RESULTS OF CORONARY BYPASS SURGERY IN PATIENTS ACS WITH UNSTABLE ANGINA

Jalilov Adkham Kakhramonovich, Merzlyakov Vadim Yurievich, Klyuchnikov Ivan Vyacheslavovich, Mammadova Sevinj, Skopin Anton, Salomov Mahmadsharif, Pulatov Oleg

Introduction: Currently, there is an increase in the number of patients with acute coronary syndrome who have undergone coronary bypass surgery. For a detailed assessment of these patients, it is necessary to study in detail the various clinical manifestations of coronary heart disease related to acute coronary syndrome. The purpose of the study: to study the immediate results of surgical treatment of СHD in patients with unstable angina who underwent coronary bypass surgery on a working heart and in conditions of artificial blood circulation. Materials and Methods: The study summarized the experience of surgical treatment of 230 patients with coronary artery disease with unstable angina, operated on in the period from 2010 to 2018, of which 110 - using the OPCAB method and 120 - using the standard method of ONCABG. The groups were comparable in age: the average age in the OPCABG group was 67.5 ± 7.4 years, and in the ONCABG - 67.8 ± 7.2 years (p> 0.05). Results: Patients of both groups were comparable in terms of the initial severity of the underlying disease, concomitant pathology, as well as damage to various major arteries and did not have significant differences in EuroSCORE II. The average number of shunts per patient in the OPCAB group was 3.8 ± 1.3, while in the CABG group with cardiopulmonary bypass it was slightly lower - 3.85 ± 1.1 and did not have a significant difference (p = 0.073). We did not find a significant difference in the incidence of perioperative myocardial infarction, although it was higher in the MIRM group - 4 (3.8%) cases, versus 5 (4.8%) in the CABG group (p> 0.05). The terms of treatment of patients in the intensive care unit averaged 21.4 ± 43 hours for the OPCAB group, and 35.7 ± 95.3 hours for the ONCABG, which showed a statistically significant difference between the groups (p = 0, 0004). Acute heart failure, requiring intra-aortic balloon counterpulsation(IAB), occurred in 8 (6.6%) patients of the CABG group with cardiopulmonary bypass and in 3 (2.7%) patients in the OPCAB group (p = 0.0016). The groups did not significantly differ in the frequency of deaths, however, mortality in patients who underwent coronary artery bypass grafting on the beating heart was less. Thus, in the OPCAB group, the frequency of lethal cases was 1.87% (2 patients died), and in the OnCABG group - 4.18% (5 patients died) (p> 0.05).Conclusions: Based on the data obtained, it is concluded that mini-invasive myocardial revascularization by means OPCAB method is highly effective in the surgical treatment of patients with acute coronary syndrome in the form of unstable angina.

Keywords:ischemic heart disease, surgical treatment, high risk, immediate results, acute coronary syndrome, unstable angina