Comparative evaluation of results of coronary bypass surgery in combination with extracardial myocardial revacularization in patients with diffuse coronary artery disease

Borshchev G.G., Miminoshvili L.G., Zainiddinov F.A., Katkov A.A., Ulbashev D.S.

Coronary heart disease (CHD) occupies a dominant place among the cardiovascular causes of death in the Russian Federation and around the world. In some patients with coronary heart disease, complete surgical revascularization is difficult due to diffuse damage to the coronary bed, small vessel diameter, pronounced calcification of the artery walls, distal stenotic-occlusive lesion, high risk of complications and severity of the clinical condition due to other concomitant diseases. The effectiveness of treatment of such patients still remains low. The effectiveness of treatment of such patients still remains low. In order to overcome this problem, Academician of the Russian Academy of Sciences Yu.L.Shevchenko developed and introduced into clinical practice the technique of surgical stimulation of extracardial myocardial vascularization «YurLeon». Currently, there are various modifications to improve the results of patient treatment.

Aim: to compare the results of coronary bypass surgery, supplemented by the YurLeon II and YurLeon III.

Materials and methods. The retrospective study included 180 patients with diffuse coronary artery disease (127 men (71%), 53 women (29%) aged 50 to 70 years, average age — 65.6±4.65 years) who were treated at the St. George Thoracic and Cardiovascular Surgery Clinic of the Federal State Budgetary Institution «National Medical and Surgical Center named after N.I. Pirogov» Ministry of Health of the Russian Federation. Patients were divided into three groups: Group I (n = 60) — after coronary artery bypass grafting (CABG) (control group); group II (n = 60) — after CABG supplemented by the YurLeon II; Group III (n = 60) — after CABG, supplemented by the YurLeon III. The clinical condition of patients, echocardiography data, gated-SPECT and quality of life indicators (questionnaire SF-36) were evaluated.

Results. In the long-term postoperative period, in groups II and III, compared with group I, there was a statistically significant decrease in the functional class of angina pectoris (1 [1-2], 1 [1-2] versus 2[2-2], p<0.05); increased left ventricular ejection fraction (59[54-62]% (group II), 59[55-63]% (group III) compared to the control group — 50 [47-53]%, p<0.05). According to myocardial scintigraphy, there was a decrease in the «Summed Rest Score» (4[3-7] points (group II), 4[2-8] points (group III) versus 11[6-18] points (group I), p<0.05); a decrease in the «Summed Thickening Score» (8[5-11] points (group II), 7 [5-8] points (group III) compared to the control — 10 [8-14] points, p<0.05). The studied patients 12-36 months after surgery differed in terms of quality of life (SF-36): PF (74[66-80] points (group I), 86[80-92] points (group II), 84 [78-90] points (group III), p<0.05); RP (76 [70-82] points (group I), 90[85-95] points (group II), 92[88-96] points (group III), P<0.05); BP (80 [75-85] points (group I), 90[85-95] points (group II), 92[86-98] points (group III), P<0.05); PH (46[42-50] points (group I), 58[54-62] points (group II), 60 [56-64] points (group III), p<0.05).

Conclusion. Coronary bypass surgery, supplemented by surgical stimulation of extracardial vascularization, in the patients with coronary artery disease and diffuse coronary artery disease improves the clinical condition of patients, their quality of life, increases the left ventricular ejection fraction, its perfusion and allows for additional blood supply to the myocardium in the long-term postoperative period.

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