Myocardial revascularization in elderly patients with severe myocardial insufficiency

Shevchenko Yu.L., Musaev I.A., Borshchev G.G., Zainiddinov F.A., Ulbashev D.S.

Coronary heart disease (CHD) is widespread among the elderly. More than 75% of all deaths from CHD occur at the age of 65 years and older. The choice of the optimal method of myocardial revascularization in this category of patients remains a debated issue. The widespread and diffuse damage of the coronary arteries, decrease in the ejection fraction make CABG the only acceptable operation for a large part of elderly and senile patients. The article demonstrates the results of treatment of patients by direct myocardial revascularization (CABG), supplemented by the innovative method of stimulation of extracardial neoangiogenesis YurLeon III.

Aim. Comprehensive assessment of the clinical application of the proposed method in elderly patients with reduced heart function in the immediate and long-term postoperative period

Materials and methods. The study group included 96 patients. All patients underwent coronary bypass surgery. Patients were divided into 2 groups: group I — traditional surgical myocardial revascularization (n = 49). Group II — CABG, supplemented by the YurLeon III (n = 47). The study included telephone interviews. In the long-term period we determined changes in angina pectoris, a 6-minute walk test, indices of Echocardiography and myocardial scintigraphy.

Results. CABG supplemented with the YurLeon III does not lead to intraoperative and long-term postoperative complications associated with the method itself (p>0.05). Significant differences were found in patients after CABG+YurLeon III in contrast to the group with isolated direct myocardial revascularization after 1 year: decrease in angina pectoris 0.6±0.5 (CABG+YurLeon III), 1.2±0.7 (CABG)(p<0.05); increase in 6-minute walk test scores: 400±17m (CABG+Yurleon III), 352±16m (CABG)(p<0.05), EF: 54.87±1.14% (CABG+Yurleon III), 50.59±1.95% (CABG)(p<0.05). SRS: 1.57±1.52% (CABG+Yurleon III), 6.68±7.77% (CABG) (p<0.05).

Conclusion. Coronary artery bypass grafting, supplemented by the YurLeon III is a clinically safe technique of myocardial revascularization in elderly patients with coronary artery disease with reduced left ventricular function. Long-term results after CABG+Yurleon III differ favorably from the results after isolated CABG in this category of patients.

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