Authors
Shevchenko Yu.L., Katkov A.A., Ulbashev D.S., Miminoshvili L.G.
St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow
Abstract
Diffuse coronary artery disease is a complex clinical problem that requires an individual approach to the choice of treatment tactics. The technique of stimulation of extracardiac myocardial vascularization "YurLeon" from a minimally invasive approach is a promising alternative for patients with severe diffuse coronary artery disease and high surgical risk, who cannot undergo complete myocardial revascularization. This article presents comparative results between surgical treatment tactics (YurLeon technique) and conservative therapy (OMT) in patients with diffuse coronary artery disease.
Aim: to evaluate the clinical effectiveness of minimally invasive stimulation of extracardiac myocardial vascularization (YurLeon method) in patients with coronary heart disease and diffuse coronary artery disease in comparison with conservative treatment.
Materials and methods. The prospective study included 63 patients with diffuse coronary artery disease, 41 (65,1%) men, 22 (34,9%) women, aged 65 to 80 years, average age 74.03±3.2 years, who were treated at the St. George Thoracic and Cardiovascular Surgery Clinic of the N.I. Pirogov National Medical and Surgical Center of the Ministry of Health of the Russian Federation. Patients were divided into two groups: Group I (n=21) – minimally invasive stimulation of extracardiac myocardial vascularization (YurLeon method); Group II (n=42) – conservative therapy. The functional class (FC) of angina, echocardiography, single-photon emission computed tomography of the myocardium synchronized with ECG, and quality of life indicators (HeartQol questionnaire) were assessed.
Results. After 12 months, in group I, compared with group II, there was a decrease in FC III-IV angina (group I - FC III from 76.2% to 42.9% (p (group I) = 0.008), FC IV from 23.8% to 4.8% (p (group I) = 0.045); group II - FC III from 81.0% to 85.7% (p (group II) = 0.157), FC IV from 7.1% to 2.4% (p (group II) = 0.157), (p (groups I-II) = 0.003)) and a significant increase in FC II angina in group I - FC II from 0% to 42.9%, (p = 0.027); an increase in the left ventricular ejection fraction (EF) in group I from 30[28-33]% to 39[35-43]% (p(group I) <0.001) compared to group II EF from 33[30-36]% to 37[37-41.75]% (p(group II) <0.001), (p(groups I-II)=0.042). According to myocardial scintigraphy data, a decrease in the volume of hibernated myocardium was noted in group I from 25[20-35]% to 9[7-15]% (p(group I) <0.001) compared to group II – from 15[12-18]% to 15[12-20]% (p(group II)=0.076), (p(groups I-II) <0.001). In the observed patients, after 12 months, the quality of life indicators according to the PF (physical subscale) of the HeartQol questionnaire differed: in group I from 1.00 [0.90-1.60] points to 1.80 [1.10-1.90] points (p (group I) <0.001), in group II from 1.00 [1.00-1.40] points to 1.25 [1.00-1.58] points (p (group II) <0.012), (p (groups I-II) = 0.004).
Conclusion. Based on the data obtained, it can be concluded that minimally invasive stimulation of extracardiac myocardial vascularization (YurLeon method) in patients with coronary heart disease and diffuse coronary artery disease with reduced myocardial contractile function improves the clinical condition of patients, provides high quality of life indicators, increases left ventricular EF and allows for additional blood supply to the myocardium in the late postoperative period.
Keywords: ischemic heart disease, diffuse coronary artery disease, minimally invasive extracardiac myocardial vascularization, YurLeon method.
References
1. Shevchenko YuL, Borshchev GG. Extracardial revascularization of the myocardium in patients with coronary artery disease with diffuse lesions of the coronary bed. – M.: Publishing House of NMHC named after N.I. Pirogov, 2022. (In Russ.)
2. Prestipino F, Spadaccio C, Nenna A, et al. Off-pump coronary artery bypass grafting versus optimal medicaltherapy alone: effectiveness of incomplete revascularization in high risk patients. J Geriatr Cardiol. 2016; 13(1): 23-30. doi: 10.11909/j.issn.1671 5411.2016.01.008.
3. Ganyukov VI, Tarasov RS, Shilov AA, et al. Mini-invasive hybrid myocardial revascularization in multivessel lesions of the coronary bed. The current state of the matter. Kompleksnyye problemy serdechno-sosudistykh zabolevaniy. 2016; 4(2): 46-50. (In Russ.) doi: 10.17802/2306-1278-2016-2-46-50.
