[Surgical treatment of a patient with coronary artery disease combined with stenosis of the left subclavian artery].

Presented in the article is a clinical case report regarding successfully used hybrid technology in combined lesions of the coronary arteries and the first segment of the left subclavian artery. The patient was subjected to simultaneous hybrid operation, i. e., transaortic angioplasty with stenting of the left subclavian artery by means of the Assurant stent accompanied by coronary artery bypass grafting. The early postoperative period turned out uneventful. The patient was discharged with no complications and in a satisfactory condition. At the 12-month follow-up visit, the patient presented no complaints, felling satisfactory as he stated, and there was no evidence of restenosis as revealed by the findings of ultrasonographic examination. This clinical case report demonstrates that in this type of combined lesion the use of hybrid technologies makes it possible to obtain a favourable surgical outcome both in the immediate and remote postoperative periods.

[Vacuum-therapy of postoperative sternomediastinitis].

AIM: To estimate the results of sternomediastinitis management using vacuum-therapy compared with conventional treatment of such wounds. MATERIAL AND METHODS: We have retrospectively analyzed data for the period from January 2007 to October 2014. The study enrolled 79 patients with infectious complication after cardiac surgery. All patients underwent coronary artery bypass grafting. The first group included 40 patients who received conventional therapy. The second group enrolled 39 patients in whom vacuum-therapy was applied. Patients were comparable in main characteristics. RESULTS: Mortality rate was significantly lower in vacuum-therapy group (2.5% vs. 15%, p=0.05). Similarly duration of hospital-stay in the 2nd group was 29±10 days, in the 1st group - 47±11 days (p<0.01). Incidence of sepsis and other complications was significantly higher in group of conventional treatment. CONCLUSION: Vacuum-therapy for infectious complications after cardiac surgery provided good results including decrease of hospital-stay duration and mortality rate in comparison with conventional management of wounds.

[Treatment of reperfusion renal lesion after surgical management of chronic post-embolic pulmonary hypertension by means of extracorporeal membrane oxygenation (ECMO)].

Thromboendarterectomy from the branches of the pulmonary artery is a conventionally accepted approach to treatment for pulmonary hypertension in chronic pulmonary embolism. A frequently encountered complication associated with this operation is the development in the postoperative period of the reperfusion syndrome as a potential cause of fatal respiratory failure. Taking into consideration that the reperfusion syndrome is a reversible process, waiting measures of support may save the patient's life. The present article deals with a case report concerning successive surgical management of a female patient suffering from chronic recurrent pulmonary thromboembolism accompanied by high pulmonary hypertension complicated by severe respiratory insufficiency in the early postoperative period, thus requiring long-term use of veno-venous extracorporeal membrane oxygenation (ECMO). The clinical case described in the article shows that veno-venous ECMO may be employed to save patients presenting with reperfusion syndrome following thromboendarterectomy from the branches of the pulmonary artery. The method of connecting ECMO namely in the veno-venous option in this particular case was determined by fact that the patient had no cardiac insufficiency. Numerous studies conducted hitherto have also confirmed that using ECMO in the veno-venous variant is accompanied and followed by a lower incidence rate of complications as compared with that of the veno-arterial variant. The results of our case report strongly suggest that timely use of ECMO in the composition of rehabilitation measures during restoration of the compromised lungs may become an effective strategy aimed at improving survival of patients after successful thromboendarterectomy from the pulmonary artery branches.