The aim – to identify clinical, angiographic and hemodynamic factors, having impact upon the decision on percutaneous coronary intervention (PCI) in stable coronary artery disease (SCAD) patients with intermediate subepicardial coronary lesions, in clinical settings. Materials and methods. The cross-sectional single-center study analyzed clinical and instrumental data from 123 SCAD patients (mean age 62 ± 9 years; 90 (73.2 %) males) and intermediate (50–90 %) stenotic subepicardial coronary lesions (by invasive coronary angiography [ICA]). The enrolled sample included 74 (60.2 %) patients with an assessment of ICA-derived fractional flow reserve (FFR). The studied parameters were analyzed in the groups of decision not to perform (PCI(–); n = 30 [24.4 %]) and to perform PCI (PCI(+); n = 93 [75.6 %]). Results. The positive decision on PCI was more frequent in patients with stable angina ІII and ІI CCS class, as compared to those without angina (93 %, 79 % і 46 %, respectively; рtrend < 0.001). PCI was considered to be appropriate in all patients with FFR < 0.8 (46 of 74 (62 %) cases). The more advanced hemodynamic compromise of coronary lesions was associated with the higher maximum degree of coronary artery stenosis. Multivariable logistic regression analysis revealed a more pronounced coronary stenosis (at least, in one subepicardial coronary artery territory) was independently associated with the PCI(+) decision (stenosis 80–90 % vs. 70–79 %; 70–79 % vs. 60–69 %; 60–69 % vs. 50–59 %: odds ratio 26 (95 % confidence interval 8–87); р < 0.001). Conclusions. A degree of coronary artery stenosis was a key factor impacting upon a positive decision on PCI in SCAD patients with intermediate (50–90 %) coronary lesions. There is a need for the broader implementation of non-invasive diagnostic tests and the tools for a quantitative assessment of myocardial ischemia in patients with intermediate pretest probability of coronary stenosis, including those with previous PCI.
{"title":"Clinical and hemodynamic characteristics of patients with intermediate coronary lesions selected for elective percutaneous coronary intervention","authors":"M.V. Stan, К.О. Mikhaliev, A.V. Khokhlov, O.J. Zharinov, B.M. Todurov","doi":"10.31928/2305-3127-2023.1-2.2940","DOIUrl":"https://doi.org/10.31928/2305-3127-2023.1-2.2940","url":null,"abstract":"The aim – to identify clinical, angiographic and hemodynamic factors, having impact upon the decision on percutaneous coronary intervention (PCI) in stable coronary artery disease (SCAD) patients with intermediate subepicardial coronary lesions, in clinical settings. Materials and methods. The cross-sectional single-center study analyzed clinical and instrumental data from 123 SCAD patients (mean age 62 ± 9 years; 90 (73.2 %) males) and intermediate (50–90 %) stenotic subepicardial coronary lesions (by invasive coronary angiography [ICA]). The enrolled sample included 74 (60.2 %) patients with an assessment of ICA-derived fractional flow reserve (FFR). The studied parameters were analyzed in the groups of decision not to perform (PCI(–); n = 30 [24.4 %]) and to perform PCI (PCI(+); n = 93 [75.6 %]). Results. The positive decision on PCI was more frequent in patients with stable angina ІII and ІI CCS class, as compared to those without angina (93 %, 79 % і 46 %, respectively; рtrend < 0.001). PCI was considered to be appropriate in all patients with FFR < 0.8 (46 of 74 (62 %) cases). The more advanced hemodynamic