This study aimed to evaluate the effects of a short course of physical prehabilitation on neurophysiological functioning and markers of the neurovascular unit in patients undergoing coronary artery bypass grafting (CABG). We performed a prospective randomized study involving 97 male CABG patients aged 45–70 years, 47 of whom underwent a 5–7-day preoperative course of aerobic physical training (PhT). Both groups of patients were comparable with respect to baseline clinical and anamnestic characteristics. An extended neuropsychological and electroencephalographic (EEG) study was performed before surgery and at 7–10 days after CABG. Markers of the neurovascular unit [S100β, neuron-specific enolase (NSE), and brain-derived neurotrophic factor (BDNF)] were examined as metabolic correlations of early postoperative cognitive dysfunction (POCD) at three time points: before surgery, within the first 24 h after surgery, and 7–10 days after CABG. POCD developed in 58% of patients who underwent preoperative PhT, and in 79.5% of patients who did not undergo training, 7–10 days after CABG. Patients without prehabilitation demonstrated a higher percentage of theta1 power increase in the relative change values as compared to the PhT patients (p = 0.015). The short preoperative course of PhT was associated with low plasma S100β concentration, but high BDNF levels in the postoperative period. Patients who underwent a short preoperative course of PhT had better cognitive and electrical cortical activity indicators. Markers of the neurovascular unit indicated lower perioperative brain injury after CABG in those who underwent training. A short course of PhT before CABG can decrease the brain’s susceptibility to ischemia and reduce the severity of cognitive impairments in cardiac surgery patients. Electrical brain activity indicators and neurovascular markers, such as S100β and BDNF, can be informative for the effectiveness of cardiac rehabilitation programs.

Коронарное шунтирование (КШ) сохраняет ведущую позицию в хирургическом лечении ишемической болезни сердца (ИБС). Предоперационная подготовка (преабилитация) и послеоперационная реабилита-ция имеют важное значение в реализации положительных эффектов реваскуляризации миокарда. Одним из методов кардиопротекции в предоперационном периоде КШ выступает ишемическое прекондициони-рование. Перспективным методом достижения эффектов ишемического прекондиционирования в предо-перационном периоде могут рассматриваться физические тренировки, обладающие инфаркт-лимитирую-щим, антиаритмическим эффектами, улучшающие функцию эндотелия, что положительно сказывается на результатах оперативного лечения.Ключевые слова: коронарное шунтирование, преабилитация, ишемическое прекондиционирование, физические тренировки. Coronary artery bypass grafting (CABG) remains the gold-standard treatment for coronary artery disease (CAD). Preoperative management (prehabilitation) and postoperative rehabilitation are pivotal for positive effects of myocardial revascularization. Ischemic preconditioning is one of the methods for cardioprotection in the preoperative period. Exercise trainings may have beneficial effects on ischemic preconditioning in the preoperative period, limiting infarct size, producing antiarrhythmic effects, and improving endothelial function. Exercise trainings produce beneficial effects on the outcomes of surgical treatment. POTENTIAL BENEFITS OF EXERCISE TRAINING ASKeywords: coronary artery bypass grafting, prehabilitation, ischemic preconditioning, exercise training. НИИ КПССЗ имеет большой опыт в разработке изделий для сердечно-сосудистой хирургии, в частности биопротезов кла-нов сердца и сосудов. С 2010 года под руководством академика РАН л. С. Барбараша начаты исследования по созданию био-зорбируемых сосудистых протезов малого диаметра. Основная цель -создание полимерных конструкций с бионаправленным йствием, способных заменить отдельные структуры живого организма, в частности сердечно-сосудистой системы. Научная но-зна поставленной задачи заключается в использовании нового подхода создания органа непосредственно в организме пациента счет биофункциональности и биорезорбируемости полимерных конструкций. доказана долгосрочная проходимость полимерных судистых графтов на основе поликапролактона и композиции полигидроксибутирата/валерата и поликапролактона. В экспери-нтах in vitro доказано, что ростовые факторы, инкорпорируемые в состав биодеградируемых графтов, сохраняют свою био-гическую активность. В долгосрочных экспериментах in vivo доказано, что сосудистый эндотелиальный фактор роста ускоряет дотелизацию и улучшает проходимость биодеградируемых полимерных сосудистых графтов.Ключевые слова: биодеградируемые полимеры, сосудистый графт, ростовые факторы. DEVELOPMENT OF TISSUE ENGINEERED SMALL DIAMETER VASCULAR GRAFT FOR THE CARDIOVASCULAR SURGERY NEEDS L. V. ANTONOVA, YU. A. KUDRYAVTSEVA Federal State Budgetary Scientific Institution Research Institute for Complex Issues of Cardiovascular Diseases. Kemerovo, RussiaRICICd has l...

