Original Research

Improvement of the results of coronary artery bypass grafting by means of additional myocardial protection

B.M. Todurov, G.I. Kovtun, S.O. Sheludko

Institute of Heart, Healthcare Ministry of Ukraine, Kyiv, Ukraine    

         The aim – to improve the results and to prevent possible complications during surgical treatment of coronary artery disease by implementing additional way to protect myocardium during coronary artery bypass surgery – аpplication of temporary intraсoronary bypass overlay instead of clamping aorta.

         Materials and methods. Using the method described above we performed surgery in 75 patients. Operations were carried out under cardiopulmonary bypass. The age of patients ranged from 56 to 72 years (mean 64.7 ± 6.3 years). Among 75 studied patients were 64 men (85.3 %) and 11 women (14.7 %). Among the complaints dominated dyspnea during exercise (90 %), compressive chest pain (85 %) and peripheral edema (65 %). Almost half of the patients (47 %) complained on palpitations. At the time of admission, all patients had heart failure ІІІ–ІV classes NYHA.

         Results. There were no fatal cases among patients operated by the proposed method. During post-surgery period acute heart failure was observed in two patients. Arrhythmias were observed in seven patients. Ischemic, embolic lesions of major vessels were not observed. The positive dynamics of ECG was observed in all patients. Significant hemodynamic improvement was revealed as well. Left ventricular ejection fraction increased by average of 9 % (from 39.5 ± 4.4 % at admission to 47.9 ± 5.7 % before discharge). All patients were discharged in satisfactory condition.

         Conclusions. Application of temporary intraсoronary shunt overlay instead of clamping aorta provides: permanent myocardial perfusion in pools of all coronary arteries including vessels subject to grafting; better visualization of the overlay zone anastomosis; does not limit surgeon at the time that is given to the imposition of anastomosis; minimizes trauma of aorta at the site of the overlay clamp decreasing complications inherent to artificial circulation.

Key words: ischemic heart disease, coronary artery bypass grafting, myocardial protection, temporary intracoronary shunt.