compromise of coronary lesions was associated with the higher maximum degree of coronary artery stenosis. Multivariable logistic regression analysis revealed a more pronounced coronary stenosis (at least, in one subepicardial coronary artery territory) was independently associated with the PCI(+) decision (stenosis 80–90 % vs. 70–79 %; 70–79 % vs. 60–69 %; 60–69 % vs. 50–59 %: odds ratio 26 (95 % confidence interval 8–87); р < 0.001). Conclusions. A degree of coronary artery stenosis was a key factor impacting upon a positive decision on PCI in SCAD patients with intermediate (50–90 %) coronary lesions. There is a need for the broader implementation of non-invasive diagnostic tests and the tools for a quantitative assessment of myocardial ischemia in patients with intermediate pretest probability of coronary stenosis, including those with previous PCI.","PeriodicalId":31527,"journal":{"name":"Kardiohirurgia ta Intervencijna Kardiologia","volume":"158 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135109097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim – to determine the long-term efficacy and safety of renal denervation (RDN) at 10-year follow-up.Materials and methods. We selected 1146 patients with resistant arterial hypertension (RAH) who received 3 or more antihypertensive drugs. 16 patients were selected for renal artery denervation. RDN was performed in 8 patients (0.70 %). 8 patients refused the procedure. The age was 52.13 ± 3.88 years (40–66), the duration of hypertension was 16.75 ± 2.17 (12–25) years. The number of antihypertensive drugs was 5.5 ± 0.18. Office SBP/DBP on optimization of therapy in patients was 156.88/95.00 ± 2.98 mm Hg and heart rate – 68.88 ± 3.28 beats/min. 24SBP/DBP was 149.16 ± 5.40/86.98 ± 5.08 mm Hg. 24HR was 70.12 ± 2.94 beats/min. All patients tolerated the procedure well.Results and discussion. The decrease in office SBP/DBP was –12.59/–10.0 mm Hg; –11.17/–2.57 mm Hg; –20.31/–11.71 mm Hg, –27.71/–13.33 mm Hg and –30.21/–16.67 mm Hg, in the dynamics of 1 month, 12 months, 2 years, 5 years and 10 years, respectively, p <0.05 for all values compared to the initial. The office heart rate at the stages of 1 month, 6, 12 months, 2 years, 5 and 10 years decreased, its dynamics were –3.74 bpm, –4.68 bpm, –1.45 bpm, –2.13 bpm, –4.21 bpm, –3.88 bpm, respectively. The decrease in 24SBP/DBP was –14.45/–6.95 mmHg, –8.70/–10.01 mm Hg, –19.45/–12.37 mm Hg, –19.91/–11.24 mm Hg, –29.93/–13.61 mm Hg. and –26.13/–23.35 mm Hg (p<0.05 for all values). 24HR dynamics: –3.16 bpm, – 4.19 bpm, + 1.43 bpm, –1.51 bpm, –4.46 bpm, and –5.49 bpm, respectively. After 2, 5, and 10 years, all patients reached the target blood pressure level both in the office and with ABPM. Patients reduced the number of antihypertensive drugs from 5.50 ± 0.18 to 3.50 ± 0.30 – after 5 years and 3.67 ± 0.18 – after 10 years after RDN. GFR practically did not change over 10 years from 76.10 ± 5.62 to 64.60 ± 1.93 ml/min/1.73m2, p>0.05. One patient died of thyroid cancer 2 years later. All other patients are alive and have not had any cardiovascular event or death during 10 years.Conclusion. Long-term results of renal artery denervation showed no cases of cardiovascular events, development of diabetes or cardiovascular death over 10 years. RDN contributed to a reduction in the number of antihypertensive drugs from 5.5 to 3.67 after 10 years of therapy against the background of 100 % achievement of the target BP level.
