[Current trends in the development of coronary surgery]

Area of Science:

• Cardiovascular Surgery
• Microsurgery
• Ischemic Heart Disease

Background:

• Ischemic heart disease (IHD) necessitates effective myocardial revascularization strategies.
• Coronary artery bypass grafting (CABG) is a primary treatment modality for IHD.
• Microsurgical techniques allow for the revascularization of smaller coronary arteries.

Purpose of the Study:

• To compare the efficacy of various coronary shunting methods using microsurgical techniques.
• To evaluate the effectiveness of total myocardial revascularization versus shunting major branches.
• To assess the advantages of different graft types under specific hemodynamic conditions.

Main Methods:

• Comparative study involving 240 patients with ischemic heart disease.
• Application of microsurgical techniques for coronary shunting.
• Evaluation of total myocardial revascularization, including small diameter arteries (<1.5 mm) and vessels in cardiosclerotic zones.
• Comparison between mammary-coronary shunts and autologous venous shunts.

Main Results:

• Total myocardial revascularization demonstrated superior effectiveness compared to shunting only major coronary branches.
• Mammary-coronary shunts showed advantages over autologous