[Modern approaches to diagnostics and surgical correction of brachiocephalic arteries disorders in patients with ischemic heart disease].

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.

[Modern approach towards surgical treatment of coronary heart disease in diabetic patients].

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.

[Modern approaches to surgical treatment of patients with complicated and combined forms of coronary heart diseases].

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.

[Alternative methods of myocardial revascularization].

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.

[Transmyocardial laser revascularization of the myocardium].

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.

[Personality disorders in postoperative period of coronary artery bypass graft surgery]. / Rasstroistva lichnosti v posleoperatsionnom periode aortokoronarnogo shuntirovaniia.

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.

Results of hospital bypass angiography in patients with coronary artery disease undergoing arterial and vein myocardial revascularization.

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.

[Dynamics of parameters of heart rate variability in patients with ischemic heart disease after direct myocardial revascularization]. / Dinamika pokazatelei variabel'nosti ritma serdtsa u bol'nykh ishemicheskoi bolezn'iu serdtsa do i posle operatsii priamoi revaskuliarizatsii miokarda.

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.

[Surgical treatment of ischemic heart disease by transmyocardial laser revascularization]. / Khirurgicheskoe lechenie ishemicheskoi bolezni serdtsa metodom transmiokardial'noi lazernoi revaskuliarizatsii miokarda.

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.

[Treatment of ischemic heart disease by minimally invasive coronary surgery with the "Octopus" system]. / Lechenie ishemicheskoi bolezni serdtsa metodom miniinvazivnoi koronarnoi khirurgii s ispol'zovaniem sistemy "Octopus".

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.

[Simultaneous reconstructive operations in combined lesions of the coronary arteries, abdominal aorta and arteries of the lower extremities]. / Odnomomentnye rekonstruktivnye operatsii pri sochetannom porazhenii koronarnykh arterii, briushnoi aorty i sosudov nizhnikh konechnostei.

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.

[Indications for aortocoronary bypass in patients with combined lesions of the coronary arteries, abdominal aorta and blood vessels of the legs]. / Obosnovanie pokazanii k aorto-koronarnomu shuntirovaniiu bol'nym s sochetannym porazheniem koronarnykh arterii, briushnoi aorty i sosudov nizhnikhonechnostei.

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.