{"title":"Long-term effectiveness of radiofrequency renal denervation in patients with resistant arterial hypertension (10-year follow-up results)","authors":"O.L. Rekovets, Yu.M. Sirenko, O.O. Torbas, S.M. Kushnir, G.F. Prymak","doi":"10.31928/2305-3127-2023.1-2.4155","DOIUrl":"https://doi.org/10.31928/2305-3127-2023.1-2.4155","url":null,"abstract":"The aim – to determine the long-term efficacy and safety of renal denervation (RDN) at 10-year follow-up.Materials and methods. We selected 1146 patients with resistant arterial hypertension (RAH) who received 3 or more antihypertensive drugs. 16 patients were selected for renal artery denervation. RDN was performed in 8 patients (0.70 %). 8 patients refused the procedure. The age was 52.13 ± 3.88 years (40–66), the duration of hypertension was 16.75 ± 2.17 (12–25) years. The number of antihypertensive drugs was 5.5 ± 0.18. Office SBP/DBP on optimization of therapy in patients was 156.88/95.00 ± 2.98 mm Hg and heart rate – 68.88 ± 3.28 beats/min. 24SBP/DBP was 149.16 ± 5.40/86.98 ± 5.08 mm Hg. 24HR was 70.12 ± 2.94 beats/min. All patients tolerated the procedure well.Results and discussion. The decrease in office SBP/DBP was –12.59/–10.0 mm Hg; –11.17/–2.57 mm Hg; –20.31/–11.71 mm Hg, –27.71/–13.33 mm Hg and –30.21/–16.67 mm Hg, in the dynamics of 1 month, 12 months, 2 years, 5 years and 10 years, respectively, p <0.05 for all values compared to the initial. The office heart rate at the stages of 1 month, 6, 12 months, 2 years, 5 and 10 years decreased, its dynamics were –3.74 bpm, –4.68 bpm, –1.45 bpm, –2.13 bpm, –4.21 bpm, –3.88 bpm, respectively. The decrease in 24SBP/DBP was –14.45/–6.95 mmHg, –8.70/–10.01 mm Hg, –19.45/–12.37 mm Hg, –19.91/–11.24 mm Hg, –29.93/–13.61 mm Hg. and –26.13/–23.35 mm Hg (p<0.05 for all values). 24HR dynamics: –3.16 bpm, – 4.19 bpm, + 1.43 bpm, –1.51 bpm, –4.46 bpm, and –5.49 bpm, respectively. After 2, 5, and 10 years, all patients reached the target blood pressure level both in the office and with ABPM. Patients reduced the number of antihypertensive drugs from 5.50 ± 0.18 to 3.50 ± 0.30 – after 5 years and 3.67 ± 0.18 – after 10 years after RDN. GFR practically did not change over 10 years from 76.10 ± 5.62 to 64.60 ± 1.93 ml/min/1.73m2, p>0.05. One patient died of thyroid cancer 2 years later. All other patients are alive and have not had any cardiovascular event or death during 10 years.Conclusion. Long-term results of renal artery denervation showed no cases of cardiovascular events, development of diabetes or cardiovascular death over 10 years. RDN contributed to a reduction in the number of antihypertensive drugs from 5.5 to 3.67 after 10 years of therapy against the background of 100 % achievement of the target BP level.","PeriodicalId":31527,"journal":{"name":"Kardiohirurgia ta Intervencijna Kardiologia","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135107096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim – to present the one-centre experience of surgical treatment with сardiac myxomas (CM) and features of the course of this disease. Materials and methods. During the period from January 1, 1969 to January 1, 2023, 1015 patients were operated for primary heart tumors. CM were found in 902 (88.9 %) patients, of which 793 (87.9 %) cases were myxomas of the left atrium. The age of CM patients ranged from 3 to 79 years (on average 48.4 ± 3.4 years), of which 653 (72.4 %) were in the age from 31 to 60 years. Malignant tumors were observed in 70 (6.9 %) cases. Results. Surgery of valvular lesions was performed in 75 (8.3 %) patients: in 15 (1.7 %) cases – valve prosthesis, in 55 (6.1 %) cases – repair surgery (25 – mitral correction, 30 – tricuspid valves, respectively) with a positive functional effect. 328 (36.3 %) and 77 (8.5 %) patients with CM had heart failure of III and IV functional classes NYHA, respectively, which often required urgent surgery. Hospital mortality in recent years was 0.2 % in the surgical treatment of CM. Conclusions. The issues of optimal tactics for patients with CM consist of urgent diagnosis and surgical intervention, which ensures the effectiveness of treatment of CM, which is confirmed by the data of long-term results. Patient survival up to 20 years was 79.7 %.
