[Simultaneous surgery for concomitant lung cancer and diffuse coronary atherosclerosis]. / Simul'tannye operatsii pri rake legkogo i diffuznom koronarnom ateroskleroze.

OBJECTIVE: To evaluate the early outcomes of simultaneous surgeries in patients with concomitant lung cancer and coronary artery disease. MATERIAL AND METHODS: We retrospectively reviewed 37 consecutive patients who underwent CABG with adjunct endarterectomy (n=21) or long segmental coronary artery reconstruction (n=25) and lung resection between 2003 and 2019. Mean age was 61.4±6.7 (range 58-71) years. Males prevailed (n=32, 86.4%). Median sternotomy was used in all patients. Myocardial revascularization was followed by on-pump lung resection. The most common procedure was lobectomy (94.6%) of the right upper lobe (83.7%). Lymph node dissection was performed in all patients. RESULTS: CPB time was 162±19.3 min, aortic cross-clamping time 71±14.2 min. There was no in-hospital mortality. Incidence of perioperative myocardial infarction was 5.4%. Postoperative complications were atrial fibrillation (n=6, 16.6%), re-exploration for bleeding (n=1, 2.7%), pneumonia (n=2, 5.4%). Mean hospital-stay was 14.4 days (range 11-21). CONCLUSION: Simultaneous lung resections and coronary artery reconstruction is a safe and reliable surgical method in patients with diffuse coronary atherosclerosis and lung cancer. The developed system of choice, evaluation and surgical treatment of patients with concomitant cardiopulmonary pathology is fundamental for successful treatment of these difficult patients. We need larger randomized studies for certainty.

[Frozen elephant trunk procedure for DeBakey type i acute aortic dissection complicated by lower limb malperfusion]. / Ostroe rassloenie aorty I tipa (po Debeiki) s sindromom mal'perfuzii nizhnikh konechnostei.

Two-stage surgical treatment of a patient with type I acute aortic dissection and lower limb malperfusion is reported in the manuscript. Frozen elephant trunk procedure was applied. A 49-year-old man was hospitalized with a diagnosis of «Debakey type I acute aortic dissection¼ in 7 hours after manifestation of the disease. At admission, paleness and numbness of both lower limbs with a violation of active movements were observed in addition to pain syndrome. Chest CT revealed false lumen thrombosis within the distal aorta followed by stenosis of aortic bifurcation up to 80% and stenosis of the right common iliac artery up to 80%. Considering critical lower limb ischemia, axillo-bifemoral bypass surgery was performed at the first stage. A day later, the patient underwent replacement of ascending aorta, aortic arch and descending thoracic aorta. E-vita Open Plus № 24 hybrid prosthesis and frozen elephant trunk procedure under hypothermia 25o C with bilateral antegrade cerebral perfusion were used. CPB time was 285 min, aortic cross-clamping time - 180 min, circulatory arrest - 135 min. Postoperative period was uneventful, ICU-stay - 5 days. The patient was discharged after 20 days. Control CT confirmed false lumen thrombosis throughout the stent-graft. Follow-up survey after 1 year revealed no complaints.

[Central cannulation of the aorta by Seldinger technique in DeBakey type I acute aortic dissection with malperfusion of internal organs]. / Tsentral'naia kaniuliatsiia aorty po Sel'dingeru pri ostrom rassloenii aorty I tipa po DeBakey s mal'perfuziei vnutrennikh organov.

Described herein is a case report concerning the use of central cannulation of the aorta by Seldinger technique for DeBakey type I aortic dissection with the involvement of both femoral arteries and the brachiocephalic trunk, as well as with thrombosis of the false lumen from the level of the ascending aorta. This is followed by a brief review discussing the methods of instrumental control of the cannula position in the true lumen of the aorta, as well as peculiarities of using this technique of cannulation in various clinical situations.

[Results of Coronary Artery Bypass Surgery Combined With Endarterectomy and Reconstruction of Anterior Descending Artery in Patients With Diabetes Mellitus].

AIM: To assess results of coronary artery bypass surgery combined with endarterectomy (EAE) in patients with ischemic heart disease (IHD) and diabetes mellitus (DM), and impact of DM on clinical outcomes. MATERIAL AND METHODS: We recruited in this study 152 patients with IHD (43 with and 109 without DM) subjected to coronary artery bypass surgery with EAE from anterior descending artery (ADA) between 2003 and 2010. Forty three patients had concomitant DM (main group) 109 - had not (control group). Mean age was 57+/-18 and 60+/-19 years, portion of patients with class III-IV angina - 71.1 and 73.3%, with history of myocardial infarction - 74.4 and 68.8%, in main and control group, respectively (p>0.05). RESULTS: In hospital mortality was 4.6 and 3.6% in main and control group, respectively. Number of patients examined in remote period was 127 (87.6%). Mean follow-up was 4.5+/-1.2 years. Survival was 90.7 and 100% (p>0.05). Graft angiography was performed in 12 and 43 patients (27.9 and 39.4%) with portions of patent arterial conduits 91.6 and 100%, patent venous conduits 90.0 and 90.3% in main and control group, respectively. CONCLUSION: Under conditions of strict control of glycemia coronary artery bypass surgery with EAE from ADA in IHD patients with DM is associated with acceptable hospital mortality and survival, moderate risk of remote cardiovascular complications, and satisfactory patency of conduits.

[Endarterectomy and reconstruction of the left anterior descending artery: immediate and long-term results].

An analysis of the results of treatment of 149 patients was made. The revasculization of the myocardium and the endarterectomy using the left anterior descending artery were carried out in these patients at the period from 2003 to 2010. The middle age was 59.5 ± 8.4 years. The exertional angina of the III-IV functional class was noted in 76% of the patients and 72% of patients had the myocardial infarction in anamneses. The follow-up study included 127 operated patients. The mean follow-up period was 43.3 ± 23.9 months (maximal period--8.5 years). The hospital lethality consisted of 2.7%. The survival rate was 89.3% in a long-term period. The cineangiography was performed on 52 patients in mean terms 50.2 ± 22.9 months. A patency of arterial grafts was 51(98.1%), the patency of venous grafts--77 (93.9%). The signs of involution of the venous grafts were in 3 (3.7%.