DOI: 10.25881/20728255_2022_17_2_17


Shevchenko Yu.L.1, Musaev I.A.1, Borshchev G.G.1, Sidorov R.V.2

1 St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow

2 Rostov State Medical University, Rostov-on-Don


Coronary heart disease occupies a dominant place among the causes of morbidity and mortality in the Russian Federation, and elderly patients account for more than 75% of all deaths. Surgical treatment of elderly patients with CHD with reduced cardiac ejection fraction presents various difficulties, they require an individual approach, attempts to treat such patients with conventional methods lead to an aggravation of the course of the disease and the development of complications. The problem of choosing the tactics of revascularization and determining a sufficient amount of surgery remains relevant at the present time.

Objective: to evaluate the effectiveness of the strategy of minimally sufficient surgical revascularization and its complement by stimulating extracardial neoangiogenesis in elderly patients with coronary heart disease with a reduced left ventricular ejection fraction.

Results. In the group of patients with limited revascularization and surgery without extracorporeal circulation, the most pronounced positive results were noted compared to other groups: a decrease in angina pectoris after 12 months from 3.2±0.3 to 1.5±0.3 (p<0.05); an increase in exercise tolerance — pain-free walking distance from 317±14 to 415±13 meters (p<0.05); increase in cardiac ejection fraction from 44.4±4.1% to 55.6±1.9% (p<0.05); improvement of myocardial perfusion by cardiac scintigraphy with 99mTc-technetril — decrease in SRS from 19.4±7.0 to 2.4±0.6 points (p<0.05); as well as improving the quality of life in the long-term postoperative period.

Conclusion. In elderly patients with reduced cardiac ejection fraction and diffuse lesions of the coronary bed, it is effective strategy to limit the scope of the operation and supplement it with the method of induction of extracardial neoangiogenesis.

Keywords: elderly patients, incomplete revascularization, coronary bypass surgery, the YurLeon.


1. Shevchenko YuL, Borisov IA, Hubulava GG, et al. Pryamaya revaskulyarizaciya miokarda u pacientov pozhilogo vozrasta. Byulleten’ NCSSKHim. A.N. Bakuleva RAMN: Serdechno-sosudistye zabolevaniya. 2000; 2. (In Russ).

2. Sidorov RV, BazilevichA.V., Katkov AA, et al. Maloinvazivnaya koronarnaya hirurgiya: obzor sovremennyh metodik hirurgicheskogo lecheniya ishemicheskoj bolezni serdca. Vestnik NMHC im. N.I. Pirogova. 2021; 3(16): 84-88. (In Russ). doi: 10.25881/20728255_2021_16_3_84.

3. Lazebnik LB, Kuznecov OO, KonevYu.V. Ishemicheskaya bolezn’ serdca u pozhilyh. Moscow: Anaharsis, 2003 (In Russ).

4. Uryuzhnikov VV, Zhbanov IV, Galimov NM, et al. Osobennosti hirurgicheskogo lecheniya bol’nyh ishemicheskoj bolezn’yu serdca pozhilogo i starcheskogo vozrasta. Hirurgiya. Zhurnalim. N.I. Pirogova. 2020; (2): 5-12. (In Russ).

5. Shevchenko YuL, Zajniddinov FA, Borshchev GG, et al. Kachestvo zhizni bol’nyh IBS s diffuznym porazheniem koronarnogo rusla v raznye sroki posle AKSH, dopolnennogo metodikoj YurLeon. Vestnik NMHC im N.I. Pirogova. 2021; 16(4): 30-35. (In Russ). doi: 10.25881/20728255_2021_16_4_30.

6. Shevchenko YuL, Zajniddinov FA, Borshchev GG, et al. Rezul’taty kompleksnogo hirurgicheskogo lecheniya pacientov s ishemicheskoj bolezn’yu serdca. Klinicheskaya medicina. 2020; 98(11-12): 766-771. (In Russ). doi:10.30629/0023-2149-2020-98-11-12-766-771.

