[In-hospital outcomes of endarterectomy and coronary artery bypass grafting in multiple diffuse lesions of coronary arteries]. / Gospital'nye rezul'taty éndarteréktomii i koronarnogo shuntirovaniia pri mnozhestvennom diffuznom porazhenii koronarnykh arterii.

BACKGROUND: According to a series of studies, performing coronary endarterectomy in direct myocardial revascularization increases the risk of myocardial infarction and in-hospital mortality. There are no commonly accepted indications for carrying out endarterectomy, and in clinical practice this technique is used in severe diffuse lesions of coronary arteries. AIM: The study was aimed at assessing in-hospital clinical outcomes of coronary artery bypass grafting (CABG) with the use of endarterectomy in patients with severe multiple diffuse lesions of coronary arteries. PATIENTS AND METHODS: This was a single-centre retrospective study enrolling a total of 205 patients presenting with multiple diffuse lesions and subjected to CABG procedures. Of these, after excluding those with severe concomitant pathology (n=28), 177 were enrolled and divided into 2 groups: 76 patients during formation of a coronary anastomosis were subjected to forced endarterectomy from the native channel (Group 1, n=76) and the remaining patients to prolonged anastomosis and/or bypass grafting of distal branches of the diffusely damaged artery (Group 2, n=101). In-hospital outcomes were analysed in both groups. RESULTS: The demographic and clinical characteristics were comparable by all parameters except for age: Group 1 patients were older (66.3±8.4 vs 63.0±8.5, p<0.05). The groups were comparable by severity of coronary lesions by both the SYNTAX Score and diffuse lesion index. The incidence of perioperative myocardial infarction during coronary endarterectomy (Group 1) amounted to 9.2% (7/71) and in the group without endarterectomy (Group 2) to 0. There were no cases of in-hospital mortality in either group. CONCLUSION: In severe diffuse coronary lesions, endarterectomy combined with CABG makes it possible to perform adequate myocardial revascularization. Performing endarterectomy from coronary arteries is associated with an increased risk for the development of myocardial infarction, but its use is justified if it is impossible to create an anastomosis by means of other techniques.

[The possibilities of using levosimendan in medical preparation to Coronary Artery Bypass Grafting in coronary artery disease patients with low left ventricular ejection fraction].

AIM: to work out an approach of preoperative drug preparation for CAD patients with low LVEF and varying degrees of compensation for CHF, to study the possibility of using levosimendan (L) in this preparation. MATERIALS AND METHODS: We studied 82 patients with severe angina pectoris, multivascular coronary disease, extensive postinfarction zone, LVEF ≤35%, chronic heart failure and proven viable myocardium, which performed CABG. All patients received long - term standard CHF therapy before surgery: loop diuretic, ACE/ARA, beta - blocker, aldosterone antagonist. In the first, retrospective part of the study (39 pts), it was determined which factors could be associated with perioperative AHF. In the second, prospective part (43 pts), the course of the operation and the early postoperative period in patients with compensated and uncompensated heart failure were compared; uncompensated pts received L 2 days before surgery in addition to standard therapy. The third, retro - prospective part of the study (37 pts) was the assessment of operation outcome in patients only with uncompensated pre - operative CHF, but with different preoperative drug preparation. RESULTS: Statistically significant direct influence on the perioperative AHF development was provided by the combined clinical sign - venous pulmonary congestion+orthopnea (p.

[Complications of the Catheter Treatment of Atrial Fibrillation: Stenosis of All Pulmonary Veins after Radiofrequency Ablation].

Radiofrequency ablation is the "gold standard" in atrial fibrillation treatment. The frequency of complications is about 3.5-3.9 %. The symptomatic pulmonary vein stenosis is one of the most severe complications. In this report we present a clinical case of stenosis of all four pulmonary veins after redo catheter ablation of atrial fibrillation in 61year-old patient, and discussion of possible causes, specific features of diagnosis, and possible approaches to treatment of this complication.

[Giant Aneurysms in Coronary Arteries of a Young Woman].

Coronary arteries aneurysms with their thrombotic occlusion are known to be detected in young patients who have suffered Kawasaki disease in childhood. The other vascular beds are usually not involved. In the literature one can find not enough information regarding diagnostics of this pathology, as well as no specific treatment algorithm. We present here a clinical case of re-emergence of giant aneurysms of coronary arteries in the young female patient with subsequent immuno-histological confirmation of previous Kawasaki disease.

[Diabetus mellitus and surgical treatment of coronary heart disease].

Nearly 40-year experience of surgical treatment of coronary heart disease testifies to higher coronary heart disease (CHD) morbidity and mortality rates among diabetes mellitus patients in comparison to non-diabetic patients. At the same time, comparative study of CHD treatment methods efficacy in diabetes mellitus patients has shown that surgery is preferred to angioplasty, especially in the most severe cases--in presence of coronary occlusion, insulin-dependent diabetes and left-ventricle dysfunction. More inferior results of coronary bypass surgery in diabetic patients in comaparison to non-diabetic were conditional on a more pronounced arterial calcinosis and diffuse distal arterial involvement, as well as more severe aortal ateromatosis, flebopathy and more often wound infection occurrence. In the department of cardio-vascular surgery in Russian cardiologic scientific productive complex a quarter of all patients waiting for the coronary bypass surgery are diabetic. Selection algorithm, preoperation preparation, peculiarities of surgical technique and principles of postoperative supervision of these patients were specially designed. With adequate preparation, remission of diabetes and use of microsurgery, postoperative prognosis for these patients (both stratified and real) is comparative to that for the main group of patients. One-year follow up after the bypass surgery data testifies to the low difference in autovenous and autoarterial shunt patency in diabetic and non-diabetic patients. Long-term (10 years) survival rate is significantly lower in the group of diabetic patients. Proposed cardioprotective postoperative strategy is designed to improve both short and long-term efficacy ofsurgical revascularization in CHD patients with concomitant diabetes mellitus.

