Abstract
Aim. To compare strategy and early results of coronary artery bypass grafting (CABG) in patients with and without calcification of target coronary arteries (TCA).Material and methods. The prospective study analyzed the data of patients (n=462) who underwent elective isolated CABG in 2017-2018 using cardiopulmonary bypass and microsurgery. Two groups were distinguished: group 1 — patients with TCA calcification (n=108), group 2 — patients without TCA calcification (n=354). In cases where the distal coronary artery lesion did not allow standard bypass grafting, additional complex anastomoses were provided. A comparison of intraoperative parameters and early results of CABG was carried out.Results. In groups 1 and 2, the revascularization index did not differ significantly and was 4,5 and 4,3, respectively. The frequency of complex surgical interventions in group 1 was higher: for example, ‘Y’ grafts were used in groups 1 and 2, respectively, in 32% (35/108) and 12% (44/354), p<0,05; sequential anastomoses in 14% (15/108) and 7% (26/354), p<0,05; prolonged patch-angioplasty — in 21% (23/108) and 5% (16/354), p<0,05; anastomoses with arteries <1,5 mm in diameter — in 33% (36/108) and 4% (14/354), p<0,05; coronary endarterectomy in 17% (18/108) and 5% (16/354), p<0,05, respectively. The duration of cardiopulmonary bypass was longer in group 1. At the same time, the hospital clinical results did not differ significantly: mortality was not registered; the frequency of perioperative myocardial infarction was 1,8% (group 1) and 1,1% (group 2); the need for inotropes, frequency of arrhythmia, length of stay in the intensive care unit and hospital were similar; there were no cases of in-hospital angina recurrence.Conclusion. CABG in patients with calcification of TCA is associated with surgical challenges and need for complex adjunct techniques. Nevertheless, complete surgical revascularization is real in these cases, and the hospital results are comparable to those in patients without calcification.
Highlights
доверительным интервалом (ДИ) — доверительный интервал, искусственного кровообращения (ИК) — искусственное кровообращение, инфаркта миокарда (ИМ) — инфаркт миокарда, КА — коронарная артерия, КАГ — коронароангиография, кальциноза коронарных артерий (ККА) — кальциноз коронарных артерий, кальциноза целевых коронарных артерий (КЦКА) — кальциноз целевых коронарных артерий, коронарного шунтирования (КШ) — коронарное шунтирование, ЛЖ — левый желудочек, мультиспиральная ком‐ пьютерная томография (МСКТ) — мультиспиральная компьютерная томография, ОШ — отношение шансов, периоперацион‐ ного ИМ (ПИМ) — периоперационный инфаркт миокарда
Features and hospital outcomes of coronary artery bypass grafting in patients with calcification of target coronary arteries
coronary artery bypass grafting (CABG) in patients with calcification of target coronary arteries (TCA) is associated with surgical challenges and need for complex adjunct techniques
Summary
In groups 1 and 2, the revascularization index did not differ significantly and was 4,5 and 4,3, respectively. Авторами было от мечено, что показатели летальности и частота пе риоперационного инфаркта миокарда (ИМ) после перенесенного КШ у пациентов с ККА были выше по сравнению с пациентами, не имеющими кальцини‐ рованного поражения коронарного русла, практиче‐ ски в 3 раза: годичная летальность составила 11,8% vs. Аналогичные результаты описаны в ра боте Bourantas CV, et al (2015): у пациентов с выра‐ женным ККА, включенных в исследование SYNTAX и реестр SYNTAX CABG, наблюдалась более высокая 5-летняя смертность: 17,1% vs 9,9% в общей группе, p
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