kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2025-14-6-182-193kpccz-1546Research ArticleОНЛАЙН. ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ. Сердечно-сосудистая хирургияONLINE. ORIGINAL STUDIES. Cardiovascular surgeryКОРОНАРНОЕ ШУНТИРОВАНИЕ НА РАБОТАЮЩЕМ СЕРДЦЕ И В УСЛОВИЯХ ИСКУССТВЕННОГО КРОВООБРАЩЕНИЯ У ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА И СОЧЕТАННЫМ ПОРАЖЕНИЕМ КЛАПАНА СЕРДЦАOFF-PUMP CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH CORONARY HEART DISEASE AND CONCOMITANT VALVULAR HEART DISEASEhttps://orcid.org/0000-0001-9831-5868ЗаракушевКазбулат РафиковичZarakushevKazbulat R.

аспирант кафедры сердечно-сосудистой хирургии Института профессионального образования федерального государственного автономного образовательного учреждения высшего образования «Первый Московский государственный медицинский университет имени И.М. Сеченова» Министерства здравоохранения Российской Федерации, Москва, Российская Федерация

Postgraduate Student of the Department of Cardiovascular Surgery at the Institute of Professional Education of the Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation

kazbulat07@mail.ruhttps://orcid.org/0000-0002-3904-6415КомаровРоман НиколаевичKomarovRoman N.

доктор медицинских наук, профессор заведующий кафедрой сердечно-сосудистой хирургии Института профессионального образования федерального государственного автономного образовательного учреждения высшего образования «Первый Московский государственный медицинский университет имени И.М. Сеченова» Министерства здравоохранения Российской Федерации, Москва, Российская Федерация

PhD, MD, Professor, Head of the Department of Cardiovascular Surgery at the Institute of Professional Education of the Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation

https://orcid.org/0000-0003-4094-8771ТлисовБорис МагометовичTlisovBoris M.

кандидат медицинских наук врач – сердечно-сосудистый хирург отделения кардиохирургии Университетской клинической больницы № 1 федерального государственного автономного образовательного учреждения высшего образования «Первый Московский государственный медицинский университет имени И.М. Сеченова» Министерства здравоохранения Российской Федерации, Москва, Российская Федерация

PhD, Doctor of Cardiovascular Surgery, Department of Cardiac Surgery at the Educational Clinical Hospital № 1 of the Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation

https://orcid.org/0009-0003-5588-4923СейфатоваНасиба БаходировнаSeifatovaNasiba B.

ординатор первого года специальности «Кардиология» федерального государственного бюджетного учреждения «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Министерства здравоохранения Российской Федерации, Москва, Российская Федерация

1st year resident in Cardiology, A.N. Bakulev National Medical Research Center for Cardiovascular Surgery of the Russian Ministry of Health, Moscow, Russian Federation

Федеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М. Сеченова» Министерства здравоохранения Российской ФедерацииРоссияFederal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian FederationRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Министерства здравоохранения Российской ФедерацииРоссияA.N. Bakulev National Medical Research Center for Cardiovascular Surgery of the Russian Ministry of HealthRussian Federation202530122025146182193Copyright © Заракушев К.Р., Комаров Р.Н., Тлисов Б.М., Сейфатова Н.Б., 20252025Заракушев К.Р., Комаров Р.Н., Тлисов Б.М., Сейфатова Н.Б.Zarakushev K.R., Komarov R.N., Tlisov B.M., Seifatova N.B.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/1546Основные положения

Основные положения

Актуальность исследования обусловлена высокой значимостью оптимизации хирургических подходов к лечению пациентов с ишемической болезнью сердца и сочетанным поражением клапанов. Сравнение методик реваскуляризации миокарда на работающем сердце и в условиях искусственного кровообращения позволяет определить тактику, обеспечивающую снижение интраоперационных рисков (сокращение времени пережатия аорты и искусственного кровообращения), уменьшение потребности в трансфузии крови, сокращение продолжительности операции и госпитализации, что в совокупности повышает безопасность вмешательства и улучшает результаты лечения данной сложной категории больных.

 

 

Цель

Цель. Сравнить результаты реваскуляризации миокарда на работающем сердце и в условиях искусственного кровообращения (ИК) у пациентов с ишемической болезнью сердца и сочетанным поражением аортального (АК) и митрального (МК) клапанов.

Материалы и методы

Материалы и методы. В исследование включены 132 пациента с ишемической болезнью сердца и сочетанным поражением клапана, которым одномоментно выполнены коронарное шунтирование (КШ) и коррекция порока клапана. Пациенты были разделены на четыре группы: КШ в условиях ИК и коррекция АК (n = 36) или МК (n = 31); КШ на работающем сердце и коррекция АК (n = 36) или МК (n = 29).

