[Minimally invasive coronary grafting without using the artificial bypass blood circulation]. / Maloinvazivnoe koronarnoe shuntirovanie bez primeneniia iskusstvennogo krovoobrashcheniia.

An analysis, the shaping-up and perfection of the surgical treatment of ischemic heart disease (IHD) by using the method of small-invasion grafting of coronary arteries without applying the artificial bypass blood circulation is described. Indications and contraindications for the surgery of coronary grafting on the working heart and with minimal approach are discussed. Advantages of such surgeries boil down to a smaller trauma, a better cosmetic effect, milder pain, a quicker rehabilitation (with a shorter stay in hospital) and cost-efficiency.

[Oxygen transport in patients with ischemic heart disease operated on under a program to preserve the patient's blood]. / Nekotorye aspekty transporta kisloroda u bol'nykh ishemicheskoi bolezn'iu serdtsa, operirovannykh v usloviiakh programmy po sokhraneniiu krovi bol'nogo.

The results of the studies performed in 112 patients operated on with preservation of the patient's blood are reviewed. This meant pre- and intraoperative blood taking, surgery under normovolemic hemodilution, blood taking and transfusion upon its neutralization with heparin, collection of the blood flowing from drainages. Acid-base balance, pO2, blood Hb level, the degree of Hb saturation with O2, free plasma Hb, platelet count, the level of 2,3-diphosphoglyceric acid have been determined and parameters of oxyhemoglobin dissociation curve have been calculated. Computer monitoring of O2 transport was performed before and after assisted circulation in 28 patients. During surgery it proved possible to collect and return to the patients 10% of the circulating blood. The blood collected during surgery had no negative effect on the hemostasis. The above technique makes it possible to reduce the amount of donor blood used during surgery and has no negative effect on O2 transport.

[The blood coagulation system after autologous blood transfusion following aortocoronary shunt]. / Sistema gemokoaguliatsii pri primenenii autokrovi posle aorto- koronarnogo shuntirovaniia.

Fibrinolysis factors were examined in 112 patients operated on for coronary heart disease. After artificial circulation was over,auto- logous blood + was collected in a cardiotomic reservoir and reinfused to the patient. The collected autologous blood was characterized by a manifest fibrinolytic potential, but already in 18-20 hrs after transfusion these changes were undetectable; no enhanced bleeding was observed after surgery. Use of autologous blood helps reduce the necessary amounts of donor blood.

[Initial experience of work on a program of complete preservation of the patient's blood in heart surgery]. / Pervyi opyt raboty po programme polnogo sokhraneniia krovi patienta v kardiokhirurgii.

A complex program on complete preservation of a patient's blood was adopted during and after cardiac surgery with extracorporeal circulation. The major principles of such a "hemotransfusionless" surgery are 1) to minimize irrevocable blood loss; 2) to fully return a cardioplegic solution into the blood during extracorporeal circulation; 3) to apply autohemotransfusion controlled by hemodilution and hemoconcentration; and 4) to reinfuse drained blood in the nearest postoperative period. One hundred and twelve patients were treated by the program. The average expenditure of donor blood per patient was 543 +/- 343 ml, donor blood was not transfused to 44 (39%) patients during their entire stay in hospital.

[Surgical tactics in patients with multi-stage occlusions]. / Nekotorye aspekty khirurgicheskoi taktiki u bol'nykh s "mnogoétazhnymi okkliuziiami."

Reconstructive operations on the vessels proved to be possible in 275 of 330 patients with "multi-stage occlusions": in 227 patients profound femoral arteries were included into the main blood flow, in 48 patients the blood flow was reestablished in the aorto-iliac and femoro-popliteal segments. Good results were obtained in 81.2% of the patients. Secondary amputation was performed in 9.1%, 8.7% of the patients died. In the postoperative period repeated interventions proved to be necessary in 46 (16.7%) patients.