The results of surgical treatment of patients with coronary artery disease and diffuse coronary artery disease
Authors:   St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow, Shevchenko Yu.L. , Katkov A.A. , Ermakov D.Yu. , Ulbashev D.S. , Vakhrameeva A.Yu. 
Published: November 2024

In recent decades, the number of patients with coronary artery disease and diffuse coronary artery disease has increased, the results of revascularization of which remain unsatisfactory, and the risk of repeated interventions and postoperative complications is high. In some cases, such patients are classified as inoperable, and drug therapy is ineffective for them. It is for such patients that the method of stimulation of extracardial neoangiogenesis has been developed and introduced into clinical practice, which allows increasing the effectiveness of surgical treatment. In our article, a comparative assessment of the results of surgery in patients with diffuse coronary lesion after various methods of myocardial revascularization was carried out. Aim: to compare the efficacy and safety of standard surgical and endovascular correction of coronary artery lesions, as well as complex myocardial revascularization (bypass surgery and percutaneous coronary intervention, supplemented by the “YurLeon” technique) in patients with diffuse coronary atherosclerosis. Materials and methods. The study included 133 patients with coronary artery disease and diffuse coronary artery disease who were treated at the St. George Clinic of Thoracic and Cardiovascular Surgery named after N.I. Pirogov NMHC from 2011 to 2024. I – patients who underwent coronary bypass surgery (n = 35); II – endovascular correction of coronary blood flow disorders (n = 33); III – patients who underwent coronary bypass surgery supplemented by stimulation of extracardial neoangiogenesis (n = 37); IV – patients to whom percutaneous coronary intervention was supplemented with a minimally invasive procedure “Yurleon” (n = 28). According to the clinical and angiographic characteristics, the patients did not differ statistically significantly from each other. Clinical data, echocardiography parameters, the degree of damage to the coronary bed, complications after surgery, cases of major adverse cardiovascular and cerebrovascular events (MACCE), and overall survival were evaluated. Results. The average follow-up period was 41.8±25.9 months. The groups differed in the frequency of repeated endovascular revascularization (repeated coronary bypass surgery was not performed) (p = 0.013): in group I (34.3%) it was observed more often than in group III (13.5%) (p = 0.04); it was the highest in group II (42.4%) of patients, which is statistically significantly higher, than in IV (17.9%) (p = 0.041). The study showed that the number of MACCE cases was statistically significantly different in different patient groups. After complex revascularization, the number of such observations decreased compared to isolated CABG or PCI (p = 0.0004), in group II the indicator was the highest (84.8%). At the same time, there was a tendency to a higher survival rate of patients in groups III and IV. Conclusion. Complex myocardial revascularization in patients with coronary artery disease and diffuse coronary artery disease is an effective and safe procedure. A new hybrid approach combining percutaneous coronary intervention under the control of intravascular research methods and minimally invasive implementation of the “YurLeon” technique makes it possible to expand the possibilities of treating patients who were previously considered inoperable.