ТРАНСПЛАНТАЦИЯ СЕРДЦА У ПАЦИЕНТКИ МОЛОДОГО ВОЗРАСТА С ДИЛАТАЦИОННОЙ КАРДИОМИОПАТИЕЙ И ВТОРИЧНЫМ АНТИФОСФОЛИПИДНЫМ СИНДРОМОМ

Patients with congestive heart failure have an increased incidence of thromboembolic events. The choice of me- dical management in patients with antiphospholipid antibodies and generalized thrombosis due to hypercoagula- bility is complex issue. We report heart transplant outcome in 15 years old patient with dilated cardiomyopathy and secondary anti-phospholipid syndrome. Пациенты с хронической сердечной недостаточностью имеют повышенный риск тромбоэмболических осложнений. Выбор врачебной тактики особенно затруднен при выявлении у таких больных антифосфо- липидных антител и развитии генерализованных тромбозов. В статье представлены результаты успеш- ной ортотопической трансплантации сердца у пациентки 15 лет с дилатационной кардиомиопатией и вторичным антифосфолипидным синдромом.

ТРАНСПЛАНТАЦИЯ СЕРДЦА У ПАЦИЕНТКИ С ПОСТТРАВМАТИЧЕСКОЙ АНЕВРИЗМОЙ ЛЕГОЧНОЙ АРТЕРИИ

Right heart catheterization (RHC) should be performed on all candidates in preparation for listing for cardiac transplantation. Patient, 64 y. o., with chronic heart failure NYHA III class, had developed a rare complication while performing that procedure – a rupture of segmental branch of pulmonary artery (PA) with pulmonary haemorrhage. The episode of pulmonary bleeding was stopped conservatively without surgical management. There was a pseudoaneurysm formation of segmental branch of PA 2,7 × 2,8 cm with signs of thrombosis. Afterfi ve months the patient underwent heart transplantation without severe complications in perioperative period. No more recurrent episodes of pulmonary haemorrhage were identifi ed.Обязательной процедурой, выполняемой перед включением кандидата на трансплантацию сердца в лист ожидания, является катетеризация правых отделов сердца и легочной артерии (ЛА). У пациентки 64 летс хронической сердечной недостаточностью III функционального класса по NYHA при выполнении данной манипуляции возникло редкое осложнение – разрыв сегментарной ветви ЛА с развитием легочного кровотечения. На фоне комплексной интенсивной терапии эпизод легочного кровотечения был купирован, не потребовав хирургического лечения. Сформировалась ложная аневризма сегментарной ветви ЛА размерами 2,7 × 2,8 см с признаками тромбирования. Спустя пять месяцев пациентка перенесла трансплантацию сердца, периоперационный период протекал без развития тяжелых осложнений, повторных эпизодов легочного кровотечения зафиксировано не было

ШЕСТИЛЕТНИЙ ОПЫТ ТРАНСПЛАНТАЦИИ СЕРДЦА В ФГБУ «СЕВЕРО-ЗАПАДНЫЙ ФЕДЕРАЛЬНЫЙ МЕДИЦИНСКИЙ ИССЛЕДОВАТЕЛЬСКИЙ ЦЕНТР ИМЕНИ В.А. АЛМАЗОВА»

