[The influence of cardiosurgical intervention type and conditions of artificial blood circulation of perioperative dynamics of cardiac biomarkers].

125 patients after cardiac surgery operated on with the use of artificial blood circulation (ABC) were followed-up. Blood levels of cardiac protein, binding aliphatic acids and troponin 1 and 3 days after the operation were registered. The study showed that aorta clamping more then 90 minutes and hypothermic perfusion regimen influence cardiomyocites negatively.

Recombinant Human Cyclophilin A in vitro Inhibits the Formation of Fibrin Clot.

The chemotactic properties of cyclophilin A are well-known. There exists however a poor level of understanding regarding the hemostatic effects of this protein. Herein it is shown that recombinant human cyclophilin A (rhСyA), in contrast to the granulocyte colony-stimulating factor, is capable of inhibitingin vitrothe formation of a fibrin clot, thereby violating the spatial dynamics of clot growth; this effect is transient and dose-independent.

[The efficacy and safety of tranexamic acid and epsilon-aminocapronic acid in cardiac surgery under extracorporeal circulation].

Sixty patients who had undergone cardiosurgical operations under extracorporeal circulation (EC) were enrolled in the study. All the patients were divided into 2 groups: (1) 40 patients were injected tranexamic acid (TA) (its loading dose was 15 mg/kg; maintenance infusion 1 mg/kg/h throughout the operation; 500 mg in the primary packing volume for an EC apparatus (EA); (2) 20 patients received epsilon-aminocapronic acid (ACA) (its loading dose was 5 g; 5 g in the primary packing volume for an EA and 10 g for infusion after EC). The effects of TA and ACA on the fibrinolytic system were evaluated from the time of XIIa-kallikrein-dependent fibrinolysis (sec) and the concentration of D-dimer (mg/ml).

[Conditions of artificial blood circulation and erythrocytic aggregation in cardiosurgical patients].

Normothermic artificial circulation, irrespective of its duration, enhances erythrocyte aggregation in response to noradrenaline stimulation. Short-term hypothermic perfusion reduces adrenergic aggregation of erythrocytes while in long-term hypothermic artificial circulation changes in erythrocyte adrenergic aggregation are not significant. In the course of cardiosurgical operation in conditions of artificial circulation adrenergic erythrocyte aggregation undergoes changes: a maximal rise before perfusion, linear lowering and rise to the preoperative level.

[Comparative assessment of criteria for postoperative renal dysfunction in cardiosurgical patients].

The paper presents data on comparison of the detection rate of renal dysfunction after cardiac surgery, by using the criteria developed by Cockroft-Gault, C. M. Mangano, L.

[Haemorheological impairments following aortic surgery and methods of correction thereof].

The article deals with the findings concerning alterations in rheological properties of the blood in patients who endured aortic surgery with and without artificial circulation. Also shown herein is the contribution of the plasmatic and erythrocytic components to the development of haemorheological disorders in the postoperative period. To this was added the assessment of the role plasmapheresis plays in correction of impaired blood rheological properties, depending upon the terms of its carrying out and the type of a surgical intervention performed.

[Comparative assessment of using various glomerular filtration rate calculations in cardiological patients].

The paper gives the data of comparing the use of various formulas to calculate glomerular filtration rate (GFR) for the evaluation of postoperative renal function in cardiosurgical patients. GFR is shown to evaluate renal filterability with a high degree of reliability. Monitoring of GFR changes may characterize the progression of renal diseases.

[The specific features of renal dysfunction in cardiosurgical patients].

Subclinically insignificant glomerular filtration disturbances were found during operations under extracorporeal circulation. After termination of perfusion, dysfunction of the proximal portion of renal tubules was recorded in all patients. This may be associated with that the proximal tubules were more susceptible to ischemia.

[Impact of protamine sulfate on hemostasis system after operations with artificial circulation].

Effects of different doses and lots of protamine sulfate on hemostasis system after cardiac operations with artificial circulation are analyzed. Overall 982 patients underwent cardiac operations with artificial circulation. Quality and purity of protamine may be the causes of side effects.

[On the mechanism of action of recombinant activated factor VII in massive non-hemophylic bleeding in cardiosurgical patients].

Recombinant activated factor VII was used in a dose of 30 to 140 mcgr/kg in 35 cardiosurgical patients during intra- and postoperative periods complicated by massive uncontrolled (5 to 25 ml/min) bleeding of non-surgical origin. Basing on the analysis of changes in the hemostasis system parameters, the mechanism of action of the preparation may be presented as follows: recombinant fVIIa forms a complex with TF at the site of lesion; the formation of TF-fVIIa complex leads to the appearance of small amount of synthesized thrombin on the membrane of TF-containing cells, which, in turn, activates thrombocytes at the site of lesion; thrombocytes excrete phosphatidylserine, which serves as a matrix for further thrombin formation. FXIII is expressed from a granules ofthrombocytes and gets activated.