{"title":"Experience of diagnosis and surgical treatment of cardiac myxomas","authors":"R.M. Vitovskyi, V.V. Isaіenko, A.R. Vitovskyi, O.A. Pishchurin, V.V. Grabarchuk, O.V. Satmari","doi":"10.31928/2305-3127-2023.1-2.5661","DOIUrl":"https://doi.org/10.31928/2305-3127-2023.1-2.5661","url":null,"abstract":"The aim – to present the one-centre experience of surgical treatment with сardiac myxomas (CM) and features of the course of this disease. Materials and methods. During the period from January 1, 1969 to January 1, 2023, 1015 patients were operated for primary heart tumors. CM were found in 902 (88.9 %) patients, of which 793 (87.9 %) cases were myxomas of the left atrium. The age of CM patients ranged from 3 to 79 years (on average 48.4 ± 3.4 years), of which 653 (72.4 %) were in the age from 31 to 60 years. Malignant tumors were observed in 70 (6.9 %) cases. Results. Surgery of valvular lesions was performed in 75 (8.3 %) patients: in 15 (1.7 %) cases – valve prosthesis, in 55 (6.1 %) cases – repair surgery (25 – mitral correction, 30 – tricuspid valves, respectively) with a positive functional effect. 328 (36.3 %) and 77 (8.5 %) patients with CM had heart failure of III and IV functional classes NYHA, respectively, which often required urgent surgery. Hospital mortality in recent years was 0.2 % in the surgical treatment of CM. Conclusions. The issues of optimal tactics for patients with CM consist of urgent diagnosis and surgical intervention, which ensures the effectiveness of treatment of CM, which is confirmed by the data of long-term results. Patient survival up to 20 years was 79.7 %.","PeriodicalId":31527,"journal":{"name":"Kardiohirurgia ta Intervencijna Kardiologia","volume":"168 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135107099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-19DOI: 10.31928/2305-3127-2023.1-2.514
G.I. Kovtun, B.M. Todurov, O.A. Kanyura
The review is devoted to the history of the development of organ transplantation and the analysis of models of organ transplantation in countries that are leaders in the field of transplantation. Organs transplantation abroad has become an effective method of treatment that saves lives, but it is also an indicator of the success of the country’s development as a whole, an important element of national pride and prestige. However, performing transplantations is associated with problems of an organizational, as well as legal, moral and ethical nature. The main problem is a shortage of donor organs. The review analyzes measures aimed at increasing the level of donation in the world and promoting the development of transplantology.
{"title":"History and actual problems of organ donation","authors":"G.I. Kovtun, B.M. Todurov, O.A. Kanyura","doi":"10.31928/2305-3127-2023.1-2.514","DOIUrl":"https://doi.org/10.31928/2305-3127-2023.1-2.514","url":null,"abstract":"The review is devoted to the history of the development of organ transplantation and the analysis of models of organ transplantation in countries that are leaders in the field of transplantation. Organs transplantation abroad has become an effective method of treatment that saves lives, but it is also an indicator of the success of the country’s development as a whole, an important element of national pride and prestige. However, performing transplantations is associated with problems of an organizational, as well as legal, moral and ethical nature. The main problem is a shortage of donor organs. The review analyzes measures aimed at increasing the level of donation in the world and promoting the development of transplantology.","PeriodicalId":31527,"journal":{"name":"Kardiohirurgia ta Intervencijna Kardiologia","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135063078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-19DOI: 10.31928/2305-3127-2023.1-2.6267
V.A. Tymoshenko, B.M. Todurov
