ENDO-ACAB EARLY POSTOPERATIVE PERIOD RESULTS: ANALYSIS AND COMPARISON.

Endoscopic atraumic coronary artery bypass grafting (EndoACAB) is a novel approach in the treatment of ischemic heart disease compared to traditional coronary artery bypass grafting (CABG). Analyzing the early and late outcome of EndoACAB is very important. EndoACAB was performed in "Tbilisi Heart and Vascular Clinic" for the first time in Georgia in 2015. The study aim was to analyze early postoperative period results and compare them with the research carried out at some leading international cardiothoracic centers. 162 patients underwent EndoACAB in 2015-2017. We studied preoperative and intraoperative characteristics of patients as well as early postoperative outcome. No intraoperative mortality was detected. Lethal outcome in early postoperative period was seen in 1,2%. Intraoperative switch from Endo-ACAB to CABG was seen in 2,5%. Pneumon was diagnosed in 0.6%, atrial fibrillation and flutter - 1,9%, no surgical wound infection nor stroke was detected. mean days of hospital stay was 4,8 days±1.2. There was no statistically significant difference in our results and mortality rate compared to the results of foreign referral centers. We assume that EndoACAB which is a novelty for Georgian medical society is successfully implemented and its early outcome is the same as operations performed in leading international centers.

COMPARISON OF EARLY POST-OPERATIVE PERIOD OF ENDO-ACAB WITH OFF-PUMP CABG: RETROSPECTIVE STUDY CONDUCTED AT TBILISI HEART AND VASCULAR CLINIC.

Our aim was to compare early post-operative period of Endo-ACAB with OPCABG. We retrospectively studied 760 cases of all patients who had underwent urgent or planned coronary artery bypass grafting at the "Tbilisi Heart and Vascular Clinic" from November 2015 till November 2017. Patients were divided into two group: first group patients who had underwent Endo-ACAB and second group patients who had underwent OPCABG. Early postoperative complications including pneumonia, stroke, ventricular fibrillation, pain intensity, wound infection and hospital stay were studied. After analyzing both groups of the patients we concluded that no statistically significant difference was revealed in presence of preoperative risk-factors like diabetes mellitus and arterial hypertension between the study groups. Mean ejection fraction was slightly lower in Endo-ACAB group but statistical analysis showed no significant difference. Moreover, no statistical difference was seen in early postoperative complications like pneumonia, stroke, ventricular fibrillation or early mortality. Respectively severely of pain was similar in Endo-ACAB group compared with CABG. Statistical analyses revealed significant lower rate of surgical wound complication and hospital stay in Endo-ACAB group. In both group no intraoperative mortality was detected. To conclude Endo-ACAB has significantly lower rate of early postoperative complications compared to OPCABG according to the date of "Tbilisi Heart and Vascular Clinic".

[Is always chronic total occlusion indication for recanalization in patients with multi-vessel disease].

The issue of recanalization chronic total occlusion (CTO) up today stays unsolved. Existence of viable myocardium in the CTO basin is regarded to be one of the proofs in cases of transitory ischemia or in the state of hibernation. But, the question of CTO opening in presence of acinetic segments is still under discussion. The aim of our study is testing assumption that CTO recanalization in the presence of other stenotic arteries, improves global and regional contractility of myocardium. One hundred and twenty patients with MI after one month were enrolled. To diagnose viability of myocardium 72% of patients went through stress-echocardiography with small dozes of dobutimin. After, all patients were divided into two groups: who have to undergo complete revascularization (Group I- 35,5%), and those who have to undergo only CTO revascularization (Group II- 64,5%). There were no significant statistic differences in hemodynamic parameters between groups. In case of multi-vessel disease restoration of antegrade flow in CTO caused to block of CAD attacks and symptoms of congestive heart failure. Therefore, results of the study let us state existence of CTO as indication for angioplasty of infarct-related artery.

[Comparison between bare metal stents and drug eluting stents for the treatment of chronic total occlusion].

Patients with chronic total occlusions (CTO) are under high risk of restenosis, repeat recanalization procedures and mortality after stent. In our study we evaluated the clinical and angiographic efficacy of bare metal stents (BMS) and drug eluting stents (DES) implantation for chronic total occlusion.107 patients were divided into two groups: who were successfully treated with BMS (n=60) 56,1% and those who had CTO lesions with Cypher implantation(n=47) 43,9%. Six-month angiographic restenosis rates and major adverse cardiac events (MACE) were compared between the groups. At 6-month angiographic follow up, the restenosis rate was significantly higher in the BMS group (21,8% vs. 4,7%; p<0,001), but there was no significant statistic difference in the rate of MACE (11,6% vs.13,3%; p>0,05). Therefore, the implantation of DES in the treatment of CTO lesions showed more favourable results regarding restenosis compared with BMS implantation, but there was not a trend towards lower MACE rates.

[Oral spiramycin for prevention of restenosis in coronary arteries].

