Abstract
Objectives – analysis of the dynamics of the immediate results of off-pump myocardial revascularization in
patients with myocardial infarction (MI) and multiple coronary artery disease.
Material and methods. 2294 patients with ischemic heart disease, 119 of whom were diagnosed with myocardial
infarction were operated in the department of minimally invasive surgery of Bakoulev Center in
2005–2014. Two groups of patients were identified: group 1 – 42 patients with MI, operated in 2005–2009,
group 2 – 77 patients with MI, operated in 2010–2014.
Results. There was a moderate decrease in left ventricular ejection fraction in both groups: 1 group – 47.4%,
2 group – 45.6% (р=0.22). The index of revascularization was 3.4±1.9 in group 1, 3.2±1.7 in group 2
(р=0.12). Mortality at the hospital stage in group 1 was 2.3%, in group 2 – 2.5% (р=0.78). At the hospital
stage, we did not detect significant differences between the groups concerning the risk of developing acute
heart failure, life-threatening rhythm disturbances, relapses of coronary insufficiency, duration of ventilation,
finding in the ICU, and complications from the central nervous system, respiratory and urinary system.
Conclusion. CABG surgery in patients with MI having multiple lesions of the coronary arteries and in local
conditions, especially when performed on a beating heart, is a significant alternative to percutaneous coronary
intervention. The risk of surgical intervention as well as the natural course of MI increases if patient is
hemodynamically unstable and if there is mechanical complications of the infarction.
References
- Bockeria L.A., Rabotnikov V.S., Glyantsev S.P.,
Alshibaya M.D. Essays on the history of coronary
surgery. Moscow; 2002 (in Russ.).
- Ibanez B., James S., Agewall S., Antunes M.J.,
Bucciarelli-Ducci C. et al. ESC Guidelines for the
management of acute myocardial infarction in
patients presenting with ST-segment elevation: The
Task Force for the management of acute myocardial
infarction in patients presenting with ST-segment elevation
of the European Society of Cardiology (ESC).
Eur. Heart J. 2018; 39 (2): 119–77. DOI: 10.1093/
eurheartj/ehx393
- Golukhova
E.Z. Surgical and interventional cardiology: evolution
and modern approaches in management of acute
coronary syndromes and stable coronary artery disease.
Bulletin of Bakoulev Center for Cardiovascular Diseases.
2016; 17 (3): 113–23 (in Russ.). DOI: 10.24022/1810-
0694-2016-17-3-113-123
- Weiss E.S., Chang D.D., Joyce D.L., Nwakanma L.U.,
Yuh D.D. Optimal timing of coronary artery bypass
after acute myocardial infarction: a review of California
discharge data. J. Thorac. Cardiovasc. Surg. 2008;
135 (3): 503–11. DOI: 10.1016/j.jtcvs.2007.10.042
- Sigaev I.Yu.,
Alshibaya M.M., Bockeria O.L., Buziashvili Yu.I., Golukhova
E.Z., Merzlyakov V.Yu., Bockeria L.A. Current
trends in the development of coronary surgery in
A.N. Bakoulev Scientific Center for Cardiovascular
Surgery. Bulletin of Bakoulev Center for Cardiovascular
Diseases. 2016; 17 (3): 66–76 (in Russ.). DOI:
10.24022/1810-0694-2016-17-3-66-76
- Chazov E.I., Matveeva L.S., Mazaev A.V., Sargin
K.E., Sadovskaya G.V., Ruda M.Ya. Intracoronary
administration of fibrinolysin in acute myocardial
infarction. Terapevticheskiy Arkhiv (Therapeutic
Archive). 1976; 48: 8–19 (in Russ.).
- Angelini G.D., Taylor F.C., Reeves B.C., Ascione R.
Early and midterm outcome after off-pump and onpump
surgery in Beating Heart Against Cardioplegic
Arrest Studies (BHACAS 1 and 2): a pooled analysis of
two randomized controlled trials. Lancet. 2002; 359:
1194–9. DOI: 10.1016/S0140-6736(02)08216-8
- Braunwald E., Wiviott S.D., Morrow D.A., Frederick
P.D., Antman E.M. National Registry of Myocardial
Infarction. Application of the Thrombolysis in
Myocardial Infarction risk index in non-ST-segment
elevation myocardial infarction: evaluation of patients
in the National Registry of Myocardial Infarction.
