ПРЕИМУЩЕСТВА ПРИМЕНЕНИЯ СЕКВЕНЦИАЛЬНЫХ И КОМПОЗИТНЫХ ШУНТОВ ПРИ РЕВАСКУЛЯРИЗАЦИИ МИОКАРДА У БОЛЬНЫХ ВЫСОКОГО РИСКА

Introduction. The change in the typical “profile” of the patient in recent decades (older patients, patients with a large number of concomitant pathologies, repeated revascularization, lack of sufficient conduits due to the presence of peripheral arterial and/or venous pathology) forces surgeons to change (adapt) the surgical technique in the direction of greater use of sequential and composite grafts for myocardial revascularization. This problem remains poorly understood in patients with high surgical risk. Material and methods. In the Department of Cardiac Surgery of the Republican Specialized Scientific and Practical Medical Center of Cardiology, during the period April 2015-January 2018, 70 off-pump CABG procedures were performed with the use of composite and/or sequential shunting techniques. Patients were divided into 2 groups depending on the value of the risk-stratification calculator EuroScore: I group - 30 (42.8%) patients with EuroScore≥5 and II group - 40 (57.2%) patients with EuroScore <5. Results. The average duration of the operation was about 224 minutes in group I and 218 minutes in group II. In both groups, the left internal thoracic artery was used in all patients. The average number of distal anastomoses per patient was 3.7 and 3.6, respectively, in Groups I and II. There were no cases of mortality in both groups. Differences in the groups by the level of complications and mortality were not noted. Conclusions. The use of the technique of sequential and composite grafting for off-pump myocardial revascularization in high risk patients is safe and effective from the point of view of immediate results of operations. Further accumulation of clinical material is required to study the long-term results of these operations.