Aortocoronary Bypass Surgery in Patients with Recurrent Post-Coronary Stenting Angina

Background. A wide adoption of percutaneous coronary operations has led to an average one-third reduction in the aortocoronary bypass surgery (ACB) rate and altering of the ACB patient profile to mainly represent advanced occlusive coronary atherosclerosis.Materials and methods. The study analyses treatment outcomes in coronary heart disease patients with recurrent angina after a previous endovascular intervention. Over years 2009–2015, 1,023 ACB operations were performed at the Almetyevsk — OAO Tatneft Medical Unit cardiac surgery rooms. Pre-surgery coronary artery stenting (CAS) was rendered at various terms in 96 patients (23 % women, 76 % men; cohort 1). The main cohort (n = 96) was divided into 2 subgroups: IA (n = 64), single CAS; IB (n = 32), multiple CAS patients. For statistical significance, cohort 2 (control) comprised 185 patients (21 % women, 79 % men) to include every 5th history of the remaining 927 patients operated within same period.Results and discussion. The mean aortic occlusion time was shorter in multiple CAS patients vs. other cohorts (61.3 ± 31.2 vs. 72.5 ± 27.8 and 70.7 ± 41.2 min). Cohort 1 had an overall higher emergency resternotomy rate due to ongoing bleeding (7.4 and 8.3 vs. 2.0 %). Furthermore, pre-surgery multiple CAS patients more likely faced the complications of perioperative MI (8.5 vs. 3.1 and 1.4 %) and acute postoperative heart failure (7.2 vs. 2.3 and 1.4 %, p < 0.01). This cohort often required inotropic support (9.3 vs. 3.8 and 2.1 %).Conclusion. Statistical analysis revealed a significantly higher complication and mortality rate in patients with previous coronary stenting compared to ACB patients. Adverse ACB outcomes were observed with multiple-coronary stenting cases, in contrast to the cohort with no pre-surgery interventions.

Tolerance to physical activity and mental performance of patients in the second stage of rehabilitation after aortocoronary bypass surgery

The article is devoted to the study of the dynamics of the restoration of physical activity tolerance (PAT), cognitive functions and mental performance (MP) in patients who completed the program of cardiac rehabilitation after aortocoronary bypass surgery. The results of the study showed that for the majority of patients before inclusion in the program of cardioresistance, PAT and MP indicators were reduced, mild and moderate cognitive impairment was detected. At the end of the rehabilitation program, the normalization of PAT was noted in 80% of patients, there were no signs of cognitive impairment in 60% of patients. The indicators of MP corresponded to the norm in the majority of those surveyed. Thus, the majority of patients who completed the program of cardiac rehabilitation II stage after aortocoronary shunting achieved restoration of cognitive functions, MP and physical performance.

Application of decision trees to select the method of cardioplegia in the aortocoronary bypass surgery

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