С момента своего внедрения в клиническую практику чрескожные коронарные вмешательства (ЧКВ) постепенно стали методом выбора при лечении пациентов с локальными и несложными поражениями венечных артерий, резистентных к оптимальной медикаментозной терапии. Несмотря на это, использование ЧКВ для лечения пациентов с тяжелыми формами поражений коронарных артерий является предметом разночтений и споров и в настоящее время. В эпоху стентов с лекарственным антипролиферативным покрытием одним из наиболее важных и значимых исследований эффективности ЧКВ и коронарного шунтирования является, бесспорно, исследование SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery согласованность ЧКВ с имплантацией стентов TAXUS и кардиохирургией). Полученные в ходе данного исследования результаты легли в основу рекомендаций по реваску1 ляризации миокарда Европейского общества кардиологов (ЕОК) 2014 и 2018 гг. Однако на данный момент имеются крайне важные и принципиальные несоответствия между современной клинической практикой и рандомизированным исследованием SYNTAX. Наибо1 лее существенным недостатком шкалы риска SYNTAX считается отсутствие индивидуализированного подхода при принятии решения о выборе метода реваскуляризации миокарда в силу отсутствия в ней клинических переменных. В данной статье будет рассмотрена новая шкала риска SYNTAX Score II (SS II) как более точный инструмент принятия решения в работе сердечной команды .Since its introduction into clinical practice, percutaneous coronary interventions (PCI) have gradually become the method of choice for treating patients with local and uncomplicated lesions of the coronary arteries that are resistant to optimal medicamental therapy. Despite this, the use of PCI for the treatment of patients with coronary artery disease carts is a matter of discrepancies and disputes even today. In the era of drug1elongated antiproliferative stents, one of the most important and significant studies of the efficacy of PCI and coronary shunting (CS) is undoubtedly the SYNTAX study (Synergy between TAXUS and Cardiac Surgery implantation of TAXUS and Cardiac Surgery). The results of this study formed the basis for the latest recommendations on myocardial revascularization of the European Society of Cardiology (EOC) 2014 and beyond 2018. However, at the moment there are extremely important and fundamental inconsistencies between modern clinical practice and the randomized SYNTAX study. The most significant drawback of the SYNTAX risk scale is the lack of an individualized approach when deciding on the choice of myocardial revascularization method due to the absence of clinical variables in it. This article will look at the new Syntax Score II risk scale as a more accurate decision1making tool in the work of the heart team.Since its introduction into clinical practice, percutaneous coronary interventions (PCI) have gradually become the method of choice for treating patients with local and uncomplicated lesions of the coronary arteries that are resistant to optimal medicamental therapy. Despite this, the use of PCI for the treatment of patients with coronary artery disease carts is a matter of discrepancies and disputes even today. In the era of drug1elongated antiproliferative stents, one of the most important and significant studies of the efficacy of PCI and coronary shunting (CS) is undoubtedly the SYNTAX study (Synergy between TAXUS and Cardiac Surgery implantation of TAXUS and Cardiac Surgery). The results of this study formed the basis for the latest recommendations on myocardial revascularization of the European Society of Cardiology (EOC) 2014 and beyond 2018. However, at the moment there are extremely important and fundamental inconsistencies between modern clinical practice and the randomized SYNTAX study. The most significant drawback of the SYNTAX risk scale is the lack of an individualized approach when deciding on the choice of myocardial revascularization method due to the absence of clinical variables in it. This article will look at the new Syntax Score II risk scale as a more accurate decision1making tool in the work of the heart team.
Surgical treatment of oncological diseases with concomitant somatic pathologies is a complex issue. In situations when concomitant somatic pathology also requires a surgical approach, the determination of adequate treatment tactics is most relevant. Delayed surgical treatment of cancer increases the risks of progression and generalization of the process; surgical treatment of a tumor against the background of decompensated concomitant pathology potentially entails risks of an unfavorable outcome. With a combination of oncological and somatic diseases, the definition of treatment algorithms today is one of the primary tasks.This paper presents a clinical observation of one-stage surgical treatment of lung cancer and severe aortic stenosis, provides a brief literature review on this topic.
<p>Aortic valve stenosis and bleeding gastric cancer are formidable diseases characterized by high mortality. For a long time, the gold standard for treating patients with aortic stenosis has been open-heart surgery — aortic valve replacement. However, the endovascular operation that appeared in 2002 — transcatheter aortic valve implantation (TAVI) has become the standard of care for patients with high surgical risk. Gastric cancer is one of the major severe oncological diseases in which surgery is the only way to cure. The combination of these two diseases significantly worsens the prognosis and is a difficult clinical task for choosing the optimal tactics for treating a patient. Given the lack of developed standards for the treatment of multimorbid patients, the treatment plan is determined by an interdisciplinary consultation. But with a combination of these diseases, there is no generally accepted approach in the known recommendations.<br />The purpose of this report is to present a clinical case of a patient with critical aortic stenosis, concomitant severe coronary artery disease, and bleeding stomach cancer, who underwent a successful one-stage operation — percutaneous coronary intervention, TAVI and open gastrectomy with Roux-loop reconstruction with one anesthetic aid by the decision of a multidisciplinary team. The patient was discharged in a satisfactory condition. In the late follow-up period, angina pectoris returned with restenosis of the stent in the anterior interventricular branch (LAD), which required repeated intervention in the form of LAD restenting with a good clinical result.<br />A hybrid approach in the treatment of patients with critical aortic valve stenosis in combination with coronary artery disease and bleeding gastric cancer can be accepted as one of the possible strategies, but further research is needed in this direction.</p><p>Received 15 October 2021. Revised 20 January 2022. Accepted 31 January 2022.</p><p><strong>Informed consent:</strong> The patient’s informed consent to use the records for medical purposes is obtained.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors</strong><br />Literature review: N.L. Irodova, L.G. Geletsyan<br />Drafting the article: N.G. Karapetyan, N.N. Meleshenko<br />Critical revision of the article: B.G. Alekyan, A.Sh. Revishvili<br />Surgical treatment: B.G. Alekyan, D.V. Ruchkin, N.G. Karapetyan, N.N. Meleshenko<br />Final approval of the version to be published: B.G. Alekyan, D.V. Ruchkin, N.G. Karapetyan, N.L. Irodova, N.N. Meleshenko, L.G. Geletsyan, A.Sh. Revishvili</p>
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