Results of surgical revascularization of the anterior interventricular branch using the left internal thoracic artery in high-risk patients and multifocal coronary artery disease

Objective: to assess the possibility of using mammary coronary bypass without bypass in high-risk patients and multifocal coronary artery disease, to analyze the immediate and long-term postoperative periods, to study clinical features in patient groups. Materials and methods: Th e study included 60 patients. All patients had a high risk of surgical intervention and a complicated pre-operative history. In the fi rst group, despite the multifocal lesion of the coronary arteries, for various reasons, we performed mammary coronary bypass on a working heart. In the second group, all patients underwent aorto-coronary bypass + mammary coronary bypass with bypass in a standard scheme using cold cardioplegia. Later, the results were evaluated aft er 30 days, 1 year, 5 years aft er the intervention. Results: It was showed that the immediate postoperative results and indices during the year had a positive dynamics - the class of angina pectoris decreased, the hemodynamic parameters changed. In addition, the rejection of bypass in patients with a complicated anamnesis made it possible to exclude complications from the excretory and nervous systems that we observed in the second group. In the future, we observed an increase in the class of angina in the fi rst group. Th e recurrence of angina pectoris is associated, in our opinion, with the progression of coronary atherosclerosis, an increase in existing stenoses and the appearance of new stenoses. Conclusions: mammary coronary bypass without bypass can be successfully used in high-risk patients and multifocal lesion of the coronary bed. Th is can be regarded as an outcome with extremely dangerous use of bypass for complete myocardial revascularization. Th e immediate results are positive and minimize postoperative risk from adjacent organs and systems. Anatomical and functional state of mammary coronary bypass is satisfactory, both in the near and the delayed period. Long-term observations indicate an increase in the class of angina and complications of IHD in this group of patients. Th e way out in this situation we see in the combined work of the surgical and endovascular team. 

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