The antithrombotic therapy of atrial fibrillation in patients with coronary heart disease

Coronary heart disease (CHD) is the most common cardiovascular disease, while atrial fibrillation (AF) is the most common heart rhythm disorder. These diseases have common risk factors such as hypertension, diabetes, sleep apnea, obesity and smoking. The frequency of CHD in patients with AF ranges from 17.0 to 46.5%, while the prevalence of AF among patients with CHD is low and is estimated at only 0.2–5.0%. AF is a well-known factor of unfavorable short-term and long-term prognosis in patients with acute myocardial infarction; it is associated with a significant increase in overall mortality. It is assumed that in 5-15% of cases of AF, coronary artery stenting and, accordingly, triple therapy with Aspirin, Clopidogrel or Ticagrelor and oral anticoagulant will ever be required. This requires very careful consideration of balanced antithrombotic therapy, taking into account the high risk of bleeding, the risk of stroke and stent thrombosis followed by acute coronary syndrome. Co-administration of oral anticoagulants with antiplatelet drugs, and in particular triple therapy, significantly increases the absolute risk of serious bleeding. In addition, severe bleeding is associated with a fivefold increase in the risk of adverse outcome after acute coronary syndrome. The presence of atrial fibrillation with coronary heart disease worsens the prognosis even in patients undergoing careful treatment

Local Use of Hydrogel with Amiodarone in Cardiac Surgery: Experiment and Translation to the Clinic

The objective of this study was to study the use of the hydrogel biopolymer based on sodium alginate (“Colegel”) with a drug substance—amiodarone—for the prevention of postoperative atrial fibrillation (POAF) in cardiac surgery. The experimental part of the study was performed on 46 rabbits. Five groups were formed: in the first group, the dose of amiodarone in hydrogel was 1 mg; in the second group—3 mg; in the third group—6 mg; in the fourth group, hydrogel was used without amiodarone; in the fifth group, 60 mg amiodarone was administered intravenously. The animals from each group were removed from the experiment for the pathomorphological study of the heart after 3, 7 and 14 days. The studied endpoints were: the heart rate control; the development of the blockades of the conduction system of the heart; and the development of inflammation according to laboratory pathomorphological studies. The translational clinical part involved a randomized clinical trial which included 60 patients, with an average age of 62 ± 8.5 years. All patients were randomized into two groups: the study group (n = 30, with the application of amiodarone hydrogel) and the control group (n = 30, without the application of amiodarone hydrogel). The dose of amiodarone in the hydrogel material was 60 mg for all patients. The heart rhythm was monitored during 5 days. The primary endpoint was the development of POAF. Secondary endpoints were: the dynamics of heart rate; the duration of the QT and PQ intervals; the development of blockades of the cardiac conduction system; as well as the dynamics of AST and ALT. According to the results of the experimental part, it was found that the method of the local epicardial delivery of amiodarone by the hydrogel material was safe. Hydrogel with amiodarone is effective for reducing the heart rate in the animal experiment in comparison to the control group and the group with the intravenous administration of the drug. The optimal dose of amiodarone in hydrogel was 1 mg per 1 kg. According to the results of the clinical part, it was found that the method of the local epicardial delivery of amiodarone as a hydrogel material proved its safety. Hydrogel with amiodarone at a dose of 60 mg was effective in preventing POAF in patients after coronary artery bypass grafting (CABG) operations in comparison to the control group (p < 0.001). The age and procedure of application of the amiodarone gel were significantly associated with POAF (p = 0.009 and p = 0.011, respectively). The use of hydrogel with amiodarone reduced the probability of developing POAF 18.9-fold. The method of the local epicardial delivery of amiodarone in the form of a hydrogel material is safe. The use of hydrogel with amiodarone after CABG reduced the probability of developing POAF

Predictors of Mortality Following Aortic Valve Replacement in Aortic Stenosis Patients

