RESUMEN
The main causes of morbidity in Russia are ischemic heart and cerebrovascular disease. The mortality rate of these conditions accounts for almost 50% of all the lethality causes of the Russian population. The frequency of associated coronary and brachiocephalic arteries disorders varies from 18 to 54%. The complex evaluation of the anatomical and functional features of the disorder, as well as of the perfusion and functional heart and brain reserves allows to choose the appropriate methods of surgical treatment of patients with associated coronary and carotid disorders and to decrease the risk of intra- and postoperative cerebral and cardiac complications. The modern approaches of myocardium and cerebral revascularization enable to safely and effectively eliminate the myocardial and cerebral ischemia, to significantly decrease the risk of myocardial infarction and stroke development and to ensure the long ability to work among this group of patients. Over 500 patients with ischemic heart disease and associated brachiocephalic arteries disorders have been operated at the A.N. Bakoulev Scientific Centre for Cardiovascular Surgery for the last 5 years. The results of these operations are comparable to the ones of the leading European clinics.
Asunto(s)
Tronco Braquiocefálico/cirugía , Diagnóstico por Imagen/tendencias , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/cirugía , Procedimientos Quirúrgicos Vasculares/tendencias , HumanosRESUMEN
In the recent years there has been registered an increase in diabetes mellitus (DM) morbidity, especially among able-bodied citizens. The steady increase in amount of DM patients inevitably leads to the increase in the amount of diabetic CHD patients--candidates for the surgical myocardial revascularization. This article contains analysis of choice of myocardial revascularization technique in patients with CHD and concomitant DM. It also contains data from the study of endovascular and surgical treatment of CHD results in diabetic patients. This study also included postoperative complications analysis with exposure of complication development predictors and was held in Bakulev Scientific Centre of cardiovascular surgery. Results obtained in the study testify to the fact that DB increases relative risk of cardio-vascular complications (cardiac death, myocardial infarction and restenosis of special-purposed stenosis) development in patients with CHD after percutaneous coronary intervention with stenting. DM is an independent risk factor that increases myocardial infarction development risk, recurrence of stenocardia and shunt failure during the three year follow up after the coronary artery bypass grafting done in CHD patients.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad Coronaria , Diabetes Mellitus , Complicaciones Posoperatorias , Adulto , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/métodos , Angioplastia Coronaria con Balón/estadística & datos numéricos , Comorbilidad , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/estadística & datos numéricos , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/fisiopatología , Enfermedad Coronaria/terapia , Diabetes Mellitus/epidemiología , Diabetes Mellitus/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Selección de Paciente , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Recurrencia , Factores de Riesgo , Stents/efectos adversosRESUMEN
The incidence of atherosclerotic lesions in coronary arteries combined with other vascular problems has been increasing during the last years. Hence, a rise in the number of patients with coronary heart disease, candidates for surgical myocardial revascularization. This paper reviews the history of surgical treatment of combined lesions of coronary and peripheral arteries and presents original criteria developed in A N Bakulev Research Centre of Cardiovascular Surgery for the choice of surgical strategy to treat multifocal atherosclerosis and postinfarction left ventricular aneurysm.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/tendencias , Enfermedad de la Arteria Coronaria/cirugía , Aneurisma Cardíaco/cirugía , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiología , Humanos , Resultado del TratamientoRESUMEN
The study was designed to analyse results of alternative methods of myocardial revascularization in "no-option patients" to whom direct revascularization is not indicated. Over 600 cases were treated with the use of transmyocardial laser revascularization (TMLR), angiogenic factors (VEGF, alpha-ECGF), and cellular therapy. It was shown that TMLR is a safe and efficacious procedure increasing perfusion and normalizing myocardial metabolism. It eliminates angina and improves quality of life of the patients. Single bolus administration of angiogenic factors alone does not stabilize perfusion and patients' condition. The use of stem cells provokes the growth of new vessels and promotes restoration of viable myocardium via stimulation of angiogenesis. However, mesenchymal stem cells do not contribute to scar reparation and are inefficient in patients with a critical mass of cicatrically-altered myocardium.