Aim. To estimate the results of 6-year experience of heart transplantation (HT) in Federal Almazov North-West Medical Research Centre. Methods. From 2010 to 2015 we have performed 65 HT. Mean age was 44.3 ± 14 years old (from 10 to 64 years old). We used biventricular assist device (BIVAD, Berlin Heart Excor) support in 7 heart transplant candidates before HT. 19 patients (29%) received thymoglobulin, whereas 46 patients (71%) had basiliximab to induce immunosuppression.Results. Extracorporeal membrane oxygenation machines were implanted in 5 patients (7.7%) after HT due to acute right ventricular failure. Suture annuloplasty (the Batista procedure) for tricuspid valve repair was carried out in 3 cases (4.6%). Venovenous hemodiafi ltration was used in 11 patients (16.9%). A total of 598 endomyocardial biopsies (EMB) were performed after HT. Evidence of cellular rejection (R1 and R2) was presented in 286 biopsies (48%). The 30-day in-hospital mortality rate was 3.1%. The 6-month survival rate after HT was 92%, 1-year – 91% and overall survival for the 6-year period of observation – 89.2%. Maximum observation period was 71 months.Conclusions. The 6-year experience of HT in our Center has shown a high level of survival. BIVAD Excor support can be effectively used as a «bridge» to HT. Prevention of graft loss due to acute rejection in heart transplant recipients can be achieved only through regular EMB monitoring. The rate of viral infection increased in 2 months after HT.Цель исследования. Оценить результаты трансплантаций сердца (ТС), выполненных в ФГБУ «Северо-Западный федеральный медицинский исследовательский центр имени В.А. Алмазова» за шесть лет.Материалы и методы. В период с 2010-го по 2015 год в Центре было выполнено 65 ТС. Средний возраст реципиентов составил 44,3 ± 14 лет (от 10 до 64 лет). В качестве «моста» к ТС у 7 пациентов перед пересадкой были имплантированы устройства вспомогательного кровообращения (УВК) Excor. Для индукции иммуносупрессивной терапии у 19 пациентов (29%) применялся антитимоцитарный иммуноглобулин, у 46 пациентов (71%) – базиликсимаб.Результаты. У 5 (7,7%) пациентов, в связи с тяжелой правожелудочковой недостаточностью, в раннем периоде после ТС была установлена система ЭКМО. У 3 (4,6%) больных ввиду развития трикуспидальной недостаточности была выполнена пластика трикуспидального клапана по Батиста. Проведение сеансов заместительной почечной терапии после ТС потребовалось у 11 (16,9%) реципиентов. Всего за шестилетний период наблюдения у всех пациентов было выполнено 598 эндомиокардиальных биопсий (ЭМБ). В 286 (48%) случаях диагностировано клеточное отторжение трансплантата стадии R1 или R2. 30-дневная госпитальная летальность составила 3,1% (2 пациента). Выживаемость в отдаленном периоде составила: через 6 месяцев – 92%, через 1 год – 91%, общая выживаемость за 6 лет наблюдения – 89%. Максимальный срок наблюдения – 71 месяц.Заключение. Шестилетний опыт ТС в нашем Центре показал высокий уровень выживаемости после операции. Имплантация УВК является «мостом» к ТС у больных с терминальной стадией ХСН. ЭМБ остается единственным эффективным методом диагностики острого отторжения трансплантата сердца. Через два месяца после ТС в структуре инфекционных осложнений увеличивается частота вирусной инфекции

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Conditions and Prerequisites for the Establishment of Environmental Forensics in the Republic of Belarus

The article considers the prerequisites and conditions for the establishment of environmental forensics as a new branch of forensic science in the Republic of Belarus. The authors advocate conducting this type of examinations at special competency centers, such as the Scientific and Practical Center (SPC) of the State Forensic Examination Committee of the Republic of Belaru

PARALLELS BETWEEN THE HEMODYNAMIC PROFILE AND BIOMARKERS ACTIVITY IN DIFFERENT FORMS OF ACUTE HEART FAILURE IN THE EARLY PERIOD AFTER AORTOCORONARY BYPASS

Goal: to study the rates of central hemodynamics and clinical progress and to evaluate the activity of biomarkers of myocarditis overload and damage in patients with isolated reduction of systolic function of right or left ventricle in early period after aortocoronary bypass. 25 patients were enrolled into the study (14 men, 11 women, average age 58 ± 7 years), admitted to the intensive care department after aortocoronary bypass with artificial circulation and in need of inotropic therapy. Rates of central hemodymanics were monitored with the help of PiCCO system and VoLEF additional module. Blood was collected to assess the NT-proBNP level in 1 and 24 hours from the admission to the intensive care department, and tropinin I level - in 24 hours. It has been found out that the acute heart failure in early period after aortoconorary bypass was associated with isolated systolic dysfunction of right ventricle in 40% of cases, with left ventricle in 32% and in 28% it was of bi-ventricular nature. Failure of right ventricle requires a continuous rehabilitation period and bigger activity pf NT-proBNR compared to the left ventricle failure while the troponin I level does not confidently differ for these groups

CARDIAC TRANSPLANTATION IN YOUNG PATIENT WITH DILATED CARDIOMYOPATHY AND SECONDARY ANTIPHOSPHOLIPID SYNDROME

Patients with congestive heart failure have an increased incidence of thromboembolic events. The choice of me- dical management in patients with antiphospholipid antibodies and generalized thrombosis due to hypercoagula- bility is complex issue. We report heart transplant outcome in 15 years old patient with dilated cardiomyopathy and secondary anti-phospholipid syndrome