Background and Objectives: To assess the correlation between the degree of target coronary artery stenosis measured by instantaneous wave-free ratio (iFR) and the intraoperative transit time flow measurement (TTFM) of attached grafts as well as evaluate flow competition between the native coronary artery and the attached graft according to the severity of stenosis. Materials and Methods: In total, 89 grafts were subjected to intraoperative transit time flow measurement after coronary artery bypass grafting (CABG) in 25 patients with multivessel coronary artery disease (CAD). The iFR was evaluated for all coronary arteries with grafts. The coronary artery stenoses were divided into three groups based on the iFR value: iFR < 0.86 (group 1); iFR 0.86–0.90 (group 2); and iFR > 0.90 (group 3). Results: The mean graft flow (MGF) was 46.9 ± 18.4 mL/min for group 1, 45.3 ± 20.9 mL/min for group 2, and 31.3 ± 18.5 mL/min for group 3. A statistically significant difference was confirmed between groups 1 and 3 (p = 0.002) and between groups 2 and 3 (p = 0.025). The pulsatility index (PI) was 2.49 ± 1.20 for group 1, 2.66 ± 2.13 for group 2, and 4.70 ± 3.66 for group 3. A statistically significant difference was found between groups 1 and 3 (p = 0.006) and between groups 2 and 3 (p = 0.032). Backward flow was detected in 7.5% of grafts for group 1, in 16.6% of grafts for group 2, and in 16% of grafts for group 3. A statistically significant difference was found between groups 1 and 2 (p = 0.025) and between groups 1 and 3 (p = 0.029). Conclusions: The iFR is a useful tool for predicting the impact of competitive flow observed between a native artery and an attached graft. The effect of competitive flow significantly increases when the graft is attached to a vessel with mild coronary stenosis. In a coronary artery where the iFR was not hemodynamically significant, the MGF was lower, the PI was higher, and a larger proportion of grafts with backward flow (BF) was detected compared to when there was significant stenosis (iFR < 0.86).

Introduction: The aim of this study was to evaluate the incidence rate of technical failure of graft patency while performing intra-operative angiography after coronary artery bypass grafting. Methods: This prospective pilot study included 50 patients with multi-vessel coronary artery disease who underwent coronary artery bypass grafting, in addition to intra-operative angiographic graft assessments, on open-chest. Overall, 144 grafts and 160 distal anastomoses were assessed in a hybrid operating room. Results: Intra-operative angiography allowed the identification of 23 angiographic defects (15.9% of all grafts) in 22 patients (44%): three graft defects (2% of all grafts), 17 anastomotic defects (10.6% of all distal anastomoses), and three target artery errors (1.8% of all grafted arteries). Ten re-interventions (43.4%) were performed based on the angiographic defects detected. During the follow-up period, computed tomography angiography of the attached grafts at a mean of 224 days (range, 80–318 days) showed that all repaired grafts were patent. During surgery, the total mean dose of radiation was 1.848 ± 0.54 mSv (range, 0.78–3.4 mSv) per patient and investigation time was 19.4 ± 4.94 minute (range, 9–31 minute). Conclusions: Intra-operative angiography is a powerful tool allowing the identification of graft defects, anastomotic defects and target vessel errors. Assuming relatively low level of exposure to radiation and short investigation time, intra-operative angiography could be included in routine practice as safe procedure improving surgery quality.

Background: Dilated cardiomyopathy (DCM) is one of the main causes of heart failure induction all over the world. In non-clinical trial many authors have demonstrated safety and effectiveness of autologous mesenchymal stem cells (MSCs). However, effectiveness of autologous MSCs in DCM with reduced ejection fraction (HFrEF) (≤40%) has been studied insufficiently. Objective: To evaluate effectiveness of autologous cell therapy in patients with dilated cardiomyopathy and reduced left ventricular ejection fraction. Methods: This single center randomized clinical study included 61 patients with DCM, class III-IV of heart failure according to New York Heart Association (NYHA), with HFrEF (≤40%) who made 2 visits every 3 months. Patients included in the study were randomized into two groups: the main group (32 patients) and the control group (29 patients). Patients of the main group received standard optimal medical therapy (OMT) and cell therapy, and patients of the second group received OMT. Data were analyzed using SPSS Statistica 10 and GraphPad Prism 7. Results: The median patient age in control group was 57.0±12.0 and in the main group was 47.0±10.4 years. On average ~2/3 of the total number of patients were male in both groups. Disease duration in control group was 4.9 ± 3.1, and in main group was 4.8 ± 2.8. Сomorbidities: type 2 diabetes mellitus (DM), arterial hypertension (AH) and cardiac arrhythmias (CA) did not differ between groups amounting to 17 to 44% of all patients. After 12 months of observation main group showed significant improvements associated with cell therapy: based on the results of laboratory test: statistically significant decrease in the level of eosinophils, normalization of coagulogram parameters, decrease in urea and increase in blood calcium, furthermore, there was a notable increase in anti-inflammatory cytokines CD73+ and IL-4, alongside reduction in pro-inflammatory CD8+ levels and brain natriuretic peptide (NT-proBNP). Echocardiographic (ECHO) data revealed significant increase in LVEF from 26.1 ± 8.4% to 37.6 ± 7.6% (p<0.0001) and reduction in end-systolic volume (ESV) from 146 ± 54 to 113 ± 42 p=0.0496) in the main group, whereas no such changes were observed in the control group. Conclusion: Combined therapy, including OMT and cell therapy, resulted in improved left ventricular function, reduced cardiac chamber dimensions (according to echocardiographic data), decreased pro-BNP levels, and improved routine laboratory parameters. However, these findings require confirmation in large-scale, multicenter randomized clinical trial Keywords: heart failure, dilated cardiomyopathy, cell therapy, mesenchymal stem cells.

