Russian Cardiology Bulletin / Kardiologicheskii Vestnik

Current trends in organizing the care for patients with acquired heart valve disease

2025-09-09T21:12:44+03:00

Despite advances in research of heart valve disease pathophysiology and active introduction of miniinvasive correction of this disease, heart valve diseases are still poorly diagnosed pathology. These diseases are detected in delayed stages, and there is still inequality in diagnostic and treatment technologies in different regions of the world and our country. In this review, we analyzed
epidemiological data on various heart valve diseases, modern phenotype of these patients and factors associated with changes
of phenotype. The main positions and limitations in organizing the medical care for these patients are presented. A particular attention is focused on importance of “valve cardiac team” making decisions on management in complex and controversial cases,
as well as in comorbid patients with heart valve disease

Valve-sparing approaches and valved conduits for aortic root surgery in patients with Marfan syndrome. Meta-analysis of immediate and long-term results

2025-09-09T21:12:46+03:00

Valve-sparing procedures in aortic root surgery demonstrate favorable short-term and long-term results. At the same time, the feasibility of valve-sparing procedures in patients with Marfan syndrome is questionable. This meta-analysis compares the immediate
and long-term results of valve-sparing approaches and valved conduits in aortic root surgery for patients with Marfan syndrome.
Data searching was performed in the MEDLINE, Embase, Cochrane and Web of Science databases. The primary endpoints were
redo surgery rate and mortality in long-term period. Long-term aortic insufficiency (AI) +3/+4 was also estimated as a primary endpoint. Secondary endpoints included surgery for acute aortic dissection type A, 30-day mortality, thromboembolism, endocarditis and bleeding. Meta-analysis was carried out in accordance with the PRISMA recommendations 2020. In-hospital mortality
was similar (OR 3.46; 95% CI 0.92—12.92; I2=0%; p=0.07). In long-term period, thromboembolism (OR 2.77; 95% CI 1.44—5.33;
I2=0%; p=0.002), endocarditis (OR 3.19; 95% CI 1.18—8.61; I2=0%; p=0.02), bleeding (OR 3.46; 95% CI 1.76—6.77; I2=0%;
p=0.0003) and mortality (OR 3.18; 95% CI 1.8—5.63; I2=12%; p<0.0001) were significantly more common after implantation
of valved conduits. In long-term period, aortic insufficiency +3/+4 was more common after reimplantation (OR 0.17; 95% CI 0.05—
0.52; I2=5%; p=0.002). In our study, valve-sparing procedures have advantage regarding the incidence of postoperative complications and mortality. However, long-term freedom from severe aortic insufficiency was higher after implantation of valved conduits

Endovascular correction of lesions of coronary arteries and coronary artery bypass grafts in patients with coronary artery disease with recurrent ischemia after surgical myocardial revascularization

2025-09-09T21:12:47+03:00

Despite the modern optimal drug therapy and various surgical methods, coronary artery disease is currently one of the most significant problems of medicine. The risk of recurrent myocardial ischemia increases in long-term period after coronary artery bypass surgery, especially in patients with diffuse coronary lesions. The main factors of such results are progression of atherosclerosis and dysfunction of coronary artery grafts. Repeated myocardial revascularization through percutaneous coronary intervention
is the safest and optimal option. However, there is currently no unambiguous and generally accepted opinion about endovascular treatment of such patients with diffuse coronary lesions.
Objective. To estimate the efficacy and safety of endovascular correction of coronary artery and bypass graft lesions in patients with
coronary artery disease, diffuse coronary artery lesions and myocardial ischemia recurrence after coronary artery bypass surgery.
Material and methods. The study included 106 patients with recurrent myocardial ischemia after coronary artery bypass surgery
who underwent treatment in 2013—2020. Coronary artery stenting was performed in the 1st group (55 (51.9%) patients), and graft
stenting was carried out in the 2nd group (51 (48.1%) patients). Clinical and angiographic characteristics were similar. The endpoints were mortality, restenosis after endovascular correction, myocardial infarction and MACE after 1 and 12 months.
Results. In the 1st group, lesion length and number of implanted stents were significantly greater: 25.7 [20.9; 31.6] and 18.8 [17.2;
22.1] mm p=0.023; 121 and 71 stents, respectively. Transradial access was more common in the 1st group (24 (43.6%)
and 9 (17.6%), respectively, p=0.004). In long–term period, mortality and restenosis rate were slightly higher in the 2nd group
(4 (7.3%) and 6 (11.8%) deaths, p=0,434; 7 (10.8%) and 9 (16.7%) cases of restenosis, respectively, p=0.352). The MACE rate
was similar (11 (20.0%) and 15 (29.4%) cases, respectively, p=0.265).
Conclusion. Stenting of native coronary arteries in patients with coronary artery disease, diffuse coronary lesions and recurrent
myocardial ischemia after coronary artery bypass surgery demonstrates a tendency to better results within 1 and 12 months regarding restenosis, myocardial infarction rate and mortality compared to stenting of coronary artery bypass grafts.

