CLINICAL CASE: CORONARY ARTERY BYPASS GRAFTING IN A PATIENT WITH CORONARY ARTERY DISEASE ACCORDING TO THE MIDCAB TECHNIQUE

Abstract

Abstract: Today the main operations of myocardial revascularization are coronary artery bypass grafting (CABG) with artificial circulation (CI) and beating heart surgery, as well as balloon angioplasty and stenting. However, the modern standard for the provision of surgical care to patients with multivessel atherosclerotic coronary artery disease is CABG under cardiopulmonary bypass (IC), introduced into clinical practice in the 60s of the XX century. This approach is convenient for surgeons and allows for good visualization of all parts of the heart and the ascending aorta with a motionless bloodless surgical field in the area of formation of distal anastomoses. At the same time, the required amount of time for performing anastomoses is provided by a sufficient level of myocardial protection. This method has a statistically significant patency of shunts in the long-term period after the intervention [1,3]. On the basis of numerous studies of the classical method of CABG in conditions of IC, indications were developed, the basic principles and approaches were formulated in patients with coronary heart disease (IHD) [2]. The classical method of performing CABG always corresponds to the traumatic sternotomy approach, and also has a number of significant negative consequences caused by the use of the IC device: systemic inflammatory response, micro- and macroembolism of the brain, as well as other organs and systems, with which renal, respiratory and other complications of the postoperative period [2,3]. To prevent or reduce these negative effects on the body, especially in the presence of concomitant pathology, as well as in elderly patients, low-traumatic techniques are currently used without the use of an infrared device. These methods include the so-called Off-Pump Coronary Artery Bypass (OPCAB). Studies have shown that CABG surgery on a beating heart without the use of a heart-lung machine is safer, including the number of neurological complications is statistically significantly lower, and the rehabilitation process for such patients is shorter, which is reflected in the economic aspects [4, 5] ... All over the world, every year more and more direct myocardial revascularization operations are performed on a beating heart. So in large centers of the USA, Europe and Russia, according to the literature, up to 70% of cases are performed using the ORSAV technique [6]. We present a description of a clinical case of multiple beating heart bypass surgery using the MIDCAB mini access, performed in our center to a patient with concomitant pathology in the form of chronic heart failure and dyscirculatory encephalopathy. Good results were obtained, both intraoperatively and postoperatively. The results of such an intervention were analyzed in terms of the presence of pain in the postoperative period, the patient's quality of life, and from the point of view of economic feasibility. The method was adopted at the Republican Specialized Scientific and Practical Medical Center for Cardiology of the Karshi branch.