Authors
Shevchenko Yu.L.1, Musaev I.A.1, Borshchev G.G.1, Sidorov R.V.2
1 St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow
2 Rostov State Medical University, Rostov-on-Don
Abstract
Coronary heart disease occupies a dominant place among the causes of morbidity and mortality in the Russian Federation, and elderly patients account for more than 75% of all deaths. Surgical treatment of elderly patients with CHD with reduced cardiac ejection fraction presents various difficulties, they require an individual approach, attempts to treat such patients with conventional methods lead to an aggravation of the course of the disease and the development of complications. The problem of choosing the tactics of revascularization and determining a sufficient amount of surgery remains relevant at the present time.
Objective: to evaluate the effectiveness of the strategy of minimally sufficient surgical revascularization and its complement by stimulating extracardial neoangiogenesis in elderly patients with coronary heart disease with a reduced left ventricular ejection fraction.
Results. In the group of patients with limited revascularization and surgery without extracorporeal circulation, the most pronounced positive results were noted compared to other groups: a decrease in angina pectoris after 12 months from 3.2±0.3 to 1.5±0.3 (p<0.05); an increase in exercise tolerance — pain-free walking distance from 317±14 to 415±13 meters (p<0.05); increase in cardiac ejection fraction from 44.4±4.1% to 55.6±1.9% (p<0.05); improvement of myocardial perfusion by cardiac scintigraphy with 99mTc-technetril — decrease in SRS from 19.4±7.0 to 2.4±0.6 points (p<0.05); as well as improving the quality of life in the long-term postoperative period.
Conclusion. In elderly patients with reduced cardiac ejection fraction and diffuse lesions of the coronary bed, it is effective strategy to limit the scope of the operation and supplement it with the method of induction of extracardial neoangiogenesis.
Keywords: elderly patients, incomplete revascularization, coronary bypass surgery, the YurLeon.
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