Long-term results of delayed endovascular treatment of acute ST-segment elevation myocardial infarction in patients with ectasia of infarct-related coronary artery

2025-09-09T21:12:50+03:00

Objective. To evaluate the safety, short-term and long-term outcomes after delayed and early stenting in patients with acute ST-segment elevation myocardial infarction and ectasia of infarct-related coronary artery.
Material and methods. A multiple-center retrospective study included 80 patients with ST-segment elevation myocardial infarction and ectasia of infarct-related coronary artery between 2014 and 2022. Of these, 50 patients underwent immediate stenting,
and 30 patients underwent delayed intervention.
Results. Delayed stenting for acute ST-segment elevation myocardial infarction in patients with ectasia of infarct-related coronary
artery improves reperfusion data, such as TIMI grade of epicardial coronary blood flow (p=0.02) and myocardial perfusion (MBG
grade) (p<0.001). The same was true for combined angiographic endpoint TIMI-3 and MBG 2-3 (p=0.005), as well as ST segment
resolution ≥70% (p=0.022). After 59 months, the incidence of adverse cardiovascular events was lower after delayed endovascular intervention (p=0.047). This was mainly due to lower risk of hospitalization for CHF (p=0.036) and recurrent myocardial infarction (p=0.179).
Conclusion. Delayed endovascular treatment is safe in patients with acute ST-segment elevation myocardial infarction and ectasia of infarct-related coronary artery. This strategy is also associated with lower risk of adverse cardiovascular events in long-term
period, mainly due to lower incidence of hospitalizations for chronic heart failure.

Prediction of no-reflow phenomenon in endovascular treatment of patients with acute ST segment elevation myocardial infarction

2025-09-09T21:12:51+03:00

No-reflow phenomenon is common in patients with ST-segment elevation myocardial infarction (STEMI) undergoing coronary artery stenting. There is still no generally accepted risk stratification model for these patients.
Objective. To identify predictors and regression model for no-reflow phenomenon in patients with STEMI.
Material and methods. A retrospective study included 143 STEMI patients who underwent infarct-related artery stenting. We estimated predictors of no-reflow phenomenon and developed appropriate prognostic model. The control group of 50 people tested performance of the model. Results. Preoperative TIMI grade of antegrade blood flow < 0—1, TIMI thrombus grade 4—5, structure of coronary arteries, leukocytosis, neutrophilia, serum glucose, period between painful attack and percutaneous coronary intervention, as well as previous diabetes mellitus are factors influencing the likelihood of no-reflow phenomenon. The mathematical model has high predictive value (AUC 0.86, p<0.01).
Conclusion. The main pattern of no-reflow phenomenon in STEMI patients undergoing PCI is a combination of distal embolism
with severity of inflammatory process. This corresponds to pathophysiological hypothesis of this complication after myocardial
revascularization.

Effect of internal carotid artery stenting on brain vascularization

2025-09-09T21:12:52+03:00

Cerebral microcirculation after internal carotid artery (ICA) stenting is an insufficiently explored and relevant area of research.
To address this question, we studied blood circulation in the eye as a part of central nervous system supplied through ICA.
Objective. To evaluate the effect of ICA stenting on eye vascularization in early period.
Materials and methods. The study included 92 patients with unilateral or bilateral ICA stenosis ≥70% who underwent stenting
of one ICA. Prior to the intervention and 3—7 days later, patients underwent optical coherence tomography (OCT). We measured
microvascular network density using VAD (image binarization method) and VSD (skeletonizing method) modes in superficial
(SCP) and deep (DCP) layers of macular retina in the area 6×6 mm (VAD SCP MZ 6×6 mm, VAD DCP MZ 6x6 mm, VSD SCP MZ
6x6 mm, VSD DCP MZ 6x6 mm) and in peripapillary (RPC) region in the area 4x4 mm (VAD RPC 4×4 mm, VSD RPC 4×4 mm).
We distinguished 2 groups depending on eye lateralization: group 1 — ipsilateral eyes, group 2 — contralateral eyes. There were
no differences in baseline OCTA parameters between ipsilateral and contralateral eyes.
Results. ICA stenting was followed by significant increase of VAD DCP MZ 6×6 mm and VSD DCP MZ 6×6 mm in ipsilateral
(p=0.01 and p<0.01, respectively) and contralateral eyes (p=0.03 and p=0.01, respectively). This indicated better microcirculation in deep retinal plexus.
Conclusion. Monitoring of retinal vascularization may be convenient for assessing the efficacy of ICA stenting regarding brain
perfusion.