The aim – to investigate the frequency of early postoperative complications and to analyze possible predictors of the prolonged stay of patients in the intensive care unit (ICU) after Bentall procedure.Materials and methods. In the study, the medical histories of adult patients (from 18 to 75 years old) who underwent Bentall procedure for ascending aortic aneurysm at the State Institution «Heart Institute of the Ministry of Health of Ukraine» between 2012 and 2021 were analyzed. Univariate and multivariate analysis (logistic regression) was used to determine prognostic risk factors.Results. Patients with prolonged stay in intensive care unit were characterized by significantly older age (p = 0.005), more frequent presence of comorbidities of arterial hypertension (p = 0.044) and significantly lower initial values of glomerular filtration rate (p = 0.045). In addition, these patients were 3.6 times more likely (p = 0.0005) to use an autohemotransfusion device and almost 6 times more likely (p = 0.0037) to require rethoracotomy due to bleeding. Acute renal failure was recorded 4.3 times (p = 0.0002) and acute respiratory failure was recorded 3.3 times more often (p = 0.0004). The duration of mechanical ventilation (OR 1.204 (CI 1.053–1.377), p = 0.007) and the development of acute renal failure (OR 4.069 (CI 1.040–15.923), p = 0.044) were two independent predictors of prolonged stay of patients in ICU.Conclusions. For patients with risk factors for a prolonged ICU stay after surgery, more active treatment strategies before and after surgery are recommended to avoid possible complications and shorten hospital stay.
{"title":"Analysis of the risk of early postoperative complications after Bentall procedure","authors":"V.A. Tymoshenko, B.M. Todurov","doi":"10.31928/2305-3127-2023.1-2.6267","DOIUrl":"https://doi.org/10.31928/2305-3127-2023.1-2.6267","url":null,"abstract":"The aim – to investigate the frequency of early postoperative complications and to analyze possible predictors of the prolonged stay of patients in the intensive care unit (ICU) after Bentall procedure.Materials and methods. In the study, the medical histories of adult patients (from 18 to 75 years old) who underwent Bentall procedure for ascending aortic aneurysm at the State Institution «Heart Institute of the Ministry of Health of Ukraine» between 2012 and 2021 were analyzed. Univariate and multivariate analysis (logistic regression) was used to determine prognostic risk factors.Results. Patients with prolonged stay in intensive care unit were characterized by significantly older age (p = 0.005), more frequent presence of comorbidities of arterial hypertension (p = 0.044) and significantly lower initial values of glomerular filtration rate (p = 0.045). In addition, these patients were 3.6 times more likely (p = 0.0005) to use an autohemotransfusion device and almost 6 times more likely (p = 0.0037) to require rethoracotomy due to bleeding. Acute renal failure was recorded 4.3 times (p = 0.0002) and acute respiratory failure was recorded 3.3 times more often (p = 0.0004). The duration of mechanical ventilation (OR 1.204 (CI 1.053–1.377), p = 0.007) and the development of acute renal failure (OR 4.069 (CI 1.040–15.923), p = 0.044) were two independent predictors of prolonged stay of patients in ICU.Conclusions. For patients with risk factors for a prolonged ICU stay after surgery, more active treatment strategies before and after surgery are recommended to avoid possible complications and shorten hospital stay.","PeriodicalId":31527,"journal":{"name":"Kardiohirurgia ta Intervencijna Kardiologia","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135063084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-19DOI: 10.31928/2305-3127-2023.1-2.2228
M.M. Zaretskyi, B.M. Todurov, O.M. Grytsay, V.B. Demyanchuk, O.V. Zelenchuk
Aortic valve replacement (AVR) is the only effective method of treating aortic stenosis. However, the increasing age of operated patients also increases the surgical risks. The most common complications after aortic valve surgery are similar to those of other cardiac surgeries which include: stroke, deep sternal wound infection, re-operation due to bleeding, myocardial infarction (1–5 %). Cardiac arrhythmias that appear after AVR surgery and require permanent pacemaker (PPM) implantation arise in connection with the anatomical features of the aortic valve, its pathological changes, and traumatic intervention during valve defect correction. A large number of single-center, and a few multi-center studies have been conducted to identify risk factors that could serve as predictors of need in PPM implantation after AVR. Further research in this direction is relevant. Currently there are no clear criteria allowing to identify patients with need for preventive PPM implantation before the AVR surgery due to the high probability of cardiac conduction disorders in the postoperative period. This might reduce the number of complications and reduce the length of a patient’s stay in a hospital.
