Aim. A retrospective analysis of the outcomes of heart transplantation (HT) with extended cold ischemic time of donor heart (more than 4 hours) versus heart transplantation with short cold ischemia time (less than 4 hours).Material and methods. The retrospective analysis included 52 recipients who underwent HT in the period from July 20, 2012 to October 23, 2019 in Meshalkin National Medical Research Center. The patients were divided into two groups: group 1 (n=26) — orthotopic HT with extended cold ischemic time (more than 240 minutes), group 2 (n=26) — short cold ischemia time (less than 240 minutes). The effect of cold ischemia duration on hospital survival, the function of donor heart, and the postoperative course was assessed.Results. A retrospective analysis revealed a higher rate of hospital survival in the group of recipients with extended cold ischemic time (more than 240 minutes) 88,5% compared to 80,7% in the second group. There was no difference between the groups in the acute rejection rate, the need for inotropic agents, mechanical circulatory support, and cardiac pacing, as well as the incidence of postoperative renal failure and infectious complications.Conclusion. Due to the small number of patients, our experience in HT with extended cold ischemic time does not allow us to draw global conclusions, but a preliminary comparison of HT with extended and short cold ischemic time did not reveal significant advantages in one group or another. This provides a basis for further accumulation of experience and research.

Цель. Изучить в эксперименте in vitro адгезию тромбоцитов к a-C:H:SiO x пленке на титане для оценки ее атромбогенного потенциала. Материалы и методы. Тонкие (менее 1 мкм) a-C:H:SiO x пленки наносили на титановые пластины марки ВТ-6 размером 10 × 10 мм 2 и толщиной 0,2 мм с помощью вакуумной ионно-плазменной установки с использованием импульсного биполярного смещения. Шероховатость поверхности оценивали согласно ГОСТ 2789-73 с помощью атомно-силового микроскопа. Исследуемые образцы культивировали при 37 °C в течение 30 мин в плазме крови человека, обогащенной тромбоцитами, подготавливали для сканирующей электронной микроскопии, после чего подсчитывали плотность распределения кровяных пластинок, адгезирующих к исследуемому покрытию. Результаты. При одинаковом индексе шероховатости исследуемых образцов a-C:H:SiO x пленка в 116 раз снижала (в сравнении с необработанным титаном) количество тромбоцитов на 1 мм 2 поверхности. Заключение. Формирование на поверхности титанового сплава ВТ-6 тонкой пленки состава a-C:H:SiO x методом плазмохимического осаждения с использованием импульсного биполярного смещения значительно снижает плотность распределения тромбоцитов в сравнении с необработанной металлической поверхностью. Полученные in vitro данные предполагают существенный атромбогенный потенциал данного вида покрытий на поверхности устройств, контактирующих с кровью. Ключевые слова: адгезия тромбоцитов человека, in vitro, углеродная поверхность, модифицированная оксидами кремния, сканирующая электронная микроскопия, атомно-силовая микроскопия. Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.

Objective: to evaluate the technical feasibility as well as functional, metabolic and structural integrity of donor heart myocardium after 4 hours of direct intracoronary oxygen persufflation in an experiment.Materials and methods. Mini-pig siblings aged 3 months with a body weight of23-36 kg were used as the experimental model. In the control group (n = 8), donor hearts were cold preserved by injecting 2 liters of Bretschneider cardioplegic solution (Custodiol®, Germany, HTK) into the aortic root. In the experimental group (n = 8), modified HTK solution (with 40 mg/L hyaluronidase added) was used to initiate cardioplegia, then moistened carbogen (95% O2, 5% CO2) was injected into the ascending aorta, maintaining 40-45 mm Hg aortic root pressure. The hearts were stored in an mHTK solution at 0-4 °С. After 3 hours of donor heart preservation, orthotopic heart transplantation (OHTx) was performed. In the post-transplant period, we studied central hemodynamic parameters, myocardial oxygen consumption, level of myocardial ischemia markers (troponin I, Tnl; creatine phosphokinase-MB, CPK-MB; lactate dehydrogenase, LDH), and histological signs of structural cellular injury.Results. Sixteen OHTx surgeries were performed during the study. At 120 minutes after restoration of spontaneous cardiac activity, cardiac output was 2.99 [4.85; 3.17] L/min and 2.48 [2.04; 2.92] L/min (p > 0.05) in the control and experimental groups, respectively. Changes in LDH, TnI and lactate levels in the blood flowing from the coronary sinus were significantly higher in the early reperfusion period. However, there was no statistically significant difference between the groups (p > 0.05). Myocardial oxygen consumption in the control and experimental groups was 8.2 [7.35; 9.35] ml-O2/min/100 g and 7.7 [6.75; 10.12] ml-O2/min/100 g, respectively (p > 0.05). Morphological examinations also showed no significant myocardial ischemia injury in the persufflation group compared to the control group.Conclusion. The experiment showed the technical feasibility and safety of direct intracoronary oxygen persufflation for 4 hours at the ex vivo donor heart conditioning stage. At the same time, experimental data showed no significant advantages of coronary persufflation over the standard protocol of cold preservation of donor heart with Bretschneider cardioplegic solution.