Scientific journal
European Journal of Natural History
ISSN 2073-4972

MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH ADVANCED ATHEROSCLEROSIS: TACTICAL ISSUES

Abzaliev K.B. 1 Kuzhukeyev M.E. 1 Dosmailov N.S. 2
1 Kazakh Medical University for Continuing Education
2 National Scientific Center of Surgery named after A.N. Syzganov

In order to assess the efficiency of CABG using nonlinear venous bypass grafts (experimental group) we compared its outcomes with linear venous bypass grafts-only CABG (control group). A total of 272 coronary arteries were bypassed in experimental group vs. 217 arteries in control one. Using sequential venous bypass grafts, we managed to restore blood flow in a total of 145 coronary arteries (53,3 %). Most bypassed were left margin artery 48 (33,1 %), circumflex artery 33 (22,7 %), diagonal artery 28 (19,3 %), posterior interventricular artery 17 (11,7 %). Using naturally bifurcated venous bypass grafts, we restored blood flow in 68 (25 %) coronary arteries. Most bypassed were CA 18 (26,4 %), left margin artery 16 (23,5 %), diagonal artery 15 (22 %), and posterior interventricular artery 11 (16,1 %). Using composite and combined bypass grafts, we restored blood flow in 12 (4,4 %) coronary arteries. The incidence of intraoperative injury to the aorta in both groups differ dramatically: 2 % vs. 11,1 %, respectively. Such a difference in intraoperative injury to the aorta is due to a lesser number of aortic anastomoses in experimental group where nonlinear versions of venous grafts were used. Acute heart failure was also notably higher in the control group: 14,8 % vs. 3,9 %. Acute heart failure caused death in four (7,4 %) control patients. Acute cerebrovascular event rate was higher in controls: 14,8 % vs. 2 %. One patient in the control group succumbed to acute cerebrovascular event. Also, there was reported high rate of respiratory failure (25,9 %) among controls compared to experimental group (11,7 %). Infective complications as represented by mediastinitis in all cases were noted in 3,9 % of experimental cases, which was almost twice as less than in controls (9,2 %). Postop hemorrhage mandating resternotomy was almost equal in both groups (3,9 % vs. 3,7 %). Significant difference in the rates of acute heart failure, acute cerebrovascular events, respiratory insufficiency, and infections is secondary to the length of pump and aorta cross-clamping times in both experimental, and control groups: 116/71 minutes vs. 138/85 minutes, respectively.

So, using the algorithm developed for nonlinear venous bypass graft CABG in multivessel coronary lesions, combined with atherosclerosis of the ascending aorta, we managed to reduce the number of aortic anastomoses and achieve complete myocardial revascularization, reduce pump time and aorta cross clamping time.


The work is submitted to the International Scientific Conference “Fundamental research”, CROATIA (Istria) 23 July–30 July 2015, came to the editorial office оn 20.07.2015.