Aim. To determine the optimal method for performing coronary artery endarterectomy (СE) based on immediate and long-term outcomes of coronary artery bypass grafting (CABG) in combination with open or closed CE in the left anterior descending artery (LAD).Material and methods. This retrospective study included 103 patients who underwent CABG in combination with closed CE and 204 after open CE in the LAD during the period from 2003 to 2016. In both groups, the patient age was comparable (65 years [56; 69] vs 67 years [58; 72] (p=0,263)). There were more men (88,3% vs 81,4% (p=0,421). The mean follow-up period was 94 months [38; 180]. Long-term outcomes were assessed in 86,4% (n=89) and 83,8% (n=171) of patients from the closed and open CE groups, respectively (p=0,141). Angiographic data were studied in 75,3% and 67,3% of patients, respectively (p=0,441).Results. In the closed and open CE groups, in-hospital mortality was 4,8% and 1,5% (p=0,0012), incidence of perioperative myocardial infarction — 11,6% vs 2,5%, (p<0,001), survival rate after 7,8 years — 81,3±5,1% and 84,4±3,2% (p=0,342), respectively. The patency of arterial shunts was significantly higher in the open CE group — 93,1% vs 80,6% (p=0,004). At the same time, the patency of venous shunts in the long-term period between the groups was comparable — 70,1% vs 73,7% (p=0,314).Conclusion. Open CE in combination with CABG provides better immediate outcomes compared to closed CE. Long-term survival and freedom from angina between the groups were comparable. In the long-term period, the patency of internal thoracic artery after open CE is better than after the closed technique. Open CE is a safe and effective method to achieve complete myocardial revascularization in patients with severe diffuse LAD atherosclerosis.

Цель. Определить оптимальную тактику лечения пациентов с диффузным атеросклеротическим поражением передней межжелудочковой артерии (ПМЖА). Материал и методы. Изучены результаты лечения 320 пациентов, из них 149 была выполнена эндартерэктомия (ЭАЭ) из ПМЖА (группа ЭАЭ), группу АКШ составили 103 больных с локально-проксимальным характером поражения коронарных артерий, группу терапии -68 пациентов, которым было отказано в хирургическом лечении в связи с крайне изменённым дистальным руслом. Средний возраст, пол, сопутствующая патология статистически значимо не раз-личались. Все операции выполнялись в условиях искусственного кровообраще-ния. В 100% случаев для реваскуляризации ПМЖА использовалась левая вну-тренняя грудная артерия. Больным, которым не выполнялось хирургическое лечение, была рекомендована оптимальная медикаментозная терапия. В отдалённом периоде обследовано 127 человек из группы ЭАЭ, 99 человек -из группы АКШ, 58 -из группы терапии. Средний срок наблюдения соста-вил 43,3±23,9 месяца. Результаты. Выживаемость после АКШ в сочетании с ЭАЭ из ПМЖА соста-вила 89,3% (95% доверительный интервал (ДИ) от 83,9 до 94,1%). Аналогич-ный показатель для больных с диффузным атеросклеротическим поражением ПМЖА, получавших только консервативную терапию, составил 70,7% (95% ДИ 60,9-80,5%) (р=0,038). Причинами смерти больных, подвергнутых хирургиче-скому лечению, явилось прогрессирование сопутствующей несердечной патологии. Летальность пациентов, получавших консервативную терапию, связана с кардиальными осложнениями. ИМ за исследуемый период перене-сли 3 больных из группы ЭАЭ и 5 пациентов из группы терапии. Свобода от стенокардии составила 95,7% в группе ЭАЭ и 93,5% в группе АКШ. По дан-ным контрольной коронарошунтографии, функционирование шунтов к арте-риям, подвергнутым ЭАЭ, в отдалённом периоде статистически значимо не отличалось по сравнению с обычным АКШ. Заключение. Результаты АКШ в сочетании с ЭАЭ сопоставимы с результа-тами изолированного АКШ, обеспечивают удовлетворительную выживае-мость и приемлемое качество жизни в отдалённом периоде. АКШ с ЭАЭ у больных с диффузным дистальным атеросклерозом ПМЖА обеспечивает лучший прогноз и качество жизни по сравнению с консервативной терапией и может быть рекомендовано для лечения подобных пациентов. Aim. To assess optimal tactics of treatment of the patients wth diffuse atherosclerotic lesions of left anterior descending artery (LAD). Material and methods.The results of 320 patients studied, of those 149 underwent endarterectomy (EAE) from LAD (the EAE group), and CABG group consisted of 103 patients with locally-proximal type of coronary arteries involvement, therapy group -68 patients, who were refused from surgical treatment due to serious changes of distal part of the arteries. Mean age, gender and concomitant pathology did not significantly differ. All operations were done under the artificial circulation conditions. In 100% cases for LAD revascularization arteria thoracica interna was used. Patients without surgical treatment were recommended optimal drug treatment.I...