[A method for calculating the additional quantity of protamine sulfate during cardiosurgical operations].

The paper describes a method for calculating the additional dose of protamine sulfate solution during incomplete heparin neutralization after cardiac surgery under extracorporeal circulation, by estimating the anti-Xa-activity of venous blood plasma. The method may be an alternative to the use of devices to measure the blood concentration of free heparin, such as a "Hepcon" apparatus.

The causes of early disorders of cerebral circulation in patients undergoing carotid endarterectomy.

Aim: to examine hemostasis in patients undergoing carotid endarterectomy as dependent on the course of the short-term postoperative period.

Materials And Methods: altogether 36 patients who had undergone unilateral carotid endarterectomy (CEAE) were examined. Intraoperatively, all the patients received unfractionated heparin (UFH) in a dose of 80 - 100 IU/kg bw.

[Intraoperative myocardial protection with extracellular cardioplegic solutions in patients with cardiac valve diseases].

A hundred patients operated on under extracorporeal circulation (EC) with bicaval cannulation in the moderate general hypothermia mode were intraoperatively examined. According to the used cardioplegic solution, all the patients were divided into three groups: 1) Konsol; 2) Konsol MF; 3) St. Thomas (a control group).

[Comparison of two schemes of administering the Russian protamine sulfate after extracorporeal circulation in cardiosurgical patients].

The paper presents data of a study comparing two schemes (Scheme 1: a heparin/protamine ratio of 1:2; Scheme 2: a heparin/protamine ratio of 1:3) for administering protamine sulfate to neutralize heparin in patients after extracorporeal circulation. A larger dose of protamine sulfate is shown to induce significant thrombocytic dysfunction, resulting in increased postoperative hemorrhage. To minimize protamine sulfate doses required for neutralization of the anticoagulant effect of heparin is a way of preventing these complications.

[Influence of extracorporeal circuits surface on hemostasis system during off-pump surgeries].

It is demonstrated that special surface of extracorporeal circuit promotes reduction of artificial circulation negative influence on hemostasis system. During artificial circulation coating "duraflo" gradually loses its protective characteristics due to washout of heparin molecules from the surface of extracorporeal circuit, whereas chemical link between heparin and protein in "safe-line" coating is more stable. The results of the study demonstrate no advantages of heparin coating of extracorporeal circuits over protein one.

[Alterations in certain indices of the haemostasis system following aortic surgery].

Material And Methods: A total of 24 patients were examined after surgery on the thoracic or abdominal aorta. Depending on the level of the aortic clamping at the main stage of the operation, the patients were subdivided into three groups: Group One was composed of 7 patients with aortic coarctation in whom the level of artery clamping was located just below the subclavian artery, Group Two comprised 7 patients with an aneurysm of the infrarenal aortic portion, with the clamp applied immediately underneath the renal arteries, and Group Three consisted of 10 patients with type IV thoracoabdominal aortic aneurysm according to Crawford's classification, with the artery being clamped above the diaphragm. The studies were carried out at the following stages: before and at the end of surgery, then 6 hours thereafter, and at 24 hours postoperatively.

[Changes in hemostasis at aortic surgery under conditions of extracorporeal circulation].

This paper describes hemostatic changes in patients who had undergone aortic surgery under conditions of extracorporeal circulation. The changes in the hemostatic system are marked by the thrombophilic condition made up for activation ox blood fibrinolytic activity in the preoperative period. The basic amount of blood loss falls within the first 6 hours after operation.

The platelet componentof hemostasis in aortic surgery.

The lack of significant changes in the count and function of platelets in aortic surgery without use of cardiopulmonary bypass (CPB) confirms that factors of extracorporeal circulation exert a remarkable adverse action on the platelet component of hemostasis. In operations performed under hypothermic perfusion or circulatory arrest, disorders of the platelet component even in case of the use of 2 mln. CIU trasylol (aprotinin) are most pronounced which gives rise to excessive postoperative blood loss in the given patient group.

[Effects of features of extracorporal circuits on thrombocyte hemostasis, the fibrinolysis system, and development of hemolysis].

The article contains data which demonstrate that use of extracorporal circuits with special coating ("safe-line" and "duraflow") improves preservation of thrombocyte functional activity, and lowers activation of the fibrinolysis system in postoperative period, which results in decrease of postoperative blood loss. Use of heat exchangers with polypropylene coating is less traumatic to blood cells, and thus lowers frequency and degree of hemolysis.