Abstractthere is no single Phase 1 cardiac rehabilitation proThe number of patients undergoing coronary ar-gram recommended for patients following CABG in the tery bypass grafting is increasing over the past decade. in-hospital settings. This review presents an analysis of Therefore, cardiac rehabilitation following CABG is existing Russian, European and American data on efgaining new relevance. Advanced cardiac rehabilitation fectiveness and safety of early rehabilitation in patients program following CABG includes three phases. Phase I after CABG in the in-hospital settings. of cardiac rehabilitation is an initial in-hospital phase, Keywords: rehabilitation, coronary artery bypass which all patients undergo after surgery. However, grafting, fast-track, exercise training. For citation: Inozem tseva A.A., A hu n ova Y.A., Pom eshkina S.A. Early rehabilitation after coronary arteгу bypassgrafting: limitations a n d prospects.

1 Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний, Кемерово 650002, Российская федерация 2 Кемеровский государственный медицинский университет, Кемерово 650056, Российская федерация Цель. Оценить эффективность и безопасность раннего начала физических тренировок с индивидуальным подбором мощности у пациентов после коронарного шунтирования (Кш) в условиях искусственного кровообращения. Материал и методы. Включено 50 пациентов, рандомизированных на две группы в зависимости от программы реабилитации. Пациентам группы 1 (n=25, средний возраст 64 [58; 67] лет) проведен курс ранних физических тренировок с индивидуальным подбором интенсивности, в группе 2 (n=25, средний возраст 62 [56; 68]) -физические тренировки не проводились. Подбор мощности тренировок и оценка эффективности осуществляли с помощью оценки показателей спировелоэргометрии. Результаты. На 14 сутки после Кш толерантность к физической нагрузке (ТфН) возросла в обеих группах с 50 Вт до 75 Вт. Классические показатели велоэргометрии в 2 группах значимо не различались, однако, в группе 1 наблюдалась тенденция (р=0,06) к меньшей величине частоты сердечных сокращений (ЧСС) в покое. Пиковое потребление кислорода на 14 сутки после Кш было значимо выше (р=0,04) в группе с физическими тренировками 14,2 [13,2; 15,4] против 12,4 [11,3; 14,5] мл/кг/мин. Ни в одной из групп не зарегистрировано серьезных осложнений. Частота развития нежизнеопасных осложнений не различалась между группами. Заключение. Раннее включение физических тренировок с индивидуальным подбором мощности в программу реабилитации после Кш является безопасным и эффективным способом повышения резервных способностей сердечно-сосудистой и легочной систем. Ключевые слова: ишемическая болезнь сердца, коронарное шунтирование, ранняя реабилитация, физические тренировки, спировелоэргометрия, персонифицированная медицина, толерантность к физической нагрузке. Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи. Для цитирования: Иноземцева АА, Аргунова ЮА, Помешкина СА, евтушенко ВВ, Барбараш Ол. Эффективность и безопасность ранних физических тренировок в реабилитации пациентов после коронарного шунтирования. Сибирское медицинское обозрение. 2018;(6):33-42. 2 Kemerovo state medical university, Kemerovo 650056, Russian FederationThe aim of the research is to assess the efficiency and safety of early onset of physical trainings with individual selection of intensity in patients after coronary artery bypass grafting (CABG) in case of artificial blood circulation. Material and methods. 50 patients were included into the survey who were randomized into two groups depending on rehabilitation program. Patients of group 1 (n = 25, average age -64 [58; 67]) had a course of early physical training with individual intensity selection; patients of group 2 (n = 25, average age -62 [56; 68]) did not have any physical trainings. Selection of training intensity and evaluation of its effectiveness was carried out ...