4. Tarasov RS, Ivanov SV, Kazantsev AN, et al. The hospital results of various strategies for the surgical treatment of patients with combined lesion of the coronary bed and internal carotid arteries. Kompleksnyye problemy serdechno-sosudistykh zabolevaniy. 2016; 4(5): 15-24. (In Russ.) doi: 10.17802/2306-1278-2016-4-15-24.
5. Akchurin RS, Shiryaev AA, Vasiliev VP, et al. Diffuse coronary artery lesion in coronary surgery (analytical review). Clinical and experimental surgery. The journal named after Academician B.V. Petrovsky. 2018; 6(4): 75-81. (In Russ.) doi: 10.24411/2308-1198-2018-14011.
6. Belash SA, Barbuhatti KO, Shevchenko SS, et al. Long-term results of myocardial revascularization in combination with endarterectomy in diffuse coronary atherosclerosis. Thoracic and cardiovascular surgery. 2021; 3(63): 188-194. (In Russ.) doi: 10.24022/0236-2791-2021-63-3-188-194.
7. Kurbanov SK, Vlasova EE, Salichkin DV, et al. Hospital and annual results of coronary bypass surgery in diffuse coronary artery disease. Cardiological Bulletin. 2019; 14(1): 60-66. (In Russ.) doi: 10.17116/Cardiobulletin20191401160.
8. Dourado LOC, Bittencourt MS, Pereira AC, et al. Coronary Artery Bypass Surgery in Diffuse Advanced Coronary Artery Disease: 1-Year Clinical and Angiographic Results. Thorac Cardiovasc Surg. 2018; 66(6): 477-482. doi: 10.1055/s-0037-1601306.
9. Shevchenko YuL, Borshchev GG, Ulbashev DS. Long-term results of coronary bypass surgery, supplemented by surgical stimulation of extracardial myocardial vascularization, in patients with diffuse coronary lesion. Complex problems of cardiovascular diseases. 2023; 12(1): 160-171. (In Russ.) doi: 10.17802/2306-1278-2023-12-1-160-171.
10. Shevchenko YuL, Baykov VYu, Borshchev GG, et al. Minimally invasive thoracoscopic technique for stimulation of extracardial myocardial vascularization by the YurLeon method in diffuse coronary artery disease in coronary artery disease. Bulletin of the NMHC named after N.I. Pirogov. 2022; 17(2): 103-106. (In Russ.) doi: 10.25881/20728255_2022_17_2_103.
11. Shevchenko YuL. The effect of extracardial myocardial revascularization (YurLeon) on the long-term results of surgical treatment of patients with coronary heart disease. Cardiological Bulletin. 2023; 18: 164. (In Russ.)
12. Shevchenko YuL, Borshchev GG. Effect of extracardial myocardial revascularization on long-term results of surgical treatment of patients with coronary heart disease. The 12th Annual International Congress of Cardiology-2023. Lisbon, Portugal. 17-19 July 2023.
13. Shevchenko YuL, Katkov AA, Ermakov DYu, Ulbashev DS, Vakhrameeva AYu. The results of surgical treatment of patients with coronary artery disease and diffuse coronary artery disease. Bulletin of Pirogo v National Medical & Surgical Center. 2024; 19(3): 4-9. (In Russ.) doi: 10.25881/20728255_2024_19_3_4.
14. Borshchev GG, Miminoshvili LG, Zainiddinov FA, Katkov AA, Ulbashev DS. Comparative evaluation of results of coronary bypass surgery in combination with extracardial myocardial revacularization in patients with diffuse coronary artery disease. Bulletin of Pirogov National Medical & Surgical Center. 2024; 19(2): 19-25. (In Russ.) doi: 10.25881/20728255_2024_19_2_19.
15. Shevchenko YuL, Borshchev GG, Katkov AA, Zainiddinov FA, Sidorov RV, Omarov AL. Extracardial stimulation of myocardial vascularization in patients with coronary artery disease with diffuse coronary lesion using a minimally invasive hybrid surgical principle. Bulletin of Pirogov National Medical & Surgical Center. 2024; 19(1): 4-8. (In Russ.) doi: 10.25881/20728255_2023_19_1_4.
