Cardiothoracic Surgery Research Department

    

Major research areas 

• Aortic valve diseases, aneurysms and thoracic aorta dissection
• CAD complicated forms
• Mitral and tricuspid valve defects, cardiac arrhythmias, atrial fibrillation (AF)
• CHF surgery, heart transplantation and hypertrophic cardiomyopathy (HCM)
• Chronic thromboembolic pulmonary hypertension (CTEPH)
• Reducing surgical risks, cerebral and organ protection

Structure

• Research Laboratory of Surgery for CAD and Heart Defects
• Thoracic Surgery Research Laboratory

Aortic and aortic valve surgery

• Approaches to valve-sparing procedures for ascending aorta dissection have been structured.
• Risk factors for residual aortic insufficiency and its recurrence after valve-sparing aortic root surgery with aortic valve reimplantation have been verified.
• Brain protection by unilateral antegrade cerebral perfusion has been substantiated and introduced into clinical practice.
• Surgical and hybrid approaches for patients with aortic dissection spreading to brachiocephalic arteries have been developed.
• Aortic root replacement complications associated with impaired coronary blood flow have been studied, and prevention methods have been developed.

CAD complicated forms 

The effectiveness of suture mitral valve annuloplasty in early and late period in patients with mitral insufficiency of ischemic origin was proved. The main predictors of MI recurrence were identified, including analysis of MRI data with Gd.

• The results of surgical treatment of patients with left ventricular aneurysm complicated by mitral regurgitation were analyzed; transventricular access to the mitral valve was substantiated and introduced into clinical practice.
• The efficiency and safety of single-stage procedures in CAD patients with brachiocephalic arteries lesions with cerebral protection by systemic hypothermia were proved.
• The technique and results of repeated CABG, including off-pump, were studied.

The Department plans to carry out research to assess the hemodynamic disorders of coronary blood flow associated with «myocardial bridges» and the surgical treatment results; to study the characteristics of blood flow in composite and T-shaped grafts.

Open surgery for AF in patients with mitral valve defects

The specialists of the Department developed and proved the high efficiency and safety of «Labyrinth III» and «Labyrinth IV» modified procedures for the surgical treatment of patients with paroxysmal and persistent AF forms and valvular heart disease, and introduced them into routine clinical practice.

Heart Transplantation

The specialists of Cardiothoracic Surgery Research Department performed more than 150 heart transplantations, standardized the management approaches for patients on the waiting list, and expanded the indications for transplantation in previously inoperable patients.

Participation in the clinical testing of two methods:

• Method of optical coherence tomography in patients with cardiac transplant vasculopathy to increase the medical care efficiency by early CAD detection in transplanted heart in comparison with histological and immunohistological screening of endomyocardial biopsy and coronary angiography
• Method of sternal osteosynthesis with self-adjusting compression in adult patients after heart transplantation for prevention of early and late postoperative complications in comparison with the traditional sternal fixation technique

The Department gained the primary experience in using LVAD as a bridge to transplant.

Hypertrophic cardiomyopathy

The Cardiothoracic Surgery Research Department has gained a unique experience in septal myectomy (over 250 procedures).

Results:

• Development of new original approaches to access the interventricular septum of the left ventricle providing sufficient myectomy visualization.
• Testing of the new technique as part of the programme of the Russian Ministry of Health (No. 2016-19-5 «Clinical testing of the cardiac mobilization method for the surgical treatment of hypertrophic cardiomyopathy (HCM) by transaortic access», 2016–2018)
• Creation of the cryobank of the excised myocardium fragments of the left interventricular septum.
• Development of methods to assess the volume of excised myocardium and the residual thickness of the interventricular septum.

3 Russian patents.

Research prospects

• Study of molecular genetic aspects of congenital and acquired aortic and aortic valve diseases. Study of aortic valve calcification and myocardial fibrosis, including HCM.
• Study and implementation of minimally invasive treatment techniques for coronary blood flow and heart valve apparatus. Physiological study of coronary blood flow and myotomy results in patients with «muscle bridges».
• Graphic program for aortic root modeling and optimal technique for valve-preserving and corrective plastic surgery.
• Study of effectiveness of circulatory assist devices as a «bridge» or alternative to heart transplantation.
• Development of cerebral protection methods for extracorporeal circulation and circulatory arrest based on improved imaging methods (biochemical and X-ray techniques).

Participation in State Assignments

As part of the state assignment «Study of genomic and cellular mechanisms of aortic and aortic valve diseases and new combination treatment methods, incl. hybrid technologies» (2015—2017), the following data were obtained:

• Impaired expression of osteogenic genes and Notch signaling genes in patients with bioacoustic correction serves as the basis for early calcification.
• Defect in Notch signaling pathway in endothelial cells of aortic aneurysm in patients with bioacoustic correction can cause the ascending aorta aneurysm without regard to mutations in the gene.
• The results were published in 7 and 19 articles in national and foreign journals with a total impact factor of 39.056.

As part of the state assignment «Development and introduction into clinical practice of methods for heart and brain protection against ischemia/reperfusion injury» (2016—2018), the following data were obtained:

• For the first time, an original technique of remote ischemic preconditioning (RIPC) was proposed.
• For the first time in the world, clinical study proved the activation of basic biochemical preconditioning processes (increase in the intracellular concentration of protein kinase C) and the effect of anesthesia method on the RIPC cardioprotective effects.
• Proven clinical efficiency and safety of aortic arch procedures with hemispheric perfusion and cerebral protection by moderate systemic hypothermia.

The Department is currently conducting the study «Effect of myocardial fibrotic changes on the long-term prognosis of HCM patients».

Chronic thromboembolic pulmonary hypertension

• First 30 pulmonary thromboendarterectomy procedures were performed.
• New access to the pulmonary artery branches was developed.
• New technique of endovascular balloon angioplasty on small pulmonary artery branches was tried out.

Currently, the Department is actively involved in research project No. 46.A19-119070490031-3.2019—2022 «Heart valve calcification: new targets for personalized therapeutic effects.» The study is underway to identify the mechanisms of aortic valve calcification on the cell culture from intraoperative material; a PET-CT method to assess the rate of calcification and myocardial fibrosis has been developed, and its high predictive value has been confirmed.

The specialists are working on the new principle of image processing for IT design of aortic root structures based on aortic valve 3D reconstruction. This invention can significantly improve the results of reconstructive surgery and endovascular aortic valve replacement.