[Left main coronary artery stenosis and progression of coronary artery atherosclerosis after angioplasty and stenting in patients directed to coronary artery bypass surgery].

Recent investigations demonstrated appearance of left main coronary artery stenosis after PTCA. We performed a retrospective study of specific characteristics of development of coronary lesions after percutaneous coronary interventions (PCI) in patients subjected to coronary artery bypass grafting (CABG) because of angina recurrence after PCI. Data of 150 patients operated because of angina recurrence after PCI were analyzed. The recurrence of angina in 93% of cases was associated with development of significant stenoses in previously intact segments of coronary arteries, but not with restenosis or occlusion of the stented segment. The recurrence of symptoms occurred in 1 year after coronary stenting in 54% of patients. In 19 patients rapid development of a novel left main coronary artery stenosis was observed. Some characteristics of this group (the use of Back-up, XB, AL-catheters, repetitive PCI, manipulations in more than 2 coronary segments, stenting of bifurcations with 2 stents, use of kissing-balloons, small diameter of left coronary artery, and concomitant diabetes) significantly differed from those of the main group. In all patients CABG was successful.

Experience in early rehabilitation of patients after coronary artery bypass graft surgery.

UNLABELLED: A strategy of rapid in-hospital postoperative rehabilitation is currently a priority trend in managing the patients after coronary artery bypass graft (CABG) surgery. OBJECTIVE: To investigate the baseline characteristics and peculiarities of perioperative treatment of patients with a short period ofin-hospital rehabilitation. MATERIALS AND METHODS: We studied a total of 690 patients who had endured CABG operations according to the conventional technique performed over the period from January 2007 to August 2008. The procedures of preoperative preparation, surgical intervention and postoperative management both at the stage of the intensive care unit (ICU) and at the Cardiosurgical Department in all the patients were carried out in accordance with the accepted protocol. RESULTS: The Study Group (Group 1) comprised a total of eighty-three 39-to-79-year-old (average age 55.7 +/- 7.9 years) patients whose postoperative hospital stay amounted to 8.1 +/- 1.3 days. Of these, there were 76 men and 7 women. The Comparison Group (Group 2) was composed of one hundred 39-to-76-year-old (mean age 56.2 +/- 8.3 years) patients, with 89 men and 11 women enrolled. The duration of the postoperative hospital stay in the Comparison Group amounted to 12 +/- 1.4 days (p < 0.05). All the operated patients according to the findings of coronary angiography (CAG) had had haemodynamically significant atherosclerotic lesions of three and more coronary arteries. The patients in both Groups were comparable by the main clinical characteristics. There were no patients with recently sustained myocardial infarction, unstable angina, or left-ventricular aneurysms in either of the groups studied. CONCLUSIONS: Employing the protocol we devised makes it possible to reduce the postoperative hospital stay to 7 days in electively operated patients presenting with a stable course of coronary artery disease (CAD), without pronounced co-existing pathology, with a satisfactory left-ventricular systolic function, with preoperatively compensated diabetes mellitus (DM) and adequately controlled arterial hypertension (AH).

[Comparative analysis of efficacy of endovascular interventions in native vascular bed and grafts in patients with ischemic heart disease after coronary artery bypass surgery].

AIM: Investigation of efficacy of endovascular interventions in native vascular bed and grafts, elucidation of factors, affecting immediate and remote prognosis after endovascular treatment. MATERIAL AND METHODS Coronary stenting was carried out in 212 patients who had previously undergone coronary bypass surgery. Stents were implanted into native vessels and grafts in 116 (native vessels group) and 96 (grafts group) patients, respectively. Frequency of angina recurrence and development of complications were assessed during hospitalization and after 1 year. Coronary angiography was repeated after 1 year in 47 and 36 patients in native vessels and grafts groups, respectively. Multifactorial analysis of predictors of complications and angina recurrence was performed with the use of logistic regression. RESULTS AND CONCLUSION: In grafts group signs of distal embolism were observed in 9 patients (9.4%), shunt thrombosis occurred in 2 of these patients. Risk factors of embolism in grafts group were complicated lesions (type C) and length of stenosis >20 mm. There was 1 non-Q wave myocardial infarction after stenting of native vascular bed (0.8%). Angina recurrence was observed after 1 year in 9 (7.8%) and 26 (27.1%), myocardial infarction developed during 1 year in 2 (1.7%) and 3 (3.1%) patients of native vessels and grafts groups, respectively. Risk factors of recurrence of clinic of ischemic heart disease (IHD) after stenting of grafts were time interval between stenting and bypass surgery >5 years and the use of stents without drug coating. More frequent recurrence of clinic of IHD in patients of grafts group was a consequence of higher level of restenosis in stented segments and more frequent progression of atherosclerosis in previously unaffected segments.

[Antibodies to Chlamydia pneumoniae in blood serum of patients with ischemic heart disease and presence of complicated lesions in coronary arteries].

Levels of IgM, IgG and IgA antibodies to Chlamydia pneumoniae were measured in 107 patients (age 33-75 years) with documented coronary atherosclerosis and 39 subjects with intact coronary arteries. Rates of seropositivity to C. pneumoniae were 77.6 and 25.6% in patients and "healthy" subjects, respectively (p<0.05). Seropositive (n=83) compared with seronegative (n=24) patients had higher prevalence of complicated lesions (p<0.05).