Background: Understanding of the risk factors for the development of adverse outcomes after aortic valve replacement is necessary to develop timely preventive measures and to improve the results of surgical treatment. Methods: We analyzed patients with aortic stenosis (n = 742) who underwent surgical treatment in the period 2014–2020. The average age was 63 (57;69) years—men 58%, women 42%. Results: The hospital mortality rate was 3% (22 patients). The following statistically significant threshold values (cut-off points) were obtained in the ROC analysis: aortic cross-clamp time > 93 min AUC (CI) 0.676 (0.640–0.710), p = 0.010; cardiopulmonary bypass time > 144 min AUC (CI) 0.809 (0.778–0.837), p < 0.0001, hemoglobin before op <120 g/L. AUC (CI) 0.762 (0.728–0.793), p < 0.0001, hematocrit before op <39% AUC (CI) 0.755 (0.721–0.786), p < 0.001, end-diastolic dimension index >2.39 AUC (CI) 0.647 (0.607–0.686), p = 0.014, end-systolic dimension index > 1.68 AUC (CI) 0.657 (0.617–0.695), p = 0.009. Statistically significant independent predictors of hospital mortality were identified: BMI > 30 kg/m2 (OR 2.84; CI 1.15–7.01), ischemic heart disease (OR 3.65; CI 1.01–13.2), diabetes (OR 3.88; CI 1.38–10.9), frequent ventricular ectopy before operation (OR 9.78; CI 1.91–50.2), mitral valve repair (OR 4.47; CI 1.76–11.3), tricuspid valve repair (OR 3.06; CI 1.09–8.58), 3 and more procedures (OR 4.44; CI 1.67–11.8). Conclusions: The hospital mortality rate was 3%. The main indicators associated with the risk of death were: diabetes, overweight (body mass index more than 30 kg/m2), frequent ventricular ectopy before surgery, hemoglobin level below 120 g/L, hematocrit level below 39%, longer cardiopulmonary bypass time and aortic cross-clamp time, additional mitral and tricuspid valve interventions

Long-Term Preoperative Atorvastatin or Rosuvastatin Use in Adult Patients before CABG Does Not Increase Incidence of Postoperative Acute Kidney Injury: A Propensity Score-Matched Analysis

Background: Acute kidney injury (AKI) is among the expected complications of cardiac surgery. Statins with pleiotropic anti-inflammatory and antioxidant effects may be effective in the prevention of AKI. However, the results of studies on the efficacy and safety of statins are varied and require further study. Methods: We conducted a retrospective cohort study to evaluate long-term preoperative intake of atorvastatin and rosuvastatin on the incidence of AKI, based on the “Kidney Disease: Improving Global Outcomes” (KDIGO) criteria in the early postoperative period after coronary artery bypass graft surgery (CABG). We performed propensity score matching to compare the findings in our study groups. The incidence of AKI was assessed on day 2 and day 4 after the surgery. Results: The analysis included 958 patients after CABG. After 1:1 individual matching, based on propensity score, the incidence of AKI was comparable both on day 2 after the surgery (7.4%) between the atorvastatin group and rosuvastatin group (6.5%) (OR: 1.182; 95%Cl 0.411–3.397; p = 0.794), and on postoperative day 4 between the atorvastatin group (3.7%) and the rosuvastatin group (4.6%) (OR: 0.723, 95%Cl 0.187–2.792; p = 0.739). Additionally, there were no statistically significant differences in terms of incidence of AKI after 1:1 individual matching, based on propensity score, between the rosuvastatin group and the control group both on postoperative day 2 (OR: 0.692; 95%Cl 0.252–1.899; p = 0.611) and day 4 (OR: 1.245; 95%Cl 0.525–2.953; p = 0.619); as well as between the atorvastatin group and the control group both on postoperative day 2 (OR: 0.549; 95%Cl 0.208–1.453; p = 0.240) and day 4 (OR: 0.580; 95%Cl 0.135–2.501; p = 0.497). Conclusion: Long-term statin use before CABG did not increase the incidence of postoperative AKI. Further, we revealed no difference in the incidence of post-CABG AKI between the atorvastatin and rosuvastatin groups

Colchicine for Prevention of Atrial Fibrillation after Cardiac Surgery in the Early Postoperative Period

Background. Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery. It has been proven to be associated with an increase in the incidence of early complications and mortality, an increase in the rate of hospital stay duration, and economic costs of their treatment. One of the pharmaceutical drugs recommended by the American College of Cardiology (ACC)/American Heart Association (AHA) for preventing POAF is colchicine (class IIB). However, the results of research on the efficacy and safety of colchicine are ambiguous and, consequently, require further study. Objective. Evaluating the efficacy of short-term colchicine administration in the prevention of POAF in patients after open-heart surgery. Materials and methods. Double-blind, randomized, placebo-controlled clinical trial. The subjects were randomly assigned to two groups: treatment group (n = 50) with subjects receiving 1 mg of colchicine 24 h before the surgery, as well as on days 2, 3, 4, and 5 in the postoperative period; and the control group (n = 51), receiving placebo on the same schedule. The primary endpoint was the frequency of POAF in both groups within 7 days after surgery. Results. The study included 101 patients (82 men, 19 women). Baseline clinical, laboratory, instrumental, and intraoperative data did not differ statistically significantly between the groups. POAF was detected in 9 patients (18%) of the treatment group and 15 subjects (29.4%) of the control group, which had no statistical significance (odds ratio, OR 0.527; 95% Cl 0.206–1.349; p = 0.178). No statistically significant differences were revealed for most secondary endpoints, as well as between the groups for all laboratory parameters. There were statistically significant differences between the groups solely in the frequency of diarrhea: 16 (32%) patients in the treatment group and 6 (11.8%) subjects in the control group (OR 3.529; 95% Cl 1.249–9.972; p = 0.010). Conclusions. We did not detect any statistical differences between the groups in terms of primary endpoints, which could be due to the insufficient volume of the sample of the study. However, we detected some trends of statistical differences among the groups in terms of some parameters. Clinical Trials Registration. ClinicalTrials. Unique identifier: NCT04224545

