Relevance. Disturbances in the diurnal blood pressure (BP) profile are attracting increasing attention due to improved detection capabilities and a confirmed association with cardiovascular risk. Elevated nocturnal BP is associated with a higher risk of target organ damage and progression of cardiac symptoms [1]. D. Elçik et al. (2021) reported a direct relationship between insufficient nocturnal BP reduction in individuals with arterial hypertension (AH) and the prevalence of coronary heart disease (CHD) and major adverse cardiac events (MACE). Aim. To investigate the features of clinical and functional manifestations of hypertension in men of working age with different daily blood pressure biorhythms. Materials and Methods. By conducting ABPM, the characteristics of the circadian blood pressure rhythm were assessed in 95 working-age men with stage I-II AH, in accordance with the ESC 2024 recommendations. Results. Conclusions. The study revealed a high prevalence of disturbances in normal physiological circadian BP biorhythms in working-age men with arterial hypertension. Given that nocturnal hypertension was associated with a greater degree of target organ damage, the goal of treatment in such patients should be not only to achieve target mean daily BP values, but also to restore physiological BP biorhythms.

Introduction. Combat vascular injury of the limbs represents one of the most complex categories of trauma. Such injuries are rarely isolated and are often accompanied by extensive soft-tissue defects and microbial contamination, leading to severe complications such as thrombosis and erosive bleeding. Their treatment remains challenging, prolonged, and frequently results in limb loss. Negative pressure wound therapy (NPWT) has proven to be an effective method for managing complex gunshot wounds in combat conditions; however, evidence on its safe application in vascular limb trauma remains limited. Aim. To analyze theoretical and practical aspects of the safe use of NPWT in combat-related injuries of major limb vessels and to determine the indications, contraindications, and optimal technical parameters for its application. Materials and Methods. A comparative analysis of published data and clinical observations was performed, including cases of combat vascular injury of the lower limbs with associated soft-tissue defects where NPWT was used as part of staged surgical management. Results. Key indications, contraindications, and principles for safe NPWT use in vascular surgery were defined. The application of a two-layer dressing with a protective interface and continuous negative pressure of 70–80 mmHg ensured procedural safety in vascular reconstruction zones, promoted rapid wound cleansing and granulation, and enabled successful delayed closure using skin-grafting techniques. Conclusions. NPWT is an effective adjunct in the complex surgical management of combat vascular limb injuries combined with soft-tissue loss. Safe application requires reliable protection of the vascular anastomosis, maintenance of continuous negative pressure, and individualized risk assessment. Further research should focus on developing unified clinical protocols for NPWT in combat vascular trauma, including reliable vessel protection methods and prevention of procedure-related complications.

Aim. To compare perioperative glycaemic dynamics and the need for inotropic support in patients with type 2 diabetes undergoing minimally invasive versus conventional coronary artery bypass grafting. Materials and Methods. The study included 60 patients with multivessel coronary artery disease and type 2 diabetes mellitus not treated with insulin. All underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass. Group 1 (prospective, n=30) underwent minimally invasive CABG (MICS CABG) via left anterior thoracotomy; Group 2 (retrospective, n=30) underwent conventional CABG via sternotomy. Glycaemic levels were assessed perioperatively at six time points, and integral indices (mean AUC, AUC>10) were calculated. Statistical analyses included the Friedman test with post-hoc Wilcoxon comparisons and Spearman correlation for associations with clinical parameters. Results. Completeness of revascularisation was comparable between groups: the completeness index was 0.95±0.138 in Group 1 and 0.94±0.127 in Group 2 (p=0.811). Operative (Group 1: 341.9±31.6 min; Group 2: 258.4±27.9 min) and perfusion times were longer in the minimally invasive group (p<0.001), reflecting greater technical complexity. However, the sternotomy group showed significantly higher postoperative glucose levels and a greater overall glycaemic load. Mean AUC was 8.3 (7.4-8.9) in Group 1 and 9.7 (8.4-11.1) in Group 2 (p<0.001), along with a longer time in clinically significant hyperglycaemia (AUC>10, p=0.01). These patients also required more frequent (p=0.021) inotropic support with dobutamine, with significantly higher dosing (p=0.018) and longer infusion duration (p=0.037). AUC>10 correlated positively with the mean dobutamine dose (p=0.42, p=0.01). Conclusions. Minimally invasive CABG, while technically more demanding, provided equivalent revascularisation with reduced metabolic and haemodynamic stress compared with sternotomy. Integral glycaemic indices, particularly AUC>10, emerged as sensitive markers of metabolic stress and potential predictors of inotropic dependence, supporting their role in personalised perioperative management