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Our aim in this study was to evaluate the effect of physical training performed before CABG on the perioperative dynamics of the serum levels of asymmetric dimethylarginine (ADMA) and endothelin-1 (ET-1) of patients with stable coronary heart disease (CHD). Patients in the preoperative period were randomized into two groups: the training group (n = 43) underwent high-intensity treadmill training; the patients in the control group (n = 35) received no training before the procedure. The serum concentrations of ADMA and ET-1 were determined in the perioperative period, and the course of the early postoperative period was analyzed. In the training group, we found a significantly lower incidence of postoperative complications during hospital stays (p = 0.013). At the end of the training program, the ADMA levels were 1.8 times higher in the controls than in the training group (p = 0.001). We found that type 2 diabetes increased the probability of complications by 12 times (OR: 12.3; 95% CI: 1.24–121.5; p = 0.03), as well as elevating the concentration of ET-1 on the eve of surgery (OR: 10.7; 95% CI: 1.4–81.3; p = 0.02). Physical prehabilitation reduced the likelihood of complications nine times (OR: 0.11; 95% CI: 0.02–0.83; p = 0.03). The AUC was 0.851 ± 0.07 (95% CI: 0.71–0.98). The obtained results indicate the benefit of physical training during the prehabilitation stage since it can help to preserve endothelial function.

Aim. To evaluate the effectiveness of a comprehensive prehabilitation program including the optimization of drug therapy for patients undergoing elective coronary artery bypass grafting (CABG).Material and methods. 56 male patients with stable angina referred to elective on-pump CABG were enrolled in a study. All patients were screened for eligibility according to the inclusion/exclusion criteria and then randomized into two groups. Group 1 patients (n=28) underwent preoperative management (prehabilitation) for 14 days, including patient education and physical rehabilitation. Trimetazidine in a dose of 80 mg per day was added to the standard drug therapy. Group 2 patients (n=28) underwent similar preoperative management, but with the standard drug therapy without trimetazidine. In addition to the routine methods of preoperative management, all patients underwent the 6-minute walk test (6MWT) to assess exercise tolerance and speckle tracking echocardiography to measure left ventricular (LV) longitudinal deformation. Serum troponin T was measured in all patients. The measurements were performed at admission and after the surgery.Results. Patients did not differ in the main clinical and demographic data, as well as the main preoperative speckle tracking echocardiography findings. The intraoperative parameters were comparable in both groups. The rate of early postoperative complications was 61% (n=17) in Group 1 and 64% (n=18) in Group 2 (p>0.05). LV ejection fraction significantly decreased postoperatively in both groups (p<0.01) as well as LV longitudinal deformation as compared to the baseline. Patients receiving the standard therapy without trimetazidine reported a significant decrease in the longitudinal strain after CABG compared with the baseline (p=0.01). There were no statistically significant differences in most preoperative and postoperative indicators of longitudinal deformation among patients treated with trimetazidine. Postoperative values of GLPS-LAX and GLPS-Avg were significantly higher in the trimetazidine group than those in the control group (p=0.04). Group 1 patients reported longer distance covered in 6MWT than Group 2 patients while assessing exercise tolerance: 370.0 [260.0;415.0] vs 242.0 [202.0;350.0] m, respectively (p=0.0059).Conclusion. The addition of trimetazidine in a dose of 80 mg daily in the prehabilitation program for patients undergoing elective CABG demonstrated better postoperative indicators of LV longitudinal deformation and an increase in exercise tolerance. Obtained findings allowed considering this approach to the preoperative management as an additional method of cardiac protection and optimization of the functional status of patients.

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