{"title":"Predictors of cardiac conduction disorders in patients after aortic valve replacement","authors":"M.M. Zaretskyi, B.M. Todurov, O.M. Grytsay, V.B. Demyanchuk, O.V. Zelenchuk","doi":"10.31928/2305-3127-2023.1-2.2228","DOIUrl":"https://doi.org/10.31928/2305-3127-2023.1-2.2228","url":null,"abstract":"Aortic valve replacement (AVR) is the only effective method of treating aortic stenosis. However, the increasing age of operated patients also increases the surgical risks. The most common complications after aortic valve surgery are similar to those of other cardiac surgeries which include: stroke, deep sternal wound infection, re-operation due to bleeding, myocardial infarction (1–5 %). Cardiac arrhythmias that appear after AVR surgery and require permanent pacemaker (PPM) implantation arise in connection with the anatomical features of the aortic valve, its pathological changes, and traumatic intervention during valve defect correction. A large number of single-center, and a few multi-center studies have been conducted to identify risk factors that could serve as predictors of need in PPM implantation after AVR. Further research in this direction is relevant. Currently there are no clear criteria allowing to identify patients with need for preventive PPM implantation before the AVR surgery due to the high probability of cardiac conduction disorders in the postoperative period. This might reduce the number of complications and reduce the length of a patient’s stay in a hospital.","PeriodicalId":31527,"journal":{"name":"Kardiohirurgia ta Intervencijna Kardiologia","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135107102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-19DOI: 10.31928/2305-3127-2023.1-2.6876
K.S. Boyko, B.M. Todurov
The aim – to analyze the results of the early postoperative period of surgical aortic valve replacement (SAVR) combined with endovascular or surgical methods of myocardial revascularization.Materials and methods. For this retrospective study, a selection of medical records of adult patients (over 18 years of age) who underwent SAVR concomitant with myocardial revascularization in the period from 2018 to 2022 was carried out.Results and discussion. We selected 95 patients who were treated with SAVR with concomitant myocardial revascularization (the first group (n = 31) – a combination of SAVR and percutaneous coronary intervention (PCI); the second group (n = 48) – a combination of SAVR and CABG). In patients of the first group, lesions of the main left coronary artery and the circumflex artery were recorded, respectively, by 24.85 % (p = 0.011) and by 23.7 % (p = 0.033) less often. Moreover, the patients of the first group required intraoperative use of more than two doses of blood red cell mass by 21.4 % less often (p = 0.046). In the early postoperative period, a lower level of bleeding was observed in patients of the first group compared to the second group (180 (150; 250) ml vs. 250 (200; 305) ml, p = 0.008).Conclusions. Patients who underwent PCI before SAVR were characterized by a shorter duration of surgery, cardiopulmonary bypass, and aortic cross-clamping, while no significant difference in major early postoperative complications was observed between the study groups.