Mini-invasive technique of implanting the first domestic wireless epicardial pacemaker with a MEMS-converter

This article describes a minimally invasive surgical technique for implanting the pacemaker with a microelectromechanical system (MEMS) converter of kinematic energy into electrical energy in patients with life-threatening rhythm disorders. This kind of technique is recommended for patients with cardiac pathology who are preparing for surgical treatment of the main pathology with simultaneous implantation of the pacemaker with MEMS-converter of kinematic energy into electrical energy. Implantation of the pacemaker should be performed in the most energy-efficient zone of the epicardium, determined in advance by the method of tissue echocardiography

Simultaneous surgical correction of atrial fibrillation and aortic valve replacement: immediate results after surgery

Aim — To assess the results of simultaneous surgical correction of atrial fibrillation and aortic valve replacement. Materials and Methods — The retrospective analysis was held for the period of 2009-2016 of patients with atrial fibrillation (AF) and pathology of the aortic valve after combined operations. 68 patients were included in the study, the average age was 56 (51; 64) years; men 53%, women 47%. All patients were in III-IV functional class by NYHA classification. The duration of AF was 34 (24; 58) months. AF: persistent in 70,6%, paroxysmal in 29,4%. Calculated risks comprised: Euro Score II – 3,8 (2,4; 5,6), the risk of in-hospital mortality and the risk of total mortality by Ambler - 5,5 (3; 7,3) and 8 (6; 9), respectively. Results ― The average number of simultaneous procedures per one patient was – 4 (4; 4), minimum – 3, maximum – 5. In 100% cases was performed aortic valve and mitral valve correction and Maze IIIB procedure. CABG was performed in 20,6% of cases and tricuspid valve repair was performed in 67,6%. The total duration of operations was 6.3 ± 1.4 hours, the time of CPB: 208 (168; 224) min, aortic clamping time: 126 (119; 151) min. In-hospital mortality was 4.4%. The main non-lethal complications in the early postoperative period were heart failure, respiratory and renal insufficience, hemorrhage and transient neurological disorder. Conclusions ― There are few data demonstrating experience in performing of such complex surgical cases due to the severity of patients and small number of institutions having such experience. In our series of hospital mortality observations correlated with the calculated and accounted for 4.4%, which is an acceptable result in this group of patients

Hemolytic Performance in Two Generations of the Sputnik Left Ventricular Assist Device: A Combined Numerical and Experimental Study

Background: Currently, left ventricular assist devices (LVADs) are a successful surgical treatment for patients with end-stage heart failure on the waiting list or with contraindicated heart transplantation. In Russia, Sputnik 1 LVAD was also successfully introduced into clinical practice as a bridge-to-transplant and a destination therapy device. Development of Sputnik 2 LVAD was aimed at miniaturization to reduce invasiveness, optimize hemocompatibility, and improve versatility for patients of various sizes. Methods: We compared hemolysis level in flow path of the Sputnik LVADs and investigated design aspects influencing other types of blood damage, using predictions of computational fluid dynamics (CFD) and experimental assessment. The investigated operating point was a flow rate of 5 L/min and a pressure head of 100 mm Hg at an impeller rotational speed of 9100 min−1. Results: Mean hemolysis indices predicted with CFD were 0.0090% in the Sputnik 1 and 0.0023% in the Sputnik 2. Averaged values of normalized index of hemolysis obtained experimentally for the Sputnik 1 and the Sputnik 2 were 0.011 ± 0.003 g/100 L and 0.004 ± 0.002 g/100 L, respectively. Conclusions: Obtained results indicate obvious improvements in hemocompatibility and sufficiently satisfy the determined miniaturization aim for the Sputnik 2 LVAD development