Результаты

Результаты. КШ на работающем сердце, в сравнении с таковым под контролем ИК, продемонстрировало ряд преимуществ: сокращение времени пережатия аорты (АК: 106,4 ± 25,1 против 83,3 ± 24,7 мин, МК: 115,6 ± 21,9 против 84,07 ± 21,3 мин; p < 0,05), снижение длительности ИК (АК: 139,4 ± 26,8 против 123,5 ± 25 мин, МК: 166,2 ± 32,7 против 133,2 ± 34,9 мин; p < 0,05), сокращение общей продолжительности операции (АК: 336,1 ± 66,4 против 306,4 ± 71 мин, МК: 352,5 ± 100,7 против 298,1 ± 84 мин; p < 0,05). Также отмечена меньшая потребность в трансфузии крови и ее компонентов – свежезамороженной плазмы (АК: 2,56 ± 0,84 против 2,2 ± 0,47 дозы, МК: 2,81 ± 0,47 против 2,38 ± 0,56 дозы; p < 0,05) и эритроцитарной взвеси (АК: 2,36 ± 0,48 против 1,94 ± 0,53 дозы, МК: 2,23 ± 0,49 против 1,83 ± 0,35 дозы; p < 0,05), определена тенденция уменьшения койка-дня пребывания в стационаре (АК: 16,6 ± 6,68 против 13,7 ± 4,3 сут, МК: 17,5 ± 6,4 против 13,5 ± 4,8 сут).

Заключение

Заключение. Коронарное шунтирование на работающем сердце у пациентов с сочетанным поражением клапанов сердца продемонстрировало ряд важных преимуществ, среди которых снижение времени пережатия аорты, искусственного кровообращения и продолжительности операции, а также уменьшение потребности в трансфузии и продолжительности пребывания в стационаре.

Highlights

Highlights

The relevance of the study is determined by the high importance of optimizing surgical approaches to treating patients with coronary artery disease and concomitant valve lesions: comparing myocardial revascularization techniques on a beating heart (OPCABG) and under conditions of extracorporeal circulation (ONCABG) allows identifying a strategy that ensures a reduction in intraoperative risks (shortening the time of aortic clamping and extracorporeal circulation), decreasing the need for blood transfusion, and reducing the duration of surgery and hospital stay. This collectively enhances the safety of the intervention and improves treatment outcomes for this complex category of patients.

 

 

Aim

Aim. To compare the results of myocardial revascularisation (MR) in the working heart (OPCABG) with MR on cardiopulmonary bypass (ONCABG) in patients with coronary heart disease (CHD) and combined mitral and aortic valve damage.

Methods

Methods. The study included 132 patients with CAD and concomitant valvular heart disease who underwent one-stage revascularization and valve surgery. Patients were divided into 4 groups: ONCABG + AV (n = 36); OPCABG + AV (n = 36); ONCABG + MV (n = 31); OPCABG + MV (n = 29).

Results

Results. The OPCABG technique demonstrated several advantages over the ONCABG technique: shorter aortic cross-clamp time (AV: 106,4 ± 25,1 min vs 83,3 ± 24,7 min / MV: 115,6 ± 21,9 min vs 84,07 ± 21,3 min, p < 0.05), reduced CPB time (AV: 139,4 ± 26,8 min vs 123,5 ± 25 min / MV: 166,2 ± 32,7 min vs 133,2 ± 34,9 min, p < 0.05), and shorter total operation time (AV: 336,1 ± 66,4 min vs 306,4 ± 71 min / MV: 352,5 ± 100,7 min vs 298,1 ± 84 min, p = 0.07). There was also a lower need for blood and blood product transfusions: packed red blood cells (AV: 2,56 ± 0,84 vs 2,2 ± 0,47 / MV: 2,81 ± 0,47 vs 2,38 ± 0,56); erythrocyte concentrate (AV: 2,36 ± 0,48 vs 1,94 ± 0,53 / MV: 2,23 ± 0,49 vs 1,83 ± 0,35), respectively p < 0.05, and a trend towards a shorter length of hospital stay (AV: 16,6 ± 6,68 vs 13,7 ± 4,3 / MV: 17,5 ± 6,4 vs 13,5 ± 4,8).

Conclusions

Conclusions. Coronary artery bypass grafting on the beating heart in patients with concomitant valvular heart disease demonstrated several important advantages: it is a safe and effective technique that can be successfully applied in clinical practice, which in turn reduces aortic cross-clamp time, cardiopulmonary bypass time, operation time, transfusion requirements, and length of hospital stay.

Коронарное шунтированиеАортальный клапанМитральный клапанИшемическая болезнь сердцаРеваскуляризация миокардаИскусственное кровообращениеCoronary bypass surgeryAortic valveMitral valveCoronary heart diseaseMyocardial revascularizationCardiopulmonary bypass timeАвторы заявляют об отсутствии финансирования исследования.ReferencesChen, Q. F., Shi, S., Wang, Y. F., Shi, J., Liu, C., Xu, T., Ni, C., Zhou, X., Lin, W., Peng, Y., & Zhou, X. D. (2024). Global, Regional, and National Burden of Valvular Heart Disease, 1990 to 2021. Journal of the American Heart Association, 13(24), e037991. https://doi.org/10.1161/JAHA.124.037991Chen, Q. F., Shi, S., Wang, Y. F., Shi, J., Liu, C., Xu, T., Ni, C., Zhou, X., Lin, W., Peng, Y., & Zhou, X. D. (2024). Global, Regional, and National Burden of Valvular Heart Disease, 1990 to 2021. Journal of the American Heart Association, 13(24), e037991. https://doi.org/10.1161/JAHA.124.037991Myasoedova, V. 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The authors declare that there are no conflicts of interest present.