Asunto(s)
Inductores de la Angiogénesis/uso terapéutico , Tratamiento Basado en Trasplante de Células y Tejidos/métodos , Terapia por Láser/métodos , Isquemia Miocárdica/terapia , Revascularización Miocárdica/métodos , Humanos , Resultado del TratamientoRESUMEN
The paper presents the results of a 5-year follow-up after coronary artery bypass grafting (CABG) combined with transmyocardial laser revascularization (TMLR). The study revealed high efficiency and safety of the combined surgery in patients with coronary heart disease (CHD) associated with diffuse lesions of coronary arteries. The procedure improved the myocardial perfusion and contractile function, thus significantly increasing the patients' life quality. Combined CABG + TMLR noticeably improved stenocardia functional class, increased physical exercise tolerance and led to a significant reduction in nitrate agent consumption in patients with CHD.
Asunto(s)
Angioplastia Coronaria con Balón/métodos , Enfermedad Coronaria/terapia , Terapia por Láser/métodos , Enfermedad Coronaria/diagnóstico , Ecocardiografía , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada de Emisión de Fotón Único , Resultado del TratamientoRESUMEN
Personality disorders (PD) are recognized among key maladaptive factors in postoperative period of coronary artery bypass surgery (CABS). However studies on PD among CABS patients are predominantly under psychological approach and information on clinical features is very limited. A present investigation aimed at assessing clinical features and prognostic value of PD in late post operative period of CABS (from 1 to 3 years). Using psychiatric, cardiological and psychological methods, 48 patients (42 male, mean age 61.3 +/- 8.2 years) with diagnosis of PD and favorable cardiological status after CABS have been assessed. PD in post operative period is an important predictor of unfavorable social and occupational outcome of CABS. Three types of clinical course of PD were singled out: 1) hypohondric personality development; 2) "second life" personality development; 3) "denial of illness" reactions. Pronounced maladaptation was observed in type 1, most severe one--in type 2 and minimal maladaptation or its absence--in type 3. These types were differentiated by different repertoires of psychological defense mechanisms (PMD): type 1 was characterized by a limited number of them with a drift to mature mechanisms; PD of type 2 are featured by a narrow and rigid repertoire of defenses with predomination of immature mechanisms and in type 3 a maximum number of PMD with balanced involvement of mature and immature mechanisms was observed.
Asunto(s)
Puente de Arteria Coronaria , Trastornos de la Personalidad/etiología , Complicaciones Posoperatorias , Adaptación Psicológica , Anciano , Mecanismos de Defensa , Negación en Psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Personalidad/diagnóstico , Pronóstico , Factores de Tiempo , Resultado del TratamientoRESUMEN
This paper analyzes the results of 94 coronary artery bypass grafts accomplished at the Department of Surgical Treatment of Concomitant Lesions of Coronary and Peripheral Arteries, A.N. Bakulev SCCVS, RAMS, in patients with coronary artery disease (CAD) provided control hospital bypass angiography over the period 1998 to 2002. Control bypass angiography revealed thrombosis of 11.7% of vein and of 1.5% of arterial grafts. The main causes of vein graft thromboses were: bypass grafting of small coronary arteries, that of the coronary arteries with so-called 'immature' stenoses, and mediastinitis. The data presented herein evidence that hospital arterial bypass graft provides for a considerably higher percentage of competence versus vein bypass graft. Hospital bypass angiography is essentially safe while its findings allow to make a detailed analysis of complications whereby upgrading the efficacy of operations.
Asunto(s)
Angiografía Coronaria , Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Arterias/trasplante , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/diagnóstico por imagen , Estudios de Seguimiento , Oclusión de Injerto Vascular , Humanos , Incidencia , Anastomosis Interna Mamario-Coronaria , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Arteria Radial/trasplante , Trombosis/etiología , Factores de Tiempo , Trasplante Autólogo , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Venas/trasplante , Trombosis de la Vena/etiologíaRESUMEN
AIM: To study dynamics of parameters of heart rate variability (HRV) in patients with ischemic heart disease after direct myocardial revascularization. MATERIAL AND METHODS: Electrocardiography (ECG), 24 hour Holter ECG with spectral and temporal analysis of 24-hour HRV, as well as echocardiography (Echo) and stress-Echo were carried out in 24 patients with ischemic heart disease before, in 2-4 weeks and 2 months after surgery. Healthy persons of the same age (n=20) were used as controls. RESULTS: Prior to operation HRV in all patients was lower than in controls. In 2-4 weeks after coronary artery bypass grafting (CABG) further lowering of HRV parameters occurred. In 2 months after CABG HRV parameters in patients without complications were similar to preoperative values but remained lower than in controls.
