The introduction of autovenous coronary artery bypass grafting (CABG) marked the era of surgical revascularization in patients with coronary artery disease. It provided effective treatment for angina and significantly improved the long-term prognosis. Venous transplants today remain the most popular conduits in coronary surgery due to their availability, ease of harvesting, and the absence of length restrictions. Despite the advantages of autovenous CABG, the main disadvantage is the high incidence of venous graft failure, which represents an important and unresolved problem in cardiac and cardiovascular surgery. On the other hand, the traditional allocation of a large saphenous vein implies the dissection of soft tissues throughout the length of the isolated conduit. Traumatic dissection causes a long-lasting persistent pain syndrome after surgery, frequent abnormalities in skin sensitivity, and a high incidence of wound complications in the lower extremities. These complications lengthen the period of rehabilitation of patients and worsen the quality of life. There is an approach of isolating the vein in a block with surrounding tissues to optimize the long-term functioning of the venous shunt, however, this technique is even more traumatic than the traditional method, and therefore its use is limited in practice. On the other hand, the introduction of minimally invasive methods of isolation allowed to reduce the incidence of wound complications and to improve the cosmetic result, but there is no convincing data regarding the effect on the consistency of shunts in the long-term postoperative period. The problems associated with the use of venous conduits in CABG are multifaceted, and their solutions are necessary to improve the effectiveness of surgical revascularization.
Aim. To assess the effect of a pharmacological protocol for the prevention of radial artery spasm, which is based on the systemic and local use of dihydropyridine calcium channel blockers, on the long-term outcomes of autoarterial coronary artery bypass grafting.Material and methods. According to the protocol, oral nifedipine at a dose of 5 mg/day is prescribed 3 days before surgery. Then, after the radial artery is isolated, the vessel is preserved in a solution of nifedipine (adalat) until it is used. After releasing the clamp from the aorta, a nifedipine (adalat) is infused intravenously at a dose of 0,63 mg/h. In the postoperative period, the infusion of nifedipine continues for 6 hours. In the future, patients are recommended to take dihydropyridine calcium channel blockers at a dose of 5 mg/day after discharge from the hospital.Results. The use of the pharmacological protocol (n=225) is associated with a lower number of major cardiovascular events (mortality, myocardial infarction, stroke) compared with the control group (n=230) (9,3% and 15,7%, p=0,031) during the 5-year follow-up. This result was achieved mainly by reducing the incidence of myocardial infarction (6,2% and 12,6%, p=0,018). Also, the use of the pharmacological protocol led to a decrease in repeated revascularizations (4,4% and 16,1%, p=0,0001) compared with the control group.Conclusion. The use of a pharmacological protocol for the prevention of radial artery spasm based on the systemic use of dihydropyridine calcium channel blockers improves the long-term outcomes of autoarterial coronary artery bypass grafting.
КЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ ХИРУРГИЯВ статье описан клинический случай аномального отхождения передней нисходящей артерии у взрослой пациентки и успешной хирургической коррекции порока -перемещения устья передней нисходящей артерии из легочной артерии в аорту.Финансирование. Исследование не имело спонсорской поддержки. Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.Для цитирования: Козлов Б.Н., Панфилов Д.С., Манвелян Д.В., Шипулин В.М. Аномальное отхождение передней нисходящей артерии от ствола легочной артерии у взрослой пациентки // Клиническая и экспериментальная хирургия.
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