Introduction. Heart failure (HF) is a global health concern characterized by significant morbidity and mortality, often associated with chronic systemic inflammation. Exercise-based cardiac rehabilitation is a cornerstone of HF management; however, accessibility limitations often restrict participation. Home-based exercise programs offer a potentially viable alternative. This study aimed to evaluate the effects of 12 weeks of center-based versus home-based exercise training on inflammatory markers, specifically high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6), in patients with heart failure with reduced ejection fraction. Aim. This study aimed to evaluate the effects of 12 weeks of center-based versus home-based exercise training on inflammatory markers, specifically high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6), in patients with heart failure reduced ejection fraction. Materials and Methods. A quasi-experimental design was employed involving 31 patients diagnosed with heart failure with left ventricular ejection fraction below 40 %. Participants were allocated into two groups: center-based exercise (n=15) and home-based exercise (n=16). Both groups underwent a 12-week exercise rehabilitation program consisting of light-intensity sessions five times per week. Baseline and post-intervention blood samples were collected to measure serum levels of hs-CRP and IL-6. Clinical and demographic data were also recorded. Statistical analyses were performed using the Mann–Whitney and Wilcoxon signed-rank tests, with significance set at p<0.05. Results and Discussion. Both exercise modalities resulted in significant reductions in IL-6 and hs-CRP levels after 12 weeks (p<0.001). Median IL-6 decreased from 13.1 pg/mL to 4.8 pg/mL, while median hs-CRP declined from 4.3 mg/L to 2.5 mg/L across all participants. No statistically significant differences were observed between the center-based and home-based groups in the extent of reduction for either biomarker (IL-6, p=0.906; hs-CRP, p=0.200). Conclusions. Twelve weeks of home-based exercise training is as effective as center-based training in reducing systemic inflammation, as measured by IL-6 and hs-CRP, in patients with heart failure with reduced ejection fraction. These findings support the use of home-based rehabilitation as a viable alternative to center-based programs for managing inflammation in this patient population.

Disruption of the balance between oxygen delivery and consumption remains a key contributor to metabolic disturbances and potential perioperative complications. This study explores the feasibility of calculating and applying the oxygen mass transfer coefficient (KO₂) as a core indicator of the mass-exchange capacity of the microcirculatory membrane. The proposed approach is grounded in the theoretical linkage between critical parameters of cardiopulmonary bypass (CPB) and the fundamental Fick’s law, enabling a quantitative assessment of oxygen diffusion efficiency under artificial circulation conditions. Objective. To improve the assessment of systemic oxygen balance during CPB by introducing an integral oxygen mass transfer coefficient (KO₂), which combines the main perfusion adequacy criteria based on Fick’s principle. Materials and Methods. A total of 129 intraoperative observations were analyzed during cardiac surgical procedures involving cardiopulmonary bypass (CPB). These data served as the basis for all necessary calculations to determine the oxygen mass transfer coefficient (KO₂). CPB monitoring parameters included standard acid–base balance and blood gas variables consistent with the alpha-stat strategy, based on Astrup’s micromethod and the Siggaard–Andersen principles, using conventional blood gas analyzers. Additionally, physiological variables were taken into account, including hemodynamic indices, hematological status, anthropometric characteristics, as well as indicators of perfusion efficiency and metabolic balance. Results. Within the framework of analytical validation, KO₂ dynamics demonstrated consistent behavior across both temperature groups and aligned with independent markers of tissue oxygenation status – specifically, increases in lactate levels and oxygen extraction, decreases in venous blood gas parameters, and shifts in acid–base balance. As these variables were not included in the clustering algorithm, their concordance supports the analytical independence and functional informativeness of KO₂. Furthermore, changes in KO₂ were often observed to precede alterations in metabolic parameters. Conclusions. The construct validity of KO₂ demonstrated sensitivity to early alterations in oxygen balance and functional concordance with independent metabolic indicators, supporting its potential as a promising engineering parameter for automated assessment of oxygenation efficiency during cardiopulmonary bypass.