Asunto(s)
Frecuencia Cardíaca/fisiología , Isquemia Miocárdica/fisiopatología , Isquemia Miocárdica/cirugía , Revascularización Miocárdica/métodos , Cuidados Posoperatorios , Cuidados Preoperatorios , Adulto , Electrocardiografía , Electrocardiografía Ambulatoria/métodos , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Results of transmyocardial laser revascularisation (TMLR) of the myocardium are analyzed. Two types of laser equipment were used domestic laser high-energy CO2 synchronized with patient's ECG, and XeCl laser Max-20. 32 patients underwent TMLR as a single method of surgical correction of the disease, 15 in combination with other methods of myocardium revascularisation. Obtained data testify that TMLR is a highly effective procedure in selective patients with IHD. Results confirm necessity of differential surgical policy for ischemic heart disease that permits to use adequate method of myocardium revascularisation for each patient.
Asunto(s)
Terapia por Láser , Isquemia Miocárdica/cirugía , Revascularización Miocárdica/métodos , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Factores de RiesgoRESUMEN
Results of 30 operations performed for combined lesions of coronary and peripheral arteries are analyzed. All the operations were performed as off-pump minimally invasive coronary surgery (MICS) on beating heart with "Octopus" system Medtromic. There were no lethal outcomes. Number of complications was minimal. MICS is high-effective procedure in selected patients with coronary heart disease. It is necessary to use differential policy of surgical treatment of coronary heart disease.
Asunto(s)
Procedimientos Quirúrgicos Mínimamente Invasivos , Isquemia Miocárdica/cirugía , Angioplastia Coronaria con Balón , Arritmias Cardíacas/complicaciones , Gasto Cardíaco , Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Ecocardiografía Transesofágica , Circulación Extracorporea , Femenino , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Infarto del Miocardio/cirugía , Revascularización Miocárdica , Selección de Paciente , Reoperación , Factores de RiesgoRESUMEN
The work deals with the results of one-stage reconstructive surgical interventions in 15 patients with affection of the coronary arteries, abdominal aorta, and lower limb arteries. All patients underwent operation for the creation of an aortocoronary shunt in combination with various types of vascular reconstructive operations, including the formation of an ascending aorta -bifemoral shunt in 3 patients. The total hospital mortality was 26.7%. The authors discuss the indications and the surgical tactics of one-stage reconstructive interventions in combined affection of the coronary and peripheral arteries.
Asunto(s)
Enfermedades de la Aorta/cirugía , Arteriosclerosis Obliterante/cirugía , Enfermedad Coronaria/cirugía , Arteria Femoral/cirugía , Arteria Ilíaca/cirugía , Pierna/irrigación sanguínea , Arteria Poplítea/cirugía , Anastomosis Quirúrgica/métodos , Aorta Abdominal/cirugía , Enfermedades de la Aorta/complicaciones , Arteriosclerosis Obliterante/complicaciones , Puente de Arteria Coronaria , Enfermedad Coronaria/complicaciones , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The literature and original research data on the incidence of combined lesions of coronary arteries, abdominal aorta, and lower-limb vessels are presented. Operative intervention was undertaken in 112 of 170 examined patients with combined coronary and vascular abnormalities. Fifteen patients underwent one-stage reconstruction of the coronary artery and aortofemoral segment; in 57 patients aortocoronary bypass was performed as the first stage; in 40 patients only vascular reconstruction was performed. Operative risks in these patients are discussed, as well as the diagnostic problems, surgical tactics, and the sequence of operation stages in combined coronary and vascular abnormalities.