Цель исследования-провести сравнительную оценку функционального состояния кондуитов из внутренней грудной артерии (ВГА) и большой подкожной вены (БПВ) в зависимости от анатомического состояния коронарных артерий (KA) (диаметр и тяжесть атеросклеротических изменений). Материал и методы. В период от 6 мес до 10 лет после операции аортокоронарного шунтирования (АКШ) (в среднем через 5,8±1,3 года) у 567 пациентов изучено функциональное состояние 1194 шунтов. Результаты. Хорошие долгосрочные результаты могут быть получены при использовании как БПВ, так и ВГА, когда диаметр KA составляет более 1,5 мм (87,2% против 90,6%; р>0,05). В случае реваскуляризации сосудов малого диаметра (менее 1,5 мм) предпочтение следует отдавать трансплантатам ВГА, чем БПВ (64,1% против 39,7%; р>0,5), особенно с диффузными изменениями. Ключевые слова: реваскуляризация миокарда, отдаленные результаты коронарного шунтирования, функциональное состояние шунтов, диаметр коронарной артерии, диффузное изменение коронарной артерии, ангиопластический анастомоз. Long-term results of direct myocardial revascularization depending on the diameter and severity of atherosclerotic changes of coronary arteries

Relevance. In recent years, concepts for assessing the quality of life have been developed. According to the WHO definition, quality of life is a person's perception of his position in life, culture and value system, it is associated with his goals, expectations, standards and concerns. Approximately three people out of every thousand have pulmonary hypertension for various reasons. This can lead to decreased exercise tolerance, quality of life, increased hospital admissions, and early death. An objective assessment of the quality of life of such patients will help achieve better clinical outcomes for patients and develop new treatments. Purpose of the study is to assessment of changes in the quality of life of patients with mitral valve disease associated with atrial fibrillation and high pulmonary hypertension (systolic blood pressure over 40 mmHg) during the first 24 months after radiofrequency denervation of the pulmonary arteries according to the SF-36 and MLHFQ questionnaires. Materials and Methods. The general population of patients (n = 202) with mitral heart disease, concomitant atrial fibrillation and high pulmonary hypertension was divided into several groups according to the complexity of surgical treatment: patients of the 1st group (n = 62) underwent only surgical correction of the mitral valve pathology (repair or replacement); patients of the 2nd group (n = 89) – surgical correction of the mitral valve pathology, as well as the Maze IV procedure using the AtriCure© bipolar ablator; patients of the 3rd group (n = 51) received complex surgical treatment by correcting mitral valvular pathology, performing the Maze IV procedure, as well as using radiofrequency denervation of the pulmonary arteries. The quality of life was assessed over several periods: initially, 6 months later, 1 and 2 years after surgical treatment. The scores were also converted to physical health component scores and mental health component scores. Results. The initial data of patients from different subgroups according to the criteria of the SF-36 questionnaire were comparable with each other. The indicators of the physical component and the psychological component of SF-36 characterize the 3rd group of patients with a lower level of quality of life in terms of the physical component, although no significant intergroup differences were found. Quality of life indicators after 6 months show positive changes in patients of all study groups without significant intergroup differences. Based on the results of 12 months, the greatest dynamics of the parameters of the questionnaire in terms of physical and mental components was observed in the 3rd group of patients. After 24 months, there is a significant advantage in changes in the indicators of patients of the 3rd group for all categories of the questionnaire. The target level after 6 months in the 3rd group was 100%, in the 2nd and 1st – 85.3% and 40.7%, respectively, maintaining differences up to 24 months. Conclusions. The use of a circular radiofrequency pulmonary artery denervation procedure is associated with a significant improvement in health status in assessing the quality of life of patients who have not undergone correction of pulmonary hypertension.

Ацетилсалициловая кислота + клопидогрел, абс. (%) 37 (37,8) Мультифокальный атеросклероз, абс. (%) 68 (69,4) Артериальная гипертензия, абс. (%) 81 (82,6) Постинфарктный кардиосклероз, абс. (%) 66 (67,3) Фракция выброса < 40%, абс. (%) 6 (6,1) Многососудистое поражение КА (3 и более), абс. (%) 74 (75,5) Поражение ствола левой КА > 50%, абс. (%) 11 (11,2) Сахарный диабет, абс. (%) 78 (79,6) Чрескожные коронарные вмешательства в анамнезе, ПКА, абс. (%) 4 (4,1%) Время от операции до шунтографии, M ± SD, месяцы 39,4 ± 8,7 КА-коронарная артерия, ПКА-правая коронарная артерия

The aim of the study. To assess the influence of radiofrequency circumferential exposure modes on the morphological parameters of the pulmonary artery tissues in animal experiment (pigs).Material and methods. In the experiments, we used outbred pigs divided into 3 groups (4 animals in each). The first experimental group included 188 histological samples of the pulmonary arteries (PA) after radiofrequency circumferential exposure on the PA using an ablator clamp. Two lines of exposure on the PA and two lines of exposure on each PA mouth were performed. Ablation was performed until the target level of tissue impedance between the ablator branches corresponding to the values at transmural damage was reached. The second experimental group included 162 histological samples of the PA after circumferential denervation of pulmonary trunk and both PA mouths. Ablation was completed upon reaching 50 % impedance level relative to the impedance values at transmural damage. The third group (control) included 55 histological samples of PA without radiofrequency exposure. The material obtained was studied using light microscopy, hematoxylin and eosin and van Gieson’s staining, and also by impregnation with silver salts according to S. Ramón y Cajal.Conclusions. Morphological criteria for irreversible destruction of nerve fibers and ganglia of the pulmonary trunk adventitial layer and for PA bifurcation were obtained when using two studied ablation modes. Circumferential PA denervation using subthreshold power of radiofrequency exposure made it possible to avoid irreversible damage to the nerve endings and ganglia of the PA intimal layer and thus to preserve physiological neuroreflectory regulation of the PA and the entire pulmonary circulation. Turning off the cascade of pathological reflexes eliminates the factor of the progression of pulmonary hypertension associated with an increase in peripheral resistance of the pulmonary arterioles precapillary link.