Search

Hybrid revasculization of myocardium combined the advantages of mammary-coronary bypass surgery and coronary arteries stenting. It presented itself as a perspective direction in treatment of ischemic coronary disease. The article provides the results of comparison of usage of hybrid revasculization of myocardium and aortocoronary bypass in 71 patients with multivessel coronary artery disease. The data obtained indicated, that hybrid approach allowed complete revasculization of the myocardium (as in case of aortocoronary bypass), fast recovery of the patient, shortening a hospital stay due to decrease of intra- and postoperative complications.

The article provides the results of minimally invasive direct revasculization of myocardium at the period from 2012 to 2014. Given method was used in 49 interventions. There weren't any lethal cases or myocardial infarctions. A mean hospital stay consisted of 8,6±2,7. Computer thomographic coronary bypass angiography was carried out after operation in terms of 6-48 months. The occlusion of mammary coronary shunt was revealed in 3 patients with minimally invasive revasculization of the myocardium in terms up to 48 months. There were noted a decrease' of hospital stay, bleeding during surgery and in early postoperative period, duration of artificial pulmonary ventilation, length of stay in intensive care unit for this group of patients.

The investigation included 45 patients with coronary heart disease operated for aorto-(mammaro)-coronary artery bypass grafting. It was found that surgical treatment resulted in the improvement of subjective symptoms of angina and increased contractile reserve of the myocardium during the first days after surgery. Significantly increased subjective and objective exercise tolerance, improvement of local myocardial contractility, diastolic function and symptoms of myocardial remodeling were registered only within 6 months after surgery. Assessment of the dynamics of the myocardial contractile reserve can be used as an objective criterion of the earliest positive result of surgical treatment of coronary artery disease.

Determination of the necessary length of the bypass is one of the principal stages of operation of the aorta-coronary bypass. The greatest difficulty of the determination of the bypass length is the first-priority applying of proximal anastomoses. It requires the surgeon to have great experience, the operation to be longer. It also makes it necessary to prepare a conduit of deliberately excessive length. A device is proposed for the determination of the necessary bypass length during operation of aorta-coronary bypass consisting of a crocodile grip with a fixed to it polymer tube.

The article presents a technique of performing coronary bypass operations on the beating heart used by the authors in 847 patients which is based on high thoracic epidural anesthesia, primary formation of proximal anastomoses of the aorto-coronary bypasses and specified succession of the formation of distal, stabilization of the local part of the heart in the field of placing distal anastomosis and access to the lateral and posterior surface of the heart with vacuum stabilizers, using blower-humidifier and intracoronary shunts.

The features of preoperative status, course of the perioperative period and immediate results of coronary shunting were compared and analyzed in 523 patients, 56 of them were women. In female patients there were more often factors negatively influencing the course of the postoperative period. No additional intraoperative risk factors were found. The direct results of coronary shunting proved to be similar in men and women. No significant difference in the frequency of the development of early postoperative complications and hospital lethality, considerable correlation between the gender and frequency of postoperative complications were established by the methods of correlative analysis.

Diffuse lesions of the anterior interventricular artery (AIVA) at different levels were diagnosed in 27 out of 417 patients operated for post-infarction aneurysm of the left ventricle (PIALV). During the preoperative period coronography, ventriculography, ultrasonic examination of the heart were made in all the patients, one-photon emission computed tomography with 123I-iodopent was used for radioisotope investigation of perfusion and metabolism of the myocardium. The presence of PIALV, diffuse atherosclerotic lesion of AIVA and viable myocardium in its basin was taken as an indication for autovenous plasty of the artery with the following shunt of the left intrathoracic artery and resection of PIALV.

The author reports the results of treatment in 58 patients with oblique aplastic pseudarthrosis of tubular bones diaphyses of the lower limbs. For treatment extrafocal with counter-lateral compression by means of pins with bearing surfaces. By the present time nearly in all patients (52 of 58) with the mentioned complications such kind of treatment resulted in rehabilitation of the main motion-bearing function of the extremity.

The experience of the treatment of 107 patients with nonunited open and gunshot fractures of the crus bone complicated by osteomyelitis is described. In 100 patients osteomyelitis was liquidated, in 97 patients consolidation of bone fragments was achieved, the supporting ability and joint movements were restored.

Some early symptoms of devascular femoral head necrosis are covered in the paper together with the results of surgical treatment of 48 cases. Both extra- and intraarticular operations were performed. The extraatricular interventions proved to be the best: intertrochanteric medializing osteotomies, drilling of the canal with introduction of cortical bone grafts into the femoral neck and head and tunnelization followed by the replacement of the femoral head defect with autospongy bone tissue.