inovmedИнновационная медицина КубаниInnovative Medicine of Kuban2541-9897Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 110.35401/2500-0268-2020-20-4-6-13inovmed-327Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОтдаленные результаты реконструктивных операций без эндартерэктомии при диффузном коронарном атеросклерозеLong-term outcomes of reconstructive procedures on coronary arteries for diffuse coronary atherosclerosis without endarterectomyhttps://orcid.org/0000-0003-3881-5451БелашС. А.BelashS. A.

Белаш Сергей Александрович, к. м. н., сердечно-сосудистый хирург, кардиохирургическое отделение № 2

350086, Краснодар, ул. 1 Мая, 167

Sergey A. Belash, Cand. of Sci. (Med.), Cardiovascular Surgeon, Cardiac Surgery Department no. 2

Krasnodar

belashsa@yahoo.comhttps://orcid.org/0000-0002-9114-6050ШевченкоС. С.ShevchenkoS. S.

Шевченко Сергей Сергеевич, сердечно-сосудистый хирург, кардиохирургическое отделение № 2

Краснодар

Sergey S. Shevchenko, Cardiovascular Surgeon, Cardiac Surgery Department no. 2

Krasnodar

https://orcid.org/0000-0003-0315-5502ЯсаковаЕ. П.YasakovaE. P.

Ясакова Елена Петровна, врач отделения рентгенологических методов исследования

Краснодар

Elena P. Yasakova, Radiologist, Department of Radiation Diagnostics

Krasnodar

https://orcid.org/0000-0002-3839-7432БарбухаттиК. О.BarbukhattiK. O.

Барбухатти Кирилл Олегович, д. м. н., заведующий кардиохирургическим отделением № 2; заведующий кафедрой кардиохирургии и кардиологии факультета повышения квалификации и профессиональной переподготовки специалистов

Краснодар

 

Kirill O. Barbukhatti, Dr. of Sci. (Med.), Head of the Cardiac Surgery Department no. 2;  Head of the Department of Cardiac Surgery and Cardiology, Department of Proficiency Enhancement

Krasnodar

https://orcid.org/0000-0003-0572-1395ПорхановВ. А.PorhanovV. A.

Порханов Владимир Алексеевич, академик РАН, д. м. н., профессор, главный врач; заведующий кафедрой онкологии с курсом торакальной хирургии факультета повышения квалификации и профессиональной переподготовки специалистов

Краснодар

Vladimir A. Porhanov, Member of the Russian Academy of Sciences, Dr. of Sci. (Med.), Professor, Chief Doctor ; Head of the Department of Oncology with the Course of Thoracic Surgery, Department of Proficiency Enhancement

Krasnodar

Научно-исследовательский институт – Краевая клиническая больница № 1 им. проф. С.В. Очаповского; Кубанский государственный медицинский университетРоссияScientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1; Kuban State Medical UniversityRussian FederationНаучно-исследовательский институт – Краевая клиническая больница № 1 им. проф. С.В. ОчаповскогоРоссияScientific Research Institute – Ochapovsky Regional Clinical Hospital no. 1Russian Federation20203012202004613Copyright © Белаш С.А., Шевченко С.С., Ясакова Е.П., Барбухатти К.О., Порханов В.А., 20202020Белаш С.А., Шевченко С.С., Ясакова Е.П., Барбухатти К.О., Порханов В.А.Belash S.A., Shevchenko S.S., Yasakova E.P., Barbukhatti K.O., Porhanov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.innovmedkub.ru/jour/article/view/327Цель

Цель. Изучить отдаленные клинические и ангиографические результаты реконструктивных процедур без выполнения эндартерэктомии при диффузном коронарном атеросклерозе.

Материал и методы

Материал и методы. Ретроспективно обследовано 660 пациентов (89,5% – мужчины, средний возраст – 68,3 ± 7,4 года), перенесших коронарное шунтирование в сочетании с реконструктивными процедурами на коронарных артериях в период с 2003 по 2016 г. Изучены отдаленные результаты 558 (84,5%) прооперированных пациентов, средний период наблюдения – 94,3 ± 31,2 месяца.

Результаты

Результаты. Отдаленная выживаемость составила 83,2% (95%-й ДИ: 74,5–89,3), свобода от кардиальной летальности – 97,4 ± 1,2% и свобода от больших сердечно-сосудистых катастроф – 64,7 ± 4,1%. Независимыми предикторами смертности в отдаленном периоде были возраст старше 70 лет на момент операции (р < 0,001), хроническая обструктивная болезнь легких (р = 0,007), мультифокальный атеросклероз (р = 0,002), сахарный диабет (р = 0,013) и хроническая почечная недостаточность (p = 0,034). Проходимость артериальных шунтов – 95,2%, венозных – 75,4%.

Заключение

Заключение. Коронарное шунтирование в сочетании с реконструктивными процедурами на коронарных артериях без эндартерэктомии обеспечивает высокую выживаемость в отдаленном периоде, большую свободу от стенокардии и кардиальной летальности, хорошую проходимость артериальных шунтов и приемлемую венозных.

 

 

Objective

Objective. This study evaluated the long-term clinical and angiographic outcomes of coronary artery reconstruction for a diffusely diseased coronary artery without endarterectomy.

Material and Methods

Material and Methods. We retrospectively reviewed 660 consecutive patients (mostly men (89.5%), mean age 68.3 ± 7.4 years) who underwent coronary artery bypass grafting in combination with coronary artery reconstruction between 2003 and 2016. 558 operated on patients (84.5%) were followed up for a mean of 94.3 ± 31.2 months.

Results

Results. Long-term survival was 83.2% (95% confidence interval: 74.5–89.3); freedom from cardiac death was 97.4 ± 1.2%; and freedom from major adverse cardiac and cerebrovascular events was 64.7 ± 4.1%. Independent predictors of long-term mortality were age at surgery (< 70 years, p < 0.001), chronic obstructive pulmonary disease (p = 0.007), peripheral arterial disease (p = 0.002), diabetes mellitus (p = 0.013) and chronic kidney disease (p = 0.034). The arterial graft patency rate was 95.2%, and the vein graft patency rate was 75.4%.

Conclusion

Conclusion. Coronary artery bypass grafting in conjunction with coronary artery reconstruction without endarterectomy confers satisfactory long-term clinical outcomes with high probability of freedom from cardiac death and angina pectoris, good rates of angiographic patency of arterial grafts and favorable rates of vein graft patency.

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The authors declare that there are no conflicts of interest present.