Пути оптимизации результатов реваскуляризации у пациентов с мультифокальным атеросклерозом

Purpose. To perform a comparative assessment of diagnostic tools and strategies of myocardial revascularization in patients with and without polyvascular disease (PolyVD) based on the findings of perioperative analysis. Materials and methods. The medical records of 2 828 patients, aged 32–84, consecutively admitted to the clinic of the Research Institute for Complex Issues of Cardiovascular Diseases between January, 2006, and July, 2010, for coronary artery bypass surgery, were retrospectively reviewed. All the patients were divided into two groups: Group 1 included 448 (15,48 %) PolyVD patients with clinically manifested or angiographically confirmed obliterating (≥ 60 %) non-cardiac artery lesions. Group 2 (the control group) included 1691(59,79 %) patients without any clinical symptoms of non-coronary atherosclerosis. The incidence rate, structure and causes of in-hospital mortality and type I neurological disorders (i.e. strokes and transient ischemic attacks) were assessed in both groups. Results. The incidence rate of significant non-cardiac occlusive stenotic lesions in patients with coronary artery disease (CAD), who had to undergo CABG, was 15,84 %. Simultaneous revascularization of coronary and non-coronary arteries was performed in 2,46 % of patients with CAD and PolyVD and multi-stage surgical procedures were chosen in other cases. Conclusions. The outcomes of CAD surgical treatment were improved in this group of patients due to the implementation of a multidisciplinary team approach, which ensured a proper diagnosis of polyvascular disease.