Background: This study aimed to assess the impact of the measurement of the degree of target coronary artery stenosis using the instantaneous wave-free ratio (iFR) on patency of attached grafts. Materials and Methods: A total of 86 grafts were assessed by computed tomography angiography (CTA) after coronary artery bypass grafting (CABG) in 24 patients with multivessel coronary artery disease (CAD). The iFR was evaluated for all target coronary arteries. The coronary artery stenoses were divided into three groups based on the iFR value: iFR < 0.86 (group 1); iFR 0.86–0.90 (group 2); and iFR > 0.90 (group 3). Results: CTA was performed at 192 ± 44 days (range: 80–318 days). The correlation coefficient (r) between iFR and failed grafts was 0.332 (p = 0.035). Graft failure was detected in three grafts (8.1%) for group 1, in two grafts (8.3 %) for group 2, and in four grafts (16%, all arterial grafts) for group 3. Statistically significant differences were found between groups 1 and 3 (p = 0.041) and between groups 2 and 3 (p = 0.044). No significant differences were found between groups 1 and 2 (p = 0.228). Conclusions: The degree of coronary artery stenosis measured by iFR is a risk factor for attached graft failure. In a coronary artery where the iFR was haemodynamically non-significant, a higher rate of graft failure was detected.

Coarctation of the aorta (CoA) is a congenital heart disease (CHD) that may remain undiagnosed until adulthood. Its clinical manifestations vary depending on the anatomical severity of the narrowing and the degree of collateral circulation development. The management of CoA, particularly when associated with additional CHDs or acquired cardiovascular pathology in adult patients, necessitates a comprehensive and individualised treatment strategy. We present a clinical case of a 33-year-old female diagnosed with CoA, complicated by an aortic root aneurysm and bicuspid aortic valve (BAV) insufficiency. Given the complexity of her condition, a staged hybrid approach was implemented. In the first stage, the patient underwent surgical valve-sparing aortic root replacement (David procedure), preserving the native valve function. Three weeks later, thoracic endovascular aortic repair (TEVAR) was performed to address the CoA. The patient’s postoperative recovery was uneventful. Follow-up imaging, including computed tomography angiography (СТА) and transthoracic echocardiography at 3 months post-discharge, demonstrated an optimal surgical outcome, confirming the efficacy of this tailored two-stage strategy.

Intraoperative graft assessment during coronary artery bypass grafting (CABG) aims to identify technical anastomotic defects before chest closure. Transit-time flow measurement (TTFM) and indocyanine green (ICG) fluorescence imaging represent complementary intraoperative assessment modalities, yet their comparative diagnostic performance against angiographic reference standards remains incompletely defined. PubMed, Scopus, Web of Science Core Collection, and CENTRAL were searched from January 2000 to February 2026 using terms for CABG, ICG, and TTFM; duplicate screening yielded κ = 0.86–0.91. Eligible studies evaluated ICG and/or TTFM against invasive coronary angiography or computed tomography coronary angiography. Methodological quality was appraised using QUADAS-2 for diagnostic cohorts and the Newcastle-Ottawa Scale (NOS) for clinical-utility cohorts. Because only three directly comparable cohorts provided sufficiently reliable paired 2×2 data, formal bivariate random-effects meta-analysis was not performed. Verified 2×2 contingency data were summarised descriptively with exact Clopper–Pearson 95% confidence intervals. Clinical-utility evidence was synthesised narratively. Eighteen unique primary clinical studies were included. Three studies (Desai et al., 2006; Yamamoto et al., 2015; Hatada et al., 2011), comprising 293 paired bypass grafts, provided directly comparable quantitative evidence. ICG demonstrated an aggregate descriptive sensitivity of 76.0% (95% CI, 54.9%–90.6%) and specificity of 99.3% (95% CI, 97.3%–99.9%). TTFM/flowmetry demonstrated aggregate sensitivity of 24.0% (95% CI, 9.4%–45.1%) and specificity of 96.3% (95% CI, 93.2%–98.2%). Formal between-modality P values were not calculated. The aggregate flowmetry estimate includes one cohort using experimental FFT-based waveform analysis (Hatada et al., 2011) and should be interpreted with caution. NOS assessment of six Tier 3 clinical-utility studies yielded scores of 5–9/9; no study provided a complete two-arm comparison with non-zero revision events in both arms, precluding pooled effect estimation. ICG fluorescence imaging showed higher descriptive sensitivity than TTFM/flowmetry for detecting structural graft abnormalities. A complementary approach combining quantitative flow assessment with selective fluorescence imaging may be considered in appropriately selected situations. Prospective multicenter studies are required before definitive recommendations can be made.