The p urpose. Preservation of native properties of autologous vein for coronary artery bypass grafting. Materials and methods. The use of preoperative ultrasound marking saphenous veins, ultrasonic harmonic scalpel, axial intraoperative marking outs. Results. The use of techniques proposed by sparing with explantation and transposition outs in the coronary arteries, in contrast to the classical methods, can significantly increase the duration of the functioning autovenous coronary bypass grafts in patients with coronary heart disease in the long term. Conclusions. Studies have shown that improving techniques of careful explantation outs for coronary artery bypass grafting and qualitative positioning in the coronary arteries, contribute to a better patency vein grafts in the late postoperative period.
OBJECTIVE To evaluate the results of direct myocardial revascularization within 72 hours after manifestation of acute coronary syndrome. MATERIAL AND METHODS A retrospective study included 48 (0.47%) out of 10 193 patients with coronary artery disease who underwent coronary artery bypass grafting for the period 2011-2019. Study patients underwent urgent direct myocardial revascularization. SYNTAX Score >22 points was observed in all cases. All patients were divided into 3 groups depending on timing of surgery: 26 patients - within 6 hours after admission, 15 patients - within 6 - 24 hours, 7 patients - within 24-72 hours. RESULTS Level of myocardial damage markers was similar after 1 and 2 days (p>0.05). In the 1st group, 1 (3.84%) patient died in hospital, 5 (19.2%) patients - within 1 year after surgery. In the 2nd group, these values were 1 (6.6%) and 0, respectively. There was no mortality in the 3rd group (p>0.05). Overall 5-year survival was 100%. CONCLUSION Early active open revascularization is advisable in patients with ACS and clear indications for surgery.
Annually, up to 850 000 coronary aortic bypass graft operations are performed worldwide. Despite modern technical equipment ensuring a high level of safety of the procedure, currently important remains a problem related to intraoperative myocardial damage in using artificial circulation. Early detection and clinical assessment of myocardial ischaemia often present a difficult task. This article deals with clinical, instrumental and laboratory methods of diagnosis, aimed at verification of an intraoperative cardiac lesion associated with graft dysfunction in coronary artery bypass grafting. Isolated electrocardiographic and echocardiographic signs of myocardial ischaemia between the comparison groups did not differ significantly. Analysing the markers of myocardial lesions, statistically significant differences were obtained only after 48 hours which, from the point of view of saving viable myocardium, is an utterly long-term interval. Studying the findings of intraoperative flowmetry showed statistically significant dependence between velocity characteristics, pulse index of shunts and their patency on angiographic examination. Thus, only combination of diagnostic parameters makes it possible to detect myocardial damage related to shunt dysfunction. This enables early determination of indications for performing bypass angiography and selection of the required therapeutic policy. Timely coronary artery angiography makes it possible to reveal defects of shunts and to timely perform surgical correction, preventing myocardial infarction.