Autopericardial neocuspidization in patients with small aortic annulus

2025-09-09T21:12:53+03:00

Introduction. Some patients with aortic valve (AV) disease have small aortic annulus. This anatomical feature can lead to prosthesispatient mismatch after AV replacement.
Objective. To improve postoperative outcomes in patients with AV disease and small aortic annulus.Material and methods. We retrospectively analyzed 77 patients with small aortic annulus divided into 2 groups: group 1 (n=49) —
autopericardial neocuspidization (AVNeo) of the aortic valve, group 2 (n=28) — aortic root enlargement and standard aortic valve
replacement using mechanical or biological prostheses. Analysis of comorbidities found no differences between groups.
Results. In-hospital mortality was similar (2,1% (n=1) and 7.1% (n=2), respectively, p=0.321). Survival rate was 96% and 74%, respectively (p=0.04), cumulative freedom from MACE — 95% and 53% (p=0.03), freedom from redo surgery — 95% and 80%, respectively (p=0.381). Duration of cardiopulmonary bypass and myocardial ischemia was similar: 113,84±36,03 vs 116.61±25.01 min,
(p=0.71); 86.74±23.19 vs 91.04±22.71 min, respectively (p=0.404). The incidence of permanent pacemaker implantations was significantly higher in group 2: 6 (21.4%) vs 2 (4.1%) cases (p=0.039). In early postoperative period, transvalvular peak blood flow
velocity (p<0.01) and pressure gradient (p<0.01) significantly decreased in the 1st group compared to the 2nd group. Mean transvalvular pressure gradient in mid-term period was significantly lower in the AVNeo group (p=0.001).
Conclusion. AVNeo in patients with small annulus demonstrates the advantages over aortic root enlargement regarding mid-term
results due to better hemodynamic parameters after surgery.

Features of drug therapy in patients with chronic heart failure in real clinical practice (chronic heart failure registry in the Tyumen region)

2025-09-09T21:12:54+03:00

In recent years, the capabilities of modern therapy in improving the prognosis of CHF have changed significantly. This is largely due to introduction of new drugs: angiotensin II receptor antagonists with neprilysin inhibitor and sodium glucose transporter type 2 inhibitors.
The purpose of the study was to analyze drug therapy in patients with CHF depending on phenotype, functional class and stage
of CHF who presented in hospitals of the Tyumen region between January 2020 and July 2023. We analyzed data on 7303 patients with CHF class I—IV. Mean age was 69.8±9.8 years. Men comprised 40.6% (n=2962). There were different stages and phenotypes of CHF. The compliance of drug therapy with modern clinical guidelines was estimated. No interventions in management
of patients were expected. Examination and treatment were completely determined by attending physicians.
Despite common use of certain classes of drugs included in optimal drug therapy, there are insufficient prescriptions of quadruple therapy (sodium glucose transporter type 2 inhibitors, angiotensin II receptor antagonists with neprilysin inhibitor, β blockers,
mineralocorticoid receptor antagonists) and individual prescriptions (sodium glucose transporter type 2 inhibitors, otensin II receptor antagonists with neprilysin inhibitor). This can affect further course of CHF in this region.

Non-fluoroscopic ablation of supraventricular tachycardia — results of a new approach

2025-09-09T21:12:56+03:00

Objective. To evaluate the efficacy and safety of catheter ablation of supraventricular tachycardia (SVT) using exclusively intracardiac ultrasound compared to conventional fluoroscopic approach.
Material and methods. There were 170 patients with SVT (85 patients in each group): 128 ones with atrioventricular nodal reentry tachycardia (AVNRT) and 42 ones with atrioventricular re-entry tachycardia (AVRT). In the non-fluoroscopic group, ablation
was performed under intracardiac ultrasound guidance. The follow-up period was 12 months.
Results. Intraoperative success rate was 100% in both groups. Freedom from recurrence was comparable among patients with
AVNRT (90.6% vs. 93.75%, p=0.74) and AVRT (95.2% vs. 95.2%). Safety of procedures was also similar (AVNRT 4.7% vs. 0%,
p=0.24; AVRT 0% vs. 0%). Fluoroscopy was used in none patient who underwent the procedure under intracardiac ultrasound
guidance (p < 0.001). However, surgery time and overall RF-ablation time was significantly shorter in the non-fluoroscopic group
among patients with AVNRT.
Conclusion. Catheter ablation of SVT under intracardiac ultrasound control is possible without fluoroscopy and electrophysiological navigation. This procedure is effective and safe.

Atrial cardiopathy. Diagnosis of causes, treatment of complications and surgical correction of cardiac remodeling

2025-09-09T21:12:58+03:00

The relationship between atrial fibrillation and thromboembolic syndrome and, above all, ischemic stroke is well known. Atrial
cardiomyopathy is important for understanding the mechanisms of thrombogenicity. In this report, we consider diagnostic algorithm, surgical treatment of a patient with long-standing persistent atrial fibrillation, thromboembolic complications, severe mitral insufficiency and atriomegaly following myocarditis. Structural and functional cardiac remodeling with subsequent arrhythmias and heart failure is a serious problem in modern cardiology and cardiac surgery. Extensive cardiac surgery is extremely difficult and does not always lead to significant clinical improvement. However, quality of life is quite low without surgical treatment
in such patients and associated with high risk of adverse cardiovascular events.

Renat Suleymanovich Akchurin (April 2, 1946 — October 6, 2024)

2025-09-09T21:13:01+03:00

obituary