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<p><strong>Aim.</strong> Postoperative atrial fibrillation is one of the most frequent complications in cardiac surgery. The aim of this trial was to evaluate the effectiveness of posterior pericardiotomy in the prevention of postoperative atrial fibrillation and pericardial effusion in patients undergoing isolated primary aortic valve replacement.<br /><strong>Methods.</strong> The trial was approved by the local ethics committee. It included adult patients under 70 y.o. who had signed the informed consent for participation in the study and who were planned to undergo isolated primary aortic valve replacement. Exclusion criteria were a history of atrial fibrillation, hyperthyroidism, amiodarone intake, severe chronic obstructive pulmonary disease, left ventricle ejection fraction less than 30%, the size of the left atrium exceeding 50 mm, active infective endocarditis, the presence of adhesions in the pericardium and/or left pleural cavity and mini-sternotomy. From October 2013 to April 2015 607 patients in our clinic underwent different aortic valve procedures. 507 patients were excluded from the study because of the inclusion and exclusion criteria. The remaining 100 patients were randomized into two groups: 49 patients underwent posterior pericardiotomy and 51 patients made up the control group. In both groups the frequency of postoperative atrial fibrillation, pericardial effusion greater than 5 mm, surgery-discharge time, as well as posterior-pericardiotomy-related complications were studied. Trial number: ISRCTN11129539.<br /><strong>Results.</strong> There were no deaths, stroke or cardiac tamponade during the postoperative stay. Neither were there any complications associated with the performance of posterior pericardiotomy. The incidence of atrial fibrillation, pericardial effusion and average duration of the postoperative stay were similar in both groups: 16% in posterior pericardiotomy group vs 14% in the control group (p=0.71), 10% in posterior pericardiotomy group vs 12% in the control group (p=0.80) and 12.4±4.3 days in posterior pericardiotomy group vs 11.9±4.1 days in the control group (p=0.27), respectively.<br /><strong>Conclusion.</strong> The trial did not confirm the effectiveness of posterior pericardiotomy in preventing postoperative atrial fibrillation and pericardial effusion during the in-hospital period after isolated primary aortic valve replacement in low risk patients. However, further investigations are needed.</p><p>Received 1 December 2016. Accepted 14 February 2017.</p><p><strong>Funding:</strong> The trial was carried out within the dissertation research and according to the research calendar of Kuban State Medical University. There was no additional funding except for the resources allocated for postgraduate scholarships.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: V.I. Kaleda, K.O. Barbuhatti.<br />Data collection and analysis: V.I. Kaleda, S.Yu. Boldyrev, S.A. Belash, I.I. Yakuba, S.S. Babeshko, I.A. Belan. <br />Drafting the article: V.I. Kaleda.<br />Critical revision of the article: V.I. Kaleda.<br />Final approval of the version to be published: V.I. Kaleda, S.Yu. Boldyrev, S.A. Belash, I.I. Yakuba, S.S. Babeshko, I.A. Belan, K.O. Barbuhatti.</p><p><strong>Acknowledgements:</strong> The authors would like to express their gratitude to Cand. Sci. (Engineering) V.P. Leonov (“Biometrika”) for assistance in statistical data processing.</p>

Steady growth of patients with diffuse coronary atherosclerosis is a challenge for cardiac surgeons and intervention cardiologists for achieving a full revascularization of myocardium. Considering results of an endarterectomy, more and more surgeons perform reconstructive procedures on coronary arteries without removal the atheromatous plaques. In the literature review various versions of the surgical equipment, perioperative techniques and results of extended segmental plastic surgeries are discussed regarding the patients with diffuse coronary atherosclerosis. The purpose of the present work consists in highlighting changes in reconstructive procedures technique.