目的:分析手术主动脉瓣置换术(SAVR)术后早期联合血管内或外科心肌血运重建术的效果。材料和方法。在这项回顾性研究中，我们选择了2018年至2022年期间接受SAVR合并心肌血运重建术的成年患者(18岁以上)的病历。结果和讨论。我们选择了95例接受SAVR合并心肌血运重建术的患者(第一组(n = 31)——SAVR联合经皮冠状动脉介入治疗(PCI);第二组(n = 48) - SAVR和CABG的组合)。第一组患者左冠状动脉主干和旋支病变发生率分别减少24.85% (p = 0.011)和23.7% (p = 0.033)。此外，第一组患者术中需要使用两剂以上红细胞团的次数减少了21.4% (p = 0.046)。在术后早期，第一组患者的出血水平低于第二组(180 (150;250) ml vs. 250 (200;305) ml, p = 0.008)。SAVR前行PCI的患者手术时间、体外循环和主动脉交叉夹持时间较短，但术后早期主要并发症在两组间无显著差异。
{"title":"Early postoperative results after surgical aortic valve replacement concomitant with different methods of myocardial revascularization","authors":"K.S. Boyko, B.M. Todurov","doi":"10.31928/2305-3127-2023.1-2.6876","DOIUrl":"https://doi.org/10.31928/2305-3127-2023.1-2.6876","url":null,"abstract":"The aim – to analyze the results of the early postoperative period of surgical aortic valve replacement (SAVR) combined with endovascular or surgical methods of myocardial revascularization.Materials and methods. For this retrospective study, a selection of medical records of adult patients (over 18 years of age) who underwent SAVR concomitant with myocardial revascularization in the period from 2018 to 2022 was carried out.Results and discussion. We selected 95 patients who were treated with SAVR with concomitant myocardial revascularization (the first group (n = 31) – a combination of SAVR and percutaneous coronary intervention (PCI); the second group (n = 48) – a combination of SAVR and CABG). In patients of the first group, lesions of the main left coronary artery and the circumflex artery were recorded, respectively, by 24.85 % (p = 0.011) and by 23.7 % (p = 0.033) less often. Moreover, the patients of the first group required intraoperative use of more than two doses of blood red cell mass by 21.4 % less often (p = 0.046). In the early postoperative period, a lower level of bleeding was observed in patients of the first group compared to the second group (180 (150; 250) ml vs. 250 (200; 305) ml, p = 0.008).Conclusions. Patients who underwent PCI before SAVR were characterized by a shorter duration of surgery, cardiopulmonary bypass, and aortic cross-clamping, while no significant difference in major early postoperative complications was observed between the study groups.","PeriodicalId":31527,"journal":{"name":"Kardiohirurgia ta Intervencijna Kardiologia","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135063086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-19DOI: 10.31928/2305-3127-2023.1-2.99102
Yu.V. Savitska, A.I. Klantsa, N.V. Shchepina
Wellens syndrome is an electrocardiographic pattern associated with acute stenosis of the proximal part of the left anterior descending artery, a high risk of anterior myocardial infarction and sudden cardiac death from fatal arrhythmias. Detection of this syndrome will significantly reduce the risk of an acute event.
{"title":"Wellens syndrome or For whom the bell tolls?","authors":"Yu.V. Savitska, A.I. Klantsa, N.V. Shchepina","doi":"10.31928/2305-3127-2023.1-2.99102","DOIUrl":"https://doi.org/10.31928/2305-3127-2023.1-2.99102","url":null,"abstract":"Wellens syndrome is an electrocardiographic pattern associated with acute stenosis of the proximal part of the left anterior descending artery, a high risk of anterior myocardial infarction and sudden cardiac death from fatal arrhythmias. Detection of this syndrome will significantly reduce the risk of an acute event.","PeriodicalId":31527,"journal":{"name":"Kardiohirurgia ta Intervencijna Kardiologia","volume":"234 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135107095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-19DOI: 10.31928/2305-3127-2023.1-2.9598
А.V. Ivaniuk
The aim – to reveal the essence of medical marketing in healthcare institutions (HCI) with principles of public-private partnership (PPP). The study used general scientific methods of analysis, synthesis, generalization, interpretation of scientific data, as well as systemic and structural-functional approaches. The article reveals the essence, principles and functions of medical marketing in HCI with the mechanisms of PPP. The substantiation of the main marketing tools is given – business processes and integration processes that contribute to effective marketing in HCI. It also identified the key points that form the structure of medical business processes. The process approach to business process management is disclosed, which allows getting benefits for HCI. The definition and significance of the medical processes integration in HCI on PPP principles is provided, which contributes to the coordination of marketing activities with the strategy development within each integrated complex of HCI and the possibility of obtaining a positive synergistic effect. Examples of internal and external integration are given. The system for managing the external integration process is shown. To stimulate the integration process, bundled payment method has been defined.Conclusions. The article provides justification for medical marketing in HCI with the principles of PPP, focused on business processes and the integration of medical services, which ensures economic, medical and social efficiency and optimal functioning of HCI in market conditions.
