Authors
Shevchenko Yu.L., Zainiddinov F.A., Borshchev G.G., Belyanin A.O., Ulbashev D.S.
St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow
Abstract
In our time, the search for new methods of treatment of patients with coronary heart disease (CHD), especially patients with diffuse lesions of the coronary bed, in which complete revascularization of the myocardium is impossible, remains relevant. This article presents comparative data on coronarography, myocardial contractility and gated-SPECT data in patients after direct myocardial revascularization and coronary bypass grafting, supplemented by the YurLeon III.
Materials and methods. We analyzed results of coronarography, gated-SPECT, and echocardiography of 202 patients who were treated in the Department of Cardiovascular Surgery of the N. I. Pirogov National Medical Center in the period from 2017 to 2020 with a diagnosis of CHD. There are two groups of patients were compared: group 1 — after isolated coronary artery bypass grafting (CABG) -150 patients; group 2 — after CABG supplemented with indirect myocardial revascularization YurLeon III (CABG+YurLeon III) — 52 patients.
Results. In the period from 12 to 24 months, EF LV indicators: 57.10±6.19% (CABG+YurLeon III), 50.11±6.33% (CABG) (p<0.05). After 1 year, there is perfusion defect:10.12±5.21% (CABG+YurLeon III), 17.99±8.37% (CABG) (p<0.05). In the second group, the number of segments of mismatch between the occluded autovenous bypass and normal myocardial perfusion in this zone statistically significantly less (p<0.05). In the first group in the long term, acute myocardial infarction (AMI) associated with autovenous bypass occlusion was approximately 10% (17 out of 150 patients), in the CABG+ YurLeonIII group — 3.8% (2 out of 52 patients).
Conclusion. The method of stimulation of extracardial angiogenesis YurLeon III, which complements coronary bypass surgery, is a safe and effective method of surgical treatment of patients with coronary heart disease.
Keywords: ischemic heart disease, bypass, coronarography, gated-SPECT, indirect revascularization, coronary bypass surgery, YurLeon.
References
1. Shevchenko YuL, Popov LV, Batrashov VA, et al. Difficulties in choosing the volume of revascularization in the treatment of coronary heart disease in a high-risk patient. Vestnik Nacional`nogo mediko-xirurgicheskogo Centra im. N.I. Pirogova. 2015; 10(4): 134–136. (In Russ).
2. Shevchenko YuL, Simonenko VB, Borshchev GG. Extracardial revascularization of the myocardium in diffuse lesions of the coronary bed, as a component of complex treatment of patients with coronary heart disease. Klinicheskaya medicina. 2018; 96(11): 10–18. (In Russ).
3. Bockeria LA, Gudkova RG. Cardiovascular surgery — 2014. Diseases and congenital anomalies of the circulatory system. Moscow: Izdatel’stvo nauchnogo tsentra serdechno-sosudistoy khirurgii imeni A.N. Bakuleva; 2015. (in Russ).
4. Shevchenko YuL, Borshhev GG, et al. Choice of conduits in coronary surgery. Vestnik Nacional`nogo mediko-xirurgicheskogo Centra im. N.I. Pirogova. 2019; 14(1): 97–104. (in Russ). doi: 10.25881/BPNMSC.2019.69.57.019.
5. Shevchenko YuL, Viller AG. Extracardial revascularization in patients with coronary heart disease after coronary bypass surgery is an existing factor of myocardial blood supply. Vestnik Nacional’nogo mediko-hirurgicheskogo Centra im. N.I. Pirogova. 2007; 2(2): 9–14. (In Russ).
6. Shevchenko YuL, Viller AG, Borshchev GG, et al. The role of extra- and intracardial collateral circulation in patients with chronic form of IHD. Vestnik Nacional’nogo mediko-hirurgicheskogo Centra im. N.I. Pirogova. 2018; 13(4): 10–18. (In Russ). doi: 10.25881/BPNMSC.2018.77.39.002.
7. Borshchev GG. Extravascular myocardial revascularization in complex treatment of patients with coronary artery disease: historical background and current realities. Medicinskij vestnik Yuga Rossii. 2015; 2: 4–8. (In Russ). doi: 10.21886/2219-8075- 2015-2-4-8.
8. Shevchenko YuL, Matveev SA, Solov`ev IA. The role of angiogenesis in norm and pathology. Vestnik Rossijskoj voenno-medicinskoj akademii. 2001; 5(1): 92–97. (In Russ).
9. Ternovoj SK, Nikonova ME, Akchurin RS, et al. Assessment of the patency of coronary bypass grafts by multispiral computed tomography in the early and late periods after aorto- and mammarocoronary bypass surgery. Ateroskleroz i dislipidemii. 2015; 3: 49–55. (In Russ).