Restenosis is the main problem of percutaneous coronary intervention (PCI). We investigated influence of oral Spiramycin (oral 16- cyclic macrolide antibiotic) on restenosis rate after uncovered metal stents implantation. 73 patients with acute myocardial infarction (1month) and one vessel lesion were divided into two groups. The first group composed of 42 patients, were treated with 100 mg aspirin +75 mg clopidogrel per day. The second group composed of 31 patients (12 patients were diabetic and 14 had long stenosis) received aspirin+clopidogrel+ spiramycin (one tablet - 3.000.000 IU per day during 6 weeks). Mean vessel diameter in first group patients was 3,2+0,4 millimeters; in second group patients was 3,1+0,3 millimeters. Angiography was performed twice: after six months of stent implantation and after an year of stent implantation. At 12-month follow up there were no major adverse cardiac events in both groups. Restenosis rate was significantly higher in the first group of patients (14,3% vs 6,4%; p<0,001; 4,8% vs 3,2% p<0,01). Oral administration of spiramycin for prevention of restenosis is safe and cost-effective in case of uncovered metal stents.

[Peculiarities of postprandial activity of lipoprotein lipase in coronary heart disease].

The aim of investigation was to study the peculiarities of activity of lipoprotein lipase (LPL) and serum lipid spectrum after fat test meal in patients with coronary heart disease (CHD). 42 persons have been investigated. The main group consisted of 27 patients with CHD (13 males, 14 females). 15 almost healthy subjects (5 males, 10 females) were unified in control group. Parameters of lipid metabolism have been studied by biochemical technique both in basal state and at 3 hours after standard test meal. In parallel, the levels of LPL activity have been investigated by potentiometric method. The values of LPL activity in patients with CHD both in basal and in postprandial states were significantly lower in comparison with analogous values of control subjects. Its postprandial level in CHD patients did not change significantly (percentage increment was 1,0+/-0,9%), but in control group - was increased by 22,3+/-4,4%. Obtained results suggest that LPL activity is not increased at increased postprandial atherogenic lipemia in patients with CHD. LPL activity should be considered as a metabolic marker of atherogenesis and CHD.

[Some peculiarities of the activity of postheparin lipoprotein lipase and parameters of lipid metabolism at ischaemic heart disease].

The study of the relation of atherosclerosis with lipid metabolism (LM) remains still very important. The aim of presented work was the investigation of peculiarities of lipoprotein lipase (LPL) and LM at IHD in different age and sex groups; also the search of possible relation of LPL activity changes with myocardial contractility function and coronarography data at IHD. 47 patients (15 females, 32 males) with IHD were investigated. They were divided on 3 groups: 1 -<50 years (n=14); 2 - 50-59 years (n=14); 3 - >/=60 years (n=19). Patients were investigated by coronarography and echocardiography. Main parameters of LM were determined by enzyme-linked immunoassay. LPL activity was defined by potentiometric method. It was observed significant difference between levels of LPL activity of different age groups (p(1-2)=0,027, p(1-3)<0,001, p(2-3)=0,035). Significant difference in this parameter by sex feature did not observed. The degree of damage in anterior descending branch of left coronary artery negatively correlated with LPL activity (r=-0,5598, p<0,001). Ejection fraction (EF) revealed positive correlation with LPL activity (r=0,4362, p=0,002). The degree of damage of left coronary artery, in particular, medial segment of circumflex branch correlated with LM parameters. EF positively correlated with high-density lipoprotein cholesterol blood level (r=0,3548, p=0,036). LPL activity in patients with IHD significantly decreased with aging. From obtained results it will be supposed that LPL activity and LM parameters influences on the damage degree, basically, left coronary artery.

[Homocysteine as risk marker of cardiovascular disease].

Basic research has demonstrated that homocysteine enhances both arteriosclerosis and thrombosis - the principal cause of CVD. Although studies demonstrate that patients with elevated homocysteine levels have small to moderate increased risk of CVD it remains unclear whether lowering plasma homocysteine levels will decrease risks of CVD. The study was aimed to detect reliability of homocysteine lowering on risk of CVD. We studied 256 patients (56 stenocardia; 96 myocardial infarction; 104 post infarction period). Besides we investigated the influence of blood homocysteine concentration on coronary vessels of patients suffering ischemic heart disease, acute heart disease and those in post infarct period. The majority of coronary vessels demonstrated occlusion and stenosis. The investigation showed the connection between body reactivity and homocysteine level. The higher body reactivity was associated with the higher homocysteine concentration in the blood. It stimulated the development of the mild form of ischemic heart disease -- stenocardia. The increase of homocysteine concentration up to the normal top level points to the danger of development of acute ischemic myocardial disease rather than stenocardia. The investigation showed that the homocysteine blood levels are among the reliable diagnostic markers of CVD. The results of the investigation would permit rational clinical decision making for individual patients and policy decisions for the health of the general population.

Saphenous vein graft pseudoaneurysm: diagnosis by transesophageal echocardiography and magnetic resonance imaging.

Coronary cineangiography showed probable pseudoaneurysm formation at the origin of an 11-year-old saphenous vein coronary bypass graft. Transesophageal echocardiography and magnetic resonance imaging were helpful in differentiating this from aortic dissection or true aneurysm formation and assisted the surgeon in avoiding perforation of the pseudoaneurysm during sternotomy.

Investigation of cystic left ventricular masses with echocardiography and magnetic resonance imaging.

We report on two patients who had cystic masses located in the left ventricle associated with findings of congestive heart failure. Both echocardiography and magnetic resonance imaging (MRI) were helpful in identifying features of these masses. Echocardiography was used to guide percutaneous transarterial catheter drainage of the mass in one patient.