Background. Anthracycline chemotherapy is a cornerstone of cancer treatment but poses a risk of cardiotoxicity, often presenting as cancer therapy–related cardiac dysfunction (CTRCD). Monitoring left ventricular ejection fraction (LVEF) is essential to detect early cardiac impairment and support safer treatment strategies. Aim. To assess LVEF changes after six cycles of anthracycline therapy and identify predictive factors associated with CTRCD. Materials and methods. This observational pre–post study included 74 patients treated with anthracyclines at Dr. Wahidin Sudirohusodo Hospital, Makassar, from 2024 to 2025. LVEF was measured via echocardiographic surveillance before and after treatment. Cardiotoxicity was defined as a ≥10 % decrease in LVEF to ≤50 %. Statistical tools included Wilcoxon signed-rank test, Chi-square, ROC curve analysis, and logistic regression. Results. The mean LVEF significantly declined from 63.08 % to 56.76 % (p = 0.001). CTRCD occurred in 20.3 % of patients. Risk factors independently associated with cardiotoxicity included age ≥51 years (OR 2.80; p = 0.016) and cumulative anthracycline dose ≥457.5 mg/m² (OR 3.25; p = 0.004). When both factors were present, the risk increased nearly sixfold (OR 5.75; p = 0.001). Conclusions. CTRCD was observed in one-fifth of patients following anthracycline therapy, with age and dose being significant contributors. These findings support the integration of risk-based echocardiographic surveillance into oncology care to ensure early detection and mitigate long-term cardiac complications.

Cardiorenal-metabolic syndrome (CRMS) is the most dangerous combination of heart failure, chronic kidney disease, and type 2 diabetes mellitus, as it combines comorbidities, each of which is a powerful proatherogenic factor. Aim. To assess the prognostic impact of using a new algorithm for managing patients with CAD and CRMS over a 5-year follow-up period. Materials and methods. In a prospective study, we included 377 patients with coronary artery disease and cardiorenal-metabolic syndrome. Patients underwent invasive coronary angiography. In case of insignificant coronary lesions, CFRi was determined to establish microvascular angina, which was treated with medication. In the case of a single-vessel stenotic coronary lesion, PCI was performed. In the case of a two- or three-vessel lesion, PCI or CABG/MCS was performed depending on the Syntax Score. Patients were followed for 5 years from the moment of initial hospitalization. Results. The total number of endpoints achieved in the entire cohort of patients with CHD and CRMS (cardiovascular death, myocardial infarction, need for repeated revascularization) was 104 (30.3%) of the 343 patients who completed the study. Interestingly, 79 (76.0%) of them reached the endpoint due to the formation of new stenosis in the coronary arteries. At the same time, the use of the algorithm for selecting revascularization tactics in patients with CAD and CRMS resulted in the need for repeated intervention due to restenosis of previously installed stents in only 3 (2.7%) of 111 PCI cases. Conclusions. In patients with cardiorenal-metabolic syndrome, the cause of coronary artery disease in 17.5% of cases is microvascular angina, while in 82.5% – stenosing atherosclerosis of coronary vessels. The risk of angina recurrence in patients with coronary artery disease and CRMS within 5 years after primary treatment is 30.3%, of which – in 76.0% of cases due to the formation of new coronary artery lesions. The use of the proposed algorithm for myocardial revascularization tactics in patients with CAD and CRMS allows achieving a frequency of significant restenosis of previously installed coronary stents in only 2.7% of cases during a 5-year follow-up.