7. Semchenko AN, Zajcev IV, Shevchenko AM, et al. Vliyanie nepolnoj revaskulyarizacii na rezul’taty koronarnogo shuntirovaniya u bol’nyh ishemicheskoj bolezn’yu serdca. Patologiya krovoobrashcheniya i kardiohirurgiya. 2021; 25(1): 74-84. (In Russ).

8. Tarasov RS, Kazancev AN, Shabaev IF, et al. Rezul’taty celesoobraznoj nepolnoj revaskulyarizacii miokarda s ispol’zovaniem miniinvazivnoj i standartnoj tekhniki koronarnogo shuntirovaniya. Rossijskij kardiologicheski jzhurnal. 2018; 23(7): 47-52. (In Russ).

9. Girerd N, Magne J, Rabilloud M, et al. The impact of complete revascularization on long-term survival is strongly dependent on age. Ann Thorac Surg. 2012; 94(4): 1166-72.

10. Leviner DB, Torregrossa G, Puskas JD. Incomplete revascularization: what the surgeon needs to know. Ann Cardiothorac Surg. 2018; 7(4): 463-469.

11. Mathisen L, Lingaas PS, Andersen MH, et al. Changes in cardiac and cognitive function and self-reported outcomes at one year after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2010; 140(1): 122-8.

12. Rastan AJ, Walther T, Falk V, et al. Does reasonable incomplete surgical revascularization affect early or long-term survival in patients with multivessel coronary artery disease receiving left internal mammary artery bypass to left anterior descending artery? Circulation. Sep 2009; 120(11): S70-7.

13. BorshchevG.G. Izolirovannoe shuntirovanie perednej mezhzheludochkovoj arterii bez iskusstvennogo krovoobrashcheniya u pacientov s vysokim hirurgicheskim riskom. [dissertation] Moscow; 2016. (In Russ).

14. Zajniddinov FA, Borshchev GG, Ul’bashev DS, et al. Stanovlenie metodov ekstrakardial’noj revaskulyarizacii miokarda pri ishemicheskoj bolezni serdca (istoriya voprosa).Vestnik Smolenskoj medicinskoj akademii. 2022; 21(1): 101-111. (In Russ). doi: 10.37903/vsgma.2022.1.14.

15. Borshchev GG. Kompleksnaya revaskulyarizaciya miokarda so stimulyaciej ekstrakardial’nogo angiogeneza u bol’nyh s IBS s diffuznym porazheniem koronarnogo rusla. [dissertation] Moscow; 2019. (In Russ).

16. Shevchenko YuL, Zajniddinov FA, Ul’bashev DS. Stimulyaciya ekstrakardial’noj revaskulyarizacii pri koronarnom shuntirovanii u bol’nyh IBS s diffuznym porazheniem venechnogo rusla. Vestnik Avicenny. 2021; 23(3): 462-472. (In Russ). doi: 10.25005/2074-0581-2021-23-3-462-472.

17. Shevchenko YuL, Zajniddinov FA, Musaev IA, et al. Revaskulyarizaciya miokarda u pozhilyh pacientov so snizhennoj funkciej serdca. Vestnik NMHC im N.I. Pirogova. 2020; 15(4): 12-18. (In Russ). doi: 10.25881/BPNMSC.2020.22.25.002.

18. Shevchenko YuL, Zajniddinov FA, Borshchev GG, et al. Koronarnoe shuntirovanie v sochetanii s metodikoj nepryamoj revaskulyarizacii miokarda u pacientov s IBS. Vestnik NMHC im. N.I. Pirogova. 2020; 15(4): 130-134. (In Russ). doi: 10.25881/BPNMSC.2020.37.95.023.

19. Généreux P, Campos CM, Farooq V, et al. Validation of the SYNTAX revascularization index to quantify reasonable level of incomplete revascularization after percutaneous coronary intervention. Am J Cardiol. 2015; 116(2): 174-86.

For citation

Shevchenko Yu.L., Musaev I.A., Borshchev G.G., Sidorov R.V. The strategy of minimally sufficient surgical revascularization in the treatment of elderly patients with coronary artery disease and reduced cardiac ejection fraction. Bulletin of Pirogov National Medical & Surgical Center. 2022;17(2):17-22. (In Russ.)