Authors
Shevchenko Yu.L., Katkov A.A., Ulbashev D.S., Ermakov D.Yu.
St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow
Abstract
In modern cardiac surgery practice, there is a significant increase in the number of patients with diffuse multivessel coronary artery disease, which is due to a combination of factors, including the widespread introduction of endovascular revascularization methods, prolonged drug therapy and the expansion of surgical indications. To optimize the treatment of this category of patients, in 2007, Academician Yu.L. Shevchenko proposed an innovative method for stimulating extracardial neoangiogenesis (“YurLeon”), which has received widespread clinical application.
Aim. To evaluate the clinical efficacy of hybrid myocardial revascularization using the «YurLeon» and percutaneous coronary intervention in patients with coronary artery disease with diffuse coronary artery disease.
Materials and methods. The study included 77 patients with diffuse coronary artery disease who were treated at the St. George Thoracic and Cardiovascular Surgery Clinic at the N.I. Pirogov National Medical and Surgical Center. 64.9% of them were men (n = 50), the median age was 72.00 years (68.00–75.00). Group I (n = 37) – patients who underwent hybrid revascularization (PCI+YurLeon); group II (n = 40) – control (isolated PCI). Clinical data, EchoCG, gated-SPECT, coronary angiography, and quality of life assessment (SAQ-7 questionnaire) were evaluated.
Results. The results of a 12-month follow-up demonstrated a significant improvement in the left ventricular ejection fraction from 49% to 58% (p<0.001), a decrease in the volume of hibernated myocardium by 44.4% (from 18% to 10%), (p<0.001) and an improvement in the functional class of angina pectoris in the PCI+YurLeon group. In 67.6% of patients in this group, functional class I–II angina pectoris was achieved. There was a significant improvement in the quality of life in group I patients (p<0.001).
Conclusion. The results of the study confirm the prospects of hybrid myocardial revascularization (PCI+YurLeon) in the treatment of patients with diffuse coronary artery disease, while the developed algorithms for patient selection and stratification according to expected effectiveness make it possible to optimize the use of this technique in clinical practice.
Keywords: ischemic heart disease, hybrid myocardial revascularization, YurLeon, percutaneous coronary interventions.
References
1. Barbarash OL, Karpov YuA, Panov AV, Akchurin RS, et al. Stable coronary heart disease. Clinical guidelines 2024. Russian Journal of Cardiology. 2024;29(9):6110. (In Russ.) doi: 10.15829/1560-4071-2024-6110.
2. Simonetto C, Rospleszcz S, Kaiser JC, Furukawa K. Heterogeneity in coronary heart disease risk. Sci Rep. 2022; 12(1): 10131. doi: 10.1038/s41598-022-14013-3.
3. The World Health Organization. Newsletter: Cardiovascular diseases. Available at: https://www.who.int/ru/health-topics/cardiovascular-diseases#tab=tab_1. Accessed 04.28.2025. (In Russ.)
4. Shevchenko YuL. Cardiovascular surgery is an indicator of the development of medical science and healthcare in the country: the main development trends. Corporate health and industrial medicine. 2024; 1(1): 8-19. (In Russ.)
5. Akchurin RS, Shiryaev AA, Vasilev VP, Galyautdinov DM, Vlasova EE. Sovremennye tendencii v koronarnoj hirurgii. Patologiya krovoobrashcheniya i kardiohirurgiya. 2017; 21(3S): 34-44. (In Russ.)
6. Petrovskii DV, Vasiliev VP, Vlasova EE, Latypov RS, et al. In-hospital results of coronary artery bypass grafting in patients with coronary artery disease and unverified distal coronary bed. Russian Cardiology Bulletin. 2025; 20(1): 81-89. (In Russ.) doi: 10.17116/Cardiobulletin20252001181.
7. Patent RUS №2758024/05.03.2021. Shevchenko YuL. Method of induction of extracardial myocardial revascularization in patients with coronary heart disease. an Federation. (In Russ.)
8. Shevchenko YuL, Borshchev GG, Bagaudin TZ, Maslennikov MA, Zainiddinov FA. On the role of extracardial vascularization and intramyocardial collaterals in patients with coronary artery disease. Bulletin of the National Medical and Surgical Center named after N.I. Pirogov. 2024; 19(2): 94-100. (In Russ.) doi: 10.25881/20728255_2024_19_2_94.
9. Shevchenko YuL, Borshchev GG. Extracardial myocardial revascularization in patients with coronary artery disease and diffuse coronary artery disease. Moscow: National Medical and Surgical Center named after N.I.Pirogov; 2022. (In Russ.)
10. Shevchenko YuL, Borshchev GG, Fomina VS, Kim KF. Investigation of vascular endothelial growth factor in patients with coronary artery disease undergoing coronary bypass surgery. Genes and cells. 2019; 13(4): 68-71. (In Russ.) doi: 10.23868/201903009.
11. Shevchenko YuL, Borshchev GG, Miminoshvili LG. Surgical treatment of patients with coronary artery disease in combination with extracardial myocardial vascularization techniques. Bulletin of the National Medical and Surgical Center named after N.I. Pirogov. 2024; 19(2): 101-107. (In Russ.) doi: 10.25881/20728255_2024_19_2_10.
12. Shevchenko YuL, Borshchev GG, Ulbashev DS, Vakhromeeva MN, Vakhrameeva AYu. Scintigraphy after Various Methods of Myocardial Revascularization. Journal of Cardiology Research and Reports. 2020; 2(2): 1-6. doi: 10.31579/2692-9759/007.
13. Chan PS, Jones PG, Arnold SA, Spertus JA. Development and validation of a short version of the Seattle angina questionnaire. Circ Cardiovasc Qual Outcomes. 2014; 7(5): 640-7. doi: 10.1161/CIRCOUTCOMES.114.000967.
