The paper presents review of the literature in terms of the advantages of no-touch great saphenous vein (GSV) harvesting technique and its impact on long-term GSV patency for coronary artery bypass grafting compared to conventional method of vein harvesting. Presented detailed pathophysiological mechanisms of venous graft failure, using conventional GSV harvesting. Purpose. Analysis of literature data for the optimal choice of additional vascular shunt used for coronary bypass grafting in multi – vessel coronary artery disease, based on patency rate. Conclusion. No-touch technique of GSV harvesting provides better structural, functional, and mechanical protection of the vein wall. Perfecting the technique of this harvesting method and long-term follow up in patients with no-touch GSV grafts may reveal a graft patency comparable to that of LITA.

A total of 207 patients with alimentary constitutional and hypothalamic obesity were examined in order to assess the status of the microcirculatory bed, including the status of capillary walls, hemocirculation, transcapillary metabolism, oxygen delivery to tissues in patients with various forms of obesity. Bulbobiomicroscopy, assessment of capillary wall permeability by the hydrostatic test, polarographic study of oxygen tension in the skin using oxygen and ischemic test were employed. Obese patients were found to develop appreciable microcirculatory disorders (vascular, intravascular, extravascular); capillary walls became better penetrable for liquid and proteins and the adaptation reserve of these vessels decreased, with the substrate movement from blood to tissues predominating. A correlation has been traced between the status of the circulation and capillary walls, and extravascular shifts, on the one hand, and capillary permeability, on the other. Oxygen delivery to tissues was disordered in obese patients, this manifesting by deterioration of both oxygen delivery and consumption. The degree of impairment of various components of microcirculation and oxygen supply of tissues augmented with body mass increase.

Background. Ischemic mitral regurgitation (IMR) is the second most common cause of mitral regurgitation (MR). IMR occurs in patients with myocardial infarction due to a rupture of the subvalvular apparatus. Pathological remodel-ing, dilatation and dysfunction of the left ventricle (LV) play a significant role in the development of IMR. The presence of a postinfarction LV aneurysm can lead to the development of MR due to dysfunction, relative and true shortening of the papillary muscles. There are various methods of surgical correction of IMR. The aim. To show the effectiveness of surgical treatment of left ventricular aneurysm combined with ischemic mitral regurgitation using a modified technique. Materials and methods. From January 2011 to December 2019, 20 patients with IMR combined with LV aneurysm underwent surgical intervention using a modified technique at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine. According to this technique, access to the mitral valve was performed through the left ventricle. The mean age of the patients was 61.2 ± 10.1 years. Among patients with IMR, the majority were men (60.0%). The overwhelming majority of patients (80.0%) had the history of hypertension. Diabetes mellitus was detected in 35.0% of patients. Mitral ring dilatation was observed in 25.0% (5) of the cases, papillary muscle displacement in 40.0% (8), chords rupture in 15.0% (3), papillary muscle infarction in 20.0% (4) of the cases. All the patients had reduced LV ejection fraction with a mean value of 34.5 ± 7.8%. Results. Aortic cross-clamp time through ventricular access was 112.9 ± 18.7 minutes. The duration of mechanical ventilation was 19.1 ± 20.6 hours. The length of stay of patients in the ICU was 99.2 ± 43.5 hours. There were no signs of acute heart failure in the early postoperative period in one in five patients (20.0%). The rate of degree III heart failure after intervention using the modified technique was 20.0% (4). The study of the incidence of cardiac arrhythmias after combined intervention showed that 85.0% (17) of patients operated using the modified technique had no cardiac arrhythmias. Conclusions. In patients who underwent surgery using the modified technique, the mortality rate was 5.0%. This is 1.6-2.8 times less than that in patients undergoing conventional operation. Postoperative occurrence of arrhythmias is much less common than that described in the literature.