{"title":"Medical marketing in healthcare institutions with public-private partnership mechanisms","authors":"А.V. Ivaniuk","doi":"10.31928/2305-3127-2023.1-2.9598","DOIUrl":"https://doi.org/10.31928/2305-3127-2023.1-2.9598","url":null,"abstract":"The aim – to reveal the essence of medical marketing in healthcare institutions (HCI) with principles of public-private partnership (PPP). The study used general scientific methods of analysis, synthesis, generalization, interpretation of scientific data, as well as systemic and structural-functional approaches. The article reveals the essence, principles and functions of medical marketing in HCI with the mechanisms of PPP. The substantiation of the main marketing tools is given – business processes and integration processes that contribute to effective marketing in HCI. It also identified the key points that form the structure of medical business processes. The process approach to business process management is disclosed, which allows getting benefits for HCI. The definition and significance of the medical processes integration in HCI on PPP principles is provided, which contributes to the coordination of marketing activities with the strategy development within each integrated complex of HCI and the possibility of obtaining a positive synergistic effect. Examples of internal and external integration are given. The system for managing the external integration process is shown. To stimulate the integration process, bundled payment method has been defined.Conclusions. The article provides justification for medical marketing in HCI with the principles of PPP, focused on business processes and the integration of medical services, which ensures economic, medical and social efficiency and optimal functioning of HCI in market conditions.","PeriodicalId":31527,"journal":{"name":"Kardiohirurgia ta Intervencijna Kardiologia","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135063081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-19DOI: 10.31928/2305-3127-2023.1-2.8894
P.M. Semeniv
The aim – to develop and put into practice a method of reducing the ischemic time of the heart during long-term cardiac surgery interventions.Materials and methods. A modified technique of coronary artery bypass grafting has been developed for combined operations that require a long time to clamp the aorta. The results of simultaneous correction of valve defects and coronary artery bypass grafting in 15 patients were analyzed. At the first stage, off-pump coronary artery bypass grafting was performed, followed by correction of valvular lesions.Results. The used technique requires more time to perform and is technically more difficult, but it allows to significantly reduce the ischemic time of the myocardium, which in turn will prevent heart failure and postoperative complications.Conclusions. The application of the technique proposed in the experiment has significant advantages in terms of the duration of artificial blood circulation and the ischemic time of the heart, which favorably affects its performance.
{"title":"A modified technique for reducing the duration of ischemic time of the heart and myocardial reperfusion in multivalve correction combined with coronary grafting","authors":"P.M. Semeniv","doi":"10.31928/2305-3127-2023.1-2.8894","DOIUrl":"https://doi.org/10.31928/2305-3127-2023.1-2.8894","url":null,"abstract":"The aim – to develop and put into practice a method of reducing the ischemic time of the heart during long-term cardiac surgery interventions.Materials and methods. A modified technique of coronary artery bypass grafting has been developed for combined operations that require a long time to clamp the aorta. The results of simultaneous correction of valve defects and coronary artery bypass grafting in 15 patients were analyzed. At the first stage, off-pump coronary artery bypass grafting was performed, followed by correction of valvular lesions.Results. The used technique requires more time to perform and is technically more difficult, but it allows to significantly reduce the ischemic time of the myocardium, which in turn will prevent heart failure and postoperative complications.Conclusions. The application of the technique proposed in the experiment has significant advantages in terms of the duration of artificial blood circulation and the ischemic time of the heart, which favorably affects its performance.","PeriodicalId":31527,"journal":{"name":"Kardiohirurgia ta Intervencijna Kardiologia","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135063082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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