In the world, minimally invasive mitral valve surgery (MIMVS) has a recognized role in the surgical treatment of mitral valve (MV) diseases, however, this technique has not yet been widely used in our country. Due to the lack of clear clinical guidelines and recommendations in the choice of access to MV, many cardiac surgery centers implement a minimally invasive technique insufficiently often, and this procedure is characterized by complex learning curve. The aim. To analyze the results of MV surgical treatment using a minimally invasive approach. Materials and methods. Between 2020 and 2024, surgical treatment of MV insufficiency through a right-sided minithoracotomy was performed in 34 patients aged 18 to 67 at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, forming the primary study group. The comparison group included 36 consecutive patients (aged 25 to 81) who underwent isolated MV insufficiency correction through the classic approach, i.e. median longitudinal sternotomy (between 2023 and 2024). Results. The studied groups did not differ in terms of echocardiographic parameters. It was established that blood loss in the operating room was significantly higher with median longitudinal sternotomy compared to minithoracotomy (268.06 ± 14.3 mL and 192.50 ± 12.1 mL, respectively; p = 0.001). However, duration of operation and time of aortic compression were significantly longer in patients in the main group compared to controls, which is consistent with data from other researchers. Patients after minithoracotomy had a likely lower number of hours of analgesia, compared to those after median longitudinal sternotomy (88.35 ± 12.9 hours and 148.11 ± 16.6 hours, respectively; p = 0.009). Complications occurred less often in patients after minithoracotomy than in controls (8.8% and 11.1%, respectively; p > 0.05). Conclusions. MIMVS was associated with less blood loss in the operative period and reduced the severity of early postoperative pain. The effectiveness of surgical treatment using MIMVS was 100%, while complications occurred less often than in controls.

Dural arteriovenous fistulas (DAVFs) are vascular anomalies where arteries from the carotid or vertebral arteries directly drain into the dural venous sinuses. Symptoms can range from asymptomatic to severe, including hemorrhage, venous hypertension, and neurological deficits. Tentorial dural arteriovenous fistulas (TDAVFs), a rare subset occurring in the tentorium, represent up to 4% of all DAVFs. Traditionally, DAVFs have been treated surgically, but recent advancements in endovascular embolization have made it a first-line treatment, although the optimal approach is still debated. The aim. To evaluate the efficacy and outcomes of endovascular treatment for TDAVFs. Materials and methods. Between 2012 and 2024, 174 patients with DAVFs were treated at the ScientificPractical Center of Endovascular Neuroradiology of the NAMS of Ukraine, including 8 patients with TDAVFs (mean age 58.5 years). All the patients with TDAVFs were symptomatic, with symptoms including hemorrhage (37.5%), headache, tinnitus, and seizures (62.5%). Endovascular treatment used liquid embolic agents and coils when required. Outcomes were assessed using postoperative angiograms and the modified Rankin Scale. Results. Nine embolization sessions were performed; of these, 8 (88.9%) using n-butyl cyanoacrylate Histoacryl and 1 (11.1%) using Onyx. Complete shunt elimination was achieved in 75% of sessions; 25% had residual lowflow shunting, with vessels unsuitable for further catheterization. No neurological deterioration occurred. The mean length of hospital stay was 5.5 days. Follow-up angiography in 7 patients showed one case of symptom worsening and vessel recruitment, which was later fully treated with repeat transvenous embolization. Conclusions. Endovascular embolization is an effective and safe treatment for TDAVFs. This case series indicates its efficacy but underscores the need for further randomized trials to compare all treatment modalities for tentorial and other deep-seated dural vascular lesions.

The aim. To study the effectiveness of left main coronary artery (LMCA) stenting in patients with coronary heart disease and to optimize the choice of percutaneous coronary intervention technique based on the experience of one clinic. Materials and methods. The study, which was conducted at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, included 107 patients with LMCA disease, who underwent stenting from January 2019 to December 2023. During the study, the patients were divided into two groups. One group underwent stenting using the single-stent method (44 patients, 41.1%), while the other group underwent stenting using the double-stent method (63 patients, 58.9%). Results. In the group of surveyed patients after stenting, an analysis was conducted regarding adherence to drug therapy and achievement of target lipid spectrum levels. It was found that one of the reasons for the active progression of atherosclerosis can be considered low adherence to drug therapy. A group of patients with recurrence of angina after stenting, the cause of which was restenosis in the stented segment, was analyzed. In the analysis of the frequency of repeated interventions in patients with hemodynamically significant lesions of the LMCA, who initially underwent stenting, it was found that 24.5% of patients (n = 24) underwent stenting again at the second visit and only 4 patients (4.1%) underwent bypass surgery, which is statistically significant (p ≤ 0.001). Conclusions. LMCA stenting is an effective way of treating patients with hemodynamically significant damage to it (effectiveness of the technique is 71.4%). Recurrence of angina was observed in 28 patients (28.6%). Both single-stent and double-stent procedures are effective: recurrence of angina was observed in 13.3% and 15.3% of cases, respectively. One of the main reasons for the recurrence of angina pectoris is the progression of atherosclerosis in new locations (39.3%) and restenosis in stenting segment (39.3%).