mvjrМедицинский вестник Юга РоссииMedical Herald of the South of Russia2219-80752618-7876The Rostov State Medical University10.21886/2219-8075-2020-11-1-46-54mvjr-1044Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESДЕСЯТИЛЕТНИЙ ОПЫТ ПРИМЕНЕНИЯ ТРАНСМИОКАРДИАЛЬНОЙ ЛАЗЕРНОЙ РЕВАСКУЛЯРИЗАЦИИ В СОЧЕТАНИИ С КОРОНАРНЫМ ШУНТИРОВАНИЕМA DECADE OF EXPERIENCE IN APPLICATION OF TRANSMYOCARDIAL LASER REVASCULARIZATION IN COMBINATION WITH AORTOCORONARY SHUNTINGhttps://orcid.org/0000-0002-5978-7632КрнчоянА. В.KrnchoyanA. V.

Крнчоян Арташес Владимирович — аспирант кафедры хирургии. 

Ростов-на-Дону

Artashes V. Krnchoyan — Graduate student of the department of surgery.

Rostov-on-Don

tash089@mail.ruЛяшенкоС. А.LyashenkoS. A.

Ляшенко Сергей Андреевич — кардиолог.

Ростов-на-Дону

Sergey A. Lyashenko — heart specialist.

Rostov-on-Don

СтаровойтенкоА. Г.StarovoitenkoA. G.

Старовойтенко Алексей Георгиевич — сердечнососудистый хирург.

Ростов-на-Дону

Aleksey G. Starovoytenko — doctor of cardiovascular surgery.

Rostov-on-Don

ДюжиковаА. В.DyuzhikovaA. V.

Дюжикова Анастасия Владимировна — к.м.н., врач ультразвуковой диагностики.

Ростов-на-Дону

Anastasiya V. Dyuzhikova — Cand. Sci. (Med.), doctor of ultrasonic diagnostics.

Rostov-on-Don

ГаспарянР. А.GasparyanR. A.

Гаспарян Рачик Артурович — сердечно-сосудистый хирург.

Ростов-на-Дону

Rachik A. Gasparyan — doctor of cardiovascular surgery.

Rostov-on-Don

ПоддубныйА. В.PoddubnyA. V.

Поддубный Андрей Викторович — к.м.н., заведующий кардиохирургическим отделением.

Ростов-на-Дону

Andrey V. Poddubny — Cand. Sci. (Med.), Head of the Cardiac Surgery Department.

Rostov-on-Don

https://orcid.org/0000-0002-1969-0086ДюжиковА. А.DyuzhikovA. А.

Дюжиков Александр Акимович — д.м.н., профессор, заслуженный врач Российской Федерации, кафедра хирургии.

Ростов-на-Дону

Aleksandr A. Dyuzhikov — Dr. Sci. (Med.), Professor, Department of Surgery.

Rostov-on-Don

Ростовский государственный медицинский университетРоссияRostov State Medical UniversityRussian FederationРостовская областная клиническая больницаРоссияRostov Regional Clinical HospitalRussian Federation2020300320201114654Copyright © Крнчоян А.В., Ляшенко С.А., Старовойтенко А.Г., Дюжикова А.В., Гаспарян Р.А., Поддубный А.В., Дюжиков А.А., 20202020Крнчоян А.В., Ляшенко С.А., Старовойтенко А.Г., Дюжикова А.В., Гаспарян Р.А., Поддубный А.В., Дюжиков А.А.Krnchoyan A.V., Lyashenko S.A., Starovoitenko A.G., Dyuzhikova A.V., Gasparyan R.A., Poddubny A.V., Dyuzhikov A.А.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medicalherald.ru/jour/article/view/1044Цель

Цель: изучить безопасность и эффективность трансмиокардиальной лазерной реваскуляризации в сочетании с аортокоронарным шунтированием у пациентов с диффузным поражением коронарных артерий.

Материал и методы

Материал и методы: в исследовании проведено сравнение результатов оперативного лечения у пациентов с диффузным дистальным поражением коронарных артерий в период с 2007 по 2013 гг. Пациенты были разделены на две группы: первую группу составили пациенты, которым выполнено АКш в сочетании с ТМлР (n-60), вторую — пациенты, которым выполнено изолированное АКш (n-46). По исходным демографическим данным и сопутствующей патологии группы статистически значимо не отличались. Последующее наблюдение (в среднем 7,5 ± 0,9 лет) включало оценку выживаемости и возврат стенокардии.

Результаты

Результаты: отдаленная летальность за период наблюдения в первой группе составила 7,6 % (n = 4), во второй группе — 18,9 % (n = 7). В обеих группах функциональный класс стенокардии значительно снизился, однако в первой группе указанная тенденция была более выражена (стенокардия напряжения I ФК в группе АКш + ТМлР отмечена у 54 (90 %) пациентов, а во второй группе — 33 (71,7 %), p = 0,02.

Выводы

Выводы: трансмиокардиальная реваскуляризация в сочетании с аортокоронарным шунтированием у пациентов высокого риска с диффузным атеросклеротическим поражением коронарных артерий способствовала увеличению толерантности к физическим нагрузкам, уменьшала симптоматику, а также обеспечивала приемлемое качество жизни в отдаленном периоде. 

Objective

Objective: to study the security and the effect of transmyocardial laser revascularization in combination with aortocoronary shunting in patience with diffuse coronary artery disease.

Materials and methods

Materials and methods: the study compared the results of surgical treatment in patients with diffuse distal coronary artery disease in the period from 2007 to 2013. Patients were divided into two groups, the first group consisted of patients who underwent CABG in combination with TMLR (n-60), the second group includes patients who underwent isolated CABG (n-46). According to the initial demographic data and comorbidity, the groups were not significantly different from each other. Subsequent observation (on average 7, 5±0, 9 years) included rating of survival and return of angina.

Results

Results: remote mortality during the observation period in the first group was 7, 6 % (n = 4), and in the second group — 18, 9 % (n = 7). In both groups the functional class of angina pectoris significantly decreased, however, in the first group this tendency was more expressed (exertional angina I EF in the CABG + TMLR group have 54 (90 %) patients, in the second group — 33 (71,7 %), p = 0,02.

Conclusions

Conclusions: transmyocardial laser revascularization in combination with aortocoronary shunting in high-risk patients with diffuse atherosclerotic lesions of the coronary arteries contributed to an increase in exercise tolerance, reduced symptoms, and provided an acceptable quality of life in the long term.

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