J. Am. Coll. Cardiol. 2006; 47 (8): 1553–8. DOI:
10.1016/j.jacc.2005.11.075
- Buffolo E., de Andrade C.S., Branco J.N., Teles C.A.,
Aguiar L.F., Gomes W.J. Coronary artery bypass grafting
without cardiopulmonary bypass. Ann. Thorac.
Surg. 1996; 61 (1): 63–6. DOI: 10.1016/0003-4975
(95)00840-3
- Mehta S.R. Routine vs. selective invasive strategies in
patients with acute coronary syndromes: a collaborative
meta-analysis of randomized trials. JAMA. 2005; 293:
2908–17. DOI: 10.1001/jama.293.23.2908
- Schumer E.M., Chaney J.H., Trivedi J.R., Linsky P.L.,
Williams M.L., Slaughter M.S. Emergency coronary
artery bypass grafting: indications and outcomes from
2003 through 2013. Tex. Heart Inst. J. 2016; 43 (3):
214–9. DOI: 10.14503/THIJ-14-4978
- Nichols E.L., McCullough J.N., Ross C.S., Kramer
R.S., Westbrook B.M., Klemperer J.D. et al.
Optimal timing from myocardial infarction to coronary
artery bypass grafting on hospital mortality. Ann.
Thorac. Surg. 2017; 103: 162–71. DOI: 10.1016/
j.athoracsur.2016.05.116
- Lee D.C., Oz M.C., Weinberg A.D., Lin S.X., Ting W.
Optimal timing of revascularization: transmural versus
nontransmural acute myocardial infarction. Ann.
Thorac. Surg. 2001; 71: 1197–202. DOI: 10.1016/
S0003-4975(01)02425-0
- Assmann A., Boeken U., Akhyari P., Lichtenberg A.
Appropriate timing of coronary artery bypass grafting
after acute myocardial infarction. Thorac.
Cardiovasc. Surg. 2012; 60: 446–51. DOI: 10.1055/
s-0032-1304542
- Fattouch K., Guccione F., Dioguardi P., Sampognaro
R., Corrado E., Caruso M. et al. Off-pump versus
on-pump myocardial revascularization in patients
with ST-segment elevation myocardial infarction: a
randomized trial. J. Thorac. Cardiovasc. Surg. 2009;
137: 650–56. DOI: 10.1016/j.jtcvs.2008.11.033
- Dioguardi P. Off-pump coronary artery bypass grafting
in patients with ST-segment elevation myocardial
infarction. J. Cardiovasc. Dis. Diagn. 2013; 2: 135. DOI:
10.4172/2329-9517.1000135
- Rastan A.J., Eckenstein J.I., Hentschel B., et al.,
Emergency coronary artery bypass graft surgery for
acute coronary syndrome: beating heart versus conventional
cardioplegic cardiac arrest strategies. Circulation.
2006; 114 (Suppl. 1): I477–85. DOI: 10.1161/
CIRCULATIONAHA.105.001545
- Pak N.L., Golukhova E.Z., Samsonova N.N., Merzlyakov
V.Yu., Klimovich L.G., Ryabinina M.N., Kubova
M.Ch. Hemostasis system condition in patients with
coronary heart disease after myocardial revascularization
surgery performed in conditions of artificial circulation
and on the working heart. Kreativnaya Kardiologiya
(Creative Cardiology). 2011; 5 (2): 60–70 (in
Russ.). DOI: 10.24022/1997-3187-2011-5-2-60-70
About the authors
- Klyuchnikov Ivan Vyacheslavovich, Dr. Med. Sc., Professor, Chief Researcher; orcid.org/0000-0002-8652-9639
-
Merzlyakov Vadim Yur'evich, Dr. Med. Sc., Head of Department; orcid.org/0000-0001-5638-3723
-
Melikulov Alisher Almardonovich, Cand. Med. Sc., Cardiovascular Surgeon; orcid.org/0000-0002-5164-9702
-
Skopin Anton Ivanovich, Cand. Med. Sc., Senior Researcher; orcid.org/0000-0002-5696-0807
-
Mamedova Sevindzh Kamil kyzy, Cand. Med. Sc., Junior Researcher; orcid.org/0000-0002-5696-0807
-
Shurupova Irina Vladimirovna, Dr. Med. Sc., Senior Researcher; orcid.org/0000-0002-2154-474X
-
Enokyan Lusine Zhorai, Cand. Med. Sc., Senior Researcher; orcid.org/0000-0002-3701-5818
-
Zhalilov Adkham Kakhramonovich, Cand. Med. Sc.; orcid.org/0000-0002-0364-6371
