischemia time was 187 ± 36 minutes with the biatrial technique and 169 ± 24 minutes with bicaval technique. That parameter made 184 ± 23 minutes for a distant organ retrieval, while for a local organ retrieval it was 155 ± 29 minutes. By the end of 2017, of 70 cardiac transplant recipients enrolled in the analyzed group, 31 patients (44%) had died, 12 of whom during their hospital stay (hospital mortality was 18%). The main cause of death was the multiple organ failure syndrome in the early postoperative period, and infectious complications in the later period.Conclusion.The advantage of establishing the organ transplantation center (particularly for heart transplantation) in a multidisciplinary medical care facility lies in reduced donor organ ischemia time and starting treatment of complications without delay. The number of infectious complications, as well as complications associated with acute cellular rejection and coronary artery disease of the transplanted heart can be reduced by creating a regional system ensuring the targeted work with post transplant patients.

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