[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.

[Adhesion of T cells and macrophages to the coronary artery endothelium in patients with coronary heart disease].

The study has found a close relationship between the early signs of atherosclerosis, i.e. between the fine-dropwise (dust-like) lipid deposition in the intima and the adhesion of monocyte clusters to the endothelium in these places. In the intimal areas without lipid depositions, adherent monocytes were absent or detectable as single cells in the field of vision. The coronary arteries displayed large clusters of T cells (CD4, CD8) adhered to the endothelium and migrated into the intima. The clusters of these cells were encountered not only in the vascular atherosclerotic lesion areas, but also in the invisibly altered ones. Some patients (with atheromas and fibroatheromas in the coronary artery segments) were found to have en face specimens with endothelial layer damages, with one or 3-5 cells being absent in the endothelial layer. The bottom of such microerosions was lined by T-cell and macrophage infiltrations and it was part of the cap of an atherosclerotic plaque. These surface erosions may be considered as an early developmental stage of an unstable plaque.

[Prevention and treatment of infectious complications in myocardial revascularization]. / Profilaktika i lechenie infektsionnykh oslozhnenii pri revaskuliarizatsii miokarda.

The study was conducted in a group of 440 patients who underwent planned operations for ischemic heart disease. Three current methods of preventive antibiotic therapy were compared. The influence of various risk factors on the incidence of infectious complications was analysed. Experience with closed mediastinitis management was also analysed. The effect of a short-term (1-3 days) course of claforan in prevention of infectious complications is the same as that of a 5-7-day course of cefamezin or gentamicin. Postoperative mediastinitis developed in 11 (2.5%) patients. It was managed in all patients by closed irrigation and drainage of the retrosternal space. The average duration of mediastinal irrigation was 7.4 days. Convalescence was attained in all cases.