Transmyocardial laser revascularization combined with coronary artery bypass grafting in patients with the ischemic heart disease having diffuse changes in their coronary arteries

Purpose. To compare surgical outcomes when analyzing the dynamics at the microvascular level. Material and methods. Outcomes of 831 surgeries for coronary artery bypass grafting (CABG) in patients with ischemic heart disease (IHD) have been evaluated. The studied patients were divided into three groups: CABG in patients without any diffuse lesions of coronary arteries (group I - 711 patients), CABG in patients with diffuse lesions of coronary arteries (group II - 33 patients) and CABG plus transmyocardial laser revascularization (TMLR) in patients with diffuse changes in coronary arteries (group III - 87 patients). The assessed findings were obtained with intraoperative EchoCG and coronary shuntography, analyses of cardiac enzymes (CPK and CPK-MB) as well as intra- and postoperative indexes which reflected patients’ state. Results. The critical spasm of coronary arteries in group I was seen in 1.7% of cases, in group II - in 33.3%, in group III - in 1.15%. As far as the patients from group I and group II were differed only by the presence or absence of diffuse changes of their coronary arteries, it appears that the critical spasm develops (and/or worsens) mostly in patients with diffuse changes of coronary arteries. The only difference in patients from group II and III was the volume of surgery, so the obtained findings indicate that TMLR in addition to CABG prevents developing the critical spasm in coronary arteries. Conclusion. The risk of intraoperative spasm in coronary arteries is predisposed by diffuse changes in coronary arteries, including those at the microvascular level. TMLR performed in addition to CABG in patients with IHD and diffuse lesions in their coronary arteries improves bypass patency and increases blood flow in coronary arteries.

трансмиокардиальная лазерная реваскуляризация, аортокоронарное шунтирование, диффузное поражение коронарных артерий, transmyocardial laser revascularization, coronary artery bypass, diffuse lesions in coronary arteries

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