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Среди пациентов, страдающих терминальной сердечной недостаточностью, смертность достигает 50% в течение года после постановки диагноза� Радикальным способом решения этой проблемы и повышения качества жизни таких пациентов является ортотопическая трансплантация сердца� Буквально еще 10 лет назад выполнение данной операции и, главное, ведение посттрансплантационного периода было по силам только ведущим научно-исследовательским центрам� Сегодня с совершенствованием и ростом доступности достижений кардиохирургии, анестезиологии, интенсивной терапии, кардиологии и иммунологии данная операция и посттрансплантационное ведение осваиваются многопрофильными краевыми и областными центрами� Последнее повышает доступность высокотехнологической помощи населению в регионах� Ключевые слова: ортотопическая трансплантация сердца, посттрансплантационный период, иммуносупрессия, многопрофильный стационар, гипертрофия миокарда донорского сердца

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Aim: To evaluate efficacy and safety of surgical myocardial revascularization with two internal thoracic arteries in the elderly patients and to identify special aspects and immediate results of the interventions on a working heart and with the use of cardiopulmonary bypass and on a working heart.Materials and methods: This retrospective single center study included patients over 65 years of age with multivessel coronary artery disease who underwent coronary artery bypass grafting with two internal thoracic arteries in a  working heart without cardiopulmonary bypass at the Federal Clinical Center of High Medical Technologies of FMBA of Russia from 2015 to 2017  (the study group, n=50) and with cardiopulmonary bypass and cardioplegia (the comparison group, n=51). We analyzed demographic characteristics, preoperative state severity, and special aspects of myocardial damage, operational parameters, rates, and structure of postoperative complications.Results: None of the patients died. Median intraoperative parameters in the study group were better than those in the comparison group: blood loss, 300  vs. 800  mL (p<0.001), duration of the surgery, 190  and 240  min (p<0.001), duration of mechanical ventilation, 3  and 5  hours (p<0.001), respectively. Early postoperative acute renal failure was less frequent in the patients who had undergone surgery without cardiopulmonary bypass (median serum creatinine levels 90  vs. 125  µmol/L (p<0.001)). Postoperative complications were observed in the group of patients operated with cardiopulmonary bypass: three cases of acute cerebrovascular accidents (stroke) and one deep wound infection of the sternum. Mean duration of the hospital stay in the patients operated on a working heart without the use of cardiopulmonary bypass was 7  days versus 9  in the comparison group.Conclusion: Myocardial revascularization without cardiopulmonary bypass is associated with lower rates of postoperative complications, decreased duration of the procedure, decreased blood loss, time on mechanical ventilation and acute renal failure rate, which all results in decreased duration of hospital stay. Bimammary myocardial revascularization without cardiopulmonary bypass could be the method of choice in the elderly patients.