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Post a Comment Results of a six-year prospective study of surgical treatment of patients with combined atherosclerosisof coronary and brachiocephalic arteries based on differentiated approach
- Authors: Marchenko A.V.1,2, Vronskiy A.S.1,2, Myalyuk P.A.1, Oborin A.A.2, Minasyan V.N.1,2, Lazarkov P.V.1, Sinelnikov Y.S.1,2
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Affiliations:
- S.G. Sukhanov Federal Center for Cardiovascular Surgery
- E.A. Vagner Perm State Medical University
- Issue: Vol 38, No 5 (2021)
- Pages: 35-48
- Section: Original studies
- URL: https://bakhtiniada.ru/PMJ/article/view/77405
- DOI: https://doi.org/10.17816/pmj38535-48
- ID: 77405
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Abstract
Objective. To present the results of surgical treatment of patients with multifocal atherosclerosis based on a differential approach of surgical strategy.
Materials and methods. During the period of 2014–2021 in the S.G. Sukhanov Federal Center for Cardiovascular Surgery, Perm, we operated 243 patients with combined atherosclerosis of coronary and carotid arteries; 104 (42.8 %) patients underwent a one-stage coronary and carotid artery surgeries, and 139 (57.2 %) patients underwent a staged correction of pathology. Critical lesion of the coronary arteries was revealed in 16 (6.6 %) patients, single-vessel critical lesion – in 24 (9.9 %), two-vessel and three-vessel critical lesion was detected in 87 (35.8 %) and 79 (32.5 %) patients, respectively. 145 (59.7 %) patients had a critical lesion of the carotid arteries, and 16 (6.58 %) had a bilateral critical lesion. We have developed an algorithm for choosing treatment tactics in patients with concomitant atherosclerotic lesions of the coronary and carotid arteries. Depending on our differential approach, we selected 104 (42.8 %) patients who underwent a one-stage surgery, and 139 (42.8 %) patients who were subjected to a staged treatment.
Results. A total hospital mortality was 0 %. In the staged group, 1 case of transitory ischemic attack (TIA) (0.7 %) was recorded, in the group of combined interventions there was no TIA. In the group of combined interventions, there were 3 (2.9 %) cases of the perioperative stroke and 1 (0.9 %) case of myocardial infarction. In the group that underwent staged interventions, there were 2 (1.4 %) cases of perioperative stroke and 2 (1.4 %) cases of myocardial infarction. Both groups had similar combined results (death, acute MI, stroke) – 5 (3.6 %) for the staged group and 4 (3.8 %) for the combined one. There was no significant difference in any of the endpoints.
Conclusions. The proposed approach to the choice of techniques for treatment of combined lesions of the carotid and coronary arteries based on the differential approach is safe and permits to adequately eliminate the lesions.
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##article.viewOnOriginalSite##About the authors
A. V. Marchenko
S.G. Sukhanov Federal Center for Cardiovascular Surgery; E.A. Vagner Perm State Medical University
Email: ASVronskiy@gmail.com
MD, PhD, Deputy Chief Physician, Associate Professor, cardiovascular surgeon
Russian Federation, Perm; PermAlexey S. Vronskiy
S.G. Sukhanov Federal Center for Cardiovascular Surgery; E.A. Vagner Perm State Medical University
Author for correspondence.
Email: asvronskiy@gmail.com
ORCID iD: 0000-0002-0465-8964
postgraduate student, cardiovascular surgeon
Russian Federation, Perm; PermP. A. Myalyuk
S.G. Sukhanov Federal Center for Cardiovascular Surgery
Email: ASVronskiy@gmail.com
Candidate of Medical Sciences, cardiovascular surgeon
Russian Federation, PermA. A. Oborin
E.A. Vagner Perm State Medical University
Email: ASVronskiy@gmail.com
resident
Russian Federation, PermV. N. Minasyan
S.G. Sukhanov Federal Center for Cardiovascular Surgery; E.A. Vagner Perm State Medical University
Email: ASVronskiy@gmail.com
cardiovascular surgeon
Russian Federation, Perm; PermP. V. Lazarkov
S.G. Sukhanov Federal Center for Cardiovascular Surgery
Email: ASVronskiy@gmail.com
cardiovascular surgeon
Russian Federation, PermYu. S. Sinelnikov
S.G. Sukhanov Federal Center for Cardiovascular Surgery; E.A. Vagner Perm State Medical University
Email: ASVronskiy@gmail.com
MD, PhD, Chief Physician, Associate Professor, cardiovascular surgeon
Russian Federation, Perm; PermReferences
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