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Objective.  To study the dynamics of immunosuppressive cell populations in patients who underwent heart valve replacement surgery under artificial circulation.  Materials and methods.  We investigated the dynamics of MDSC, PD-1-positive cells among Th and Tcyt and PD-L1-positive monocytes in patients operated on for the heart under cardiopulmonary bypass in the volume of prosthetic heart valves, the study points were before surgery, immediately after surgery and after 1, 3, 7 days. The study was carried out on a CytoFlex laser flow cytometer.  Results.  In the group of patients without complications and in the group with complications outside the infection, an increase in all MDSC populations was observed 1 day after surgery, with a return to baseline values within a week. The dynamics of MDSC in a patients with sepsis was characterized by an increase within 3 days with the achievement of maximum figures in comparison with the previous groups. In patients without complications, an increase in PD-L1+, PD-1+ CD4+ and PD-1+CD8+ monocytes were observed immediately after surgery and one day later. In the case of the development of infectious complications in the postoperative period, a relatively moderate increase in the monocyte content was observed only by 3 days after the operation. The content of PD-1 positive T cells increased moderately up to 7 days among Th, and significantly by 7 days, followed by a decrease among Tcyt.  Conclusions.  A high initial content of Mon-MDSC is a risk factor for the development of postoperative infectious complications. A significant increase in immunosuppressive populations in the early postoperative period can be regarded as an unfavorable variant of the course of the compensatory anti-inflammatory syndrome.

Immunosuppressive profile of patients operated for acquired heart diseases under artificial circulation. A prospective study