Modern approach to surgical treatment in patients with acute coronary syndrome with lesions of the left coronary artery

Jalilov Adkham Kakhramonovich

Cardiovascular surgery is a fairly young and rapidly developing branch of medicine. In recent years, the latest surgical aids have been developed, huge steps have been taken in the anesthesiological support of operations, the range of resuscitation measures has expanded, allowing you to take care of extremely serious patients. In coronary surgery, the emphasis has shifted towards minimally invasive techniques that are most attractive to both patients and surgeons. In this article, we would like to reflect the evolution of treatment methods for patients with lesions of the left trunk of the coronary artery. A number of authors have found that surgical treatment not only reduces the clinical manifestations of acute coronal syndrome, but also significantly prolongs the life of patients [5]. However, the lack of randomization and evaluation of long-term results was a drawback of these studies. Therefore, the next step was to conduct long-term, multicenter, randomized trials that assessed life expectancy, quality and cost of treatment. However, in the arsenal of cardiologists, since 1977, a new treatment for coronary heart disease has appeared - transluminal balloon angioplasty. This technique is actively developing and today most types of atherosclerotic lesions of the coronary bed are successfully corrected with the help of percutaneous angioplasty. Nevertheless, lesion of the left trunk of the coronary artery remains one of the few contraindications for angioplasty. This is due to the high mortality rate in acute occlusion of the LCA trunk, which occurs at the time of balloon inflation, while the risk in coronary artery bypass grafting does not exceed 5%. This position is enshrined in the guidelines for percutaneous coronary angioplasty published by the American College of Cardiology / American Heart Association in 1993 [6]. But, despite the contraindication, transluminal balloon angioplasty is performed in a number of cases in patients with lesions of the LCA trunk. This category includes patients with the so-called "protected" left coronary artery trunk, which implies the presence of a functioning shunt into the left coronary artery system, patients with acute myocardial infarction, as well as those cases when acute occlusion of the trunk occurred at the time of diagnostic catheterization. Balloon angioplasty with stenting in such, often emergency cases, has made it possible to accumulate some experience in the interventional treatment of patients with lesions of the left coronary artery.

Keywords:ischemic heart disease, acute coronary syndrome, trunk of the LCA