Authors
Shevchenko Yu.L., Zainiddinov F.A., Borshchev G.G., Ulbashev D.S.
St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow
Abstract
In the recent decades, coronary heart disease (CHD) has consistently occupied a leading place in the structure of morbidity and mortality in cardiovascular diseases. One of the most effective methods of treating this pathology is direct myocardial revascularization — coronary artery bypass surgery (CABG), which allows not only to increase the survival rate of patients, but also to improve their quality of life. However, in patients with diffuse lesions of the coronary arteries, CABG and PCI are not effective. It allows to improve the results of extracardial myocardial revascularization, which is based on the principle of stimulating angiogenesis in order to create anastomoses between the coronary bed and the arterial systems of various mediastinal tissues surrounding the heart. This is achieved by a specially developed surgical and biotechnological technology called YurLeon.
Aim. Comparison of the quality of life of patients at different times after isolated coronary bypass surgery and supplemented with the YurLeon procedure.
Materials and methods. The study included 1070 patients with a diagnosis of CHD, angina pectoris III, IV FC, 645 men (60.28%) and 425 (39.72%) women, aged from 50 to 75 years (65.79±10.45) were included. General clinical data, quality of life indicators, gated-SPECT, echocardiography, computer tomography results were evaluated in the immediate and long-term postoperative period.
Results. At the intraoperative stage and in the early postoperative period, there were no significant differences in the indicators of complications between the two groups (p>0.05). There were statistically significant differences after 12 months, in the LV ejection fraction: 52.55±5.98% (CABG) and 57.0±5.78% (CABG+YurLeon) (p<0.05); perfusion defects: 17.47±9.34% (CABG) and 8.57±6.65% (CABG+YurLeon) (p<0.05). Quality of life: PF: 75±14.15 (CABG) and 87±10.32 (CABG+YurLeon) (p<0.05); RP: 79±7.01 (CABG) and 90.01±10.50 (CABG+YurLeon) (p<0.05); BP: 80±5.21 (CABG) and 93.10±6.37 (CABG+YurLeon) (p<0.05).
Conclusion. With a modern individual approach to the treatment of patients with CHD and diffuse coronary artery disease, it is advisable to supplement CABG with the YurLeon method, as an effective and safe method to provide additional blood supply to the myocardium.
Keywords: CHD, YurLeon, angiogenesis, revascularization, CABG.
References
1. SHevchenko YUL, Borshchev GG. Kompleksnyj podhod pri revaskulyarizacii miokarda u bol’nyh IBS s diffuznym porazheniem koronarnogo rusla s primeneniem metodik stimulyacii ekstrakardial’nogo angioneogeneza. Sovremennaya medicina: novye podhody i aktual’nye issledovaniya. Sbornik statej po materialam XXIV mezhdunarodnoj nauchno-prakticheskoj konferencii. 2019: 90-98. (In Russ).
2. Borshchev GG. Ekstravazal’naya revaskulyarizaciya miokarda v kompleksnom lechenii pacientov s IBS: istoricheskie predposylki i sovremennye realii. Medicinskij vestnik YUga Rossii. 2015; 2: 4-8. (In Russ). doi: 10.21886/2219-8075- 2015-2-4-8.
3. Seiler C. The human coronary collateral circulation. Eur J Clin Invest. May 2010. 40(5): 465-476.
4. Beck С. Revascularization of the heart. Ann. Surg. 1948; 4: 854-864.
5. O’Shaughnessy L. Surgical treatment of cardiac ischemia. Lancet. 1937; 1: 185.
6. Thompson S. Experiences with cardiopericardiopexy in the treatment of coronary disease. J. Amer. Med. 1953; 152: 678-681.
7. SHevchenko YUL, Borshchev GG. Stimulyaciya angiogeneza endogennymi faktorami rosta. Vestnik nacional’nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2018; 13(3): 96-102. (In Russ).
8. SHevchenko YuL, Musaev IA, Borshchev GG, Zajniddinov FA, Ul’bashev DS. Myocardial revascularization in elderly patients with severe myocardial insufficiency. Bulletin of Pirogov National Medical & Surgical Center. 2020; 15(4): 12-18. (In Russ). doi: 10.25881/BPNMSC.2020.22.25.002.
9. Shevchenko YuL, Zajniddinov FA, Borshchev GG, Ul’bashev DS, Musaev IA. The results of complex surgical treatment of patients with coronary heart disease. Clinical Medicine. 2020; 98(11-12): 766-771. (In Russ). doi:10.30629/0023-2149-2020-98-11-12-766-771.
10. Shevchenko YuL, Borshchev GG, Zajniddinov FA, Ul’bashev DS. Coronary bypass surgery in combination with indirect myocardial revascularization in patients with IHD (clinical observations). Bulletin of Pirogov National Medical & Surgical Center. 2020; 15(4): 130-134. (In Russ). doi: 10.25881/BPNMSC.2020.37.95.023.
11. Shevchenko YuL, Borshchev GG, Zajniddinov FA, Belyanin AO, Ul’bashev DS. The results of coronarography and gated-spect in patients with coronary heart disease after myocardial revascularization. Bulletin of Pirogov National Medical & Surgical Center. 2021; 16(1): 11-16. (In Russ).] doi: 10.25881/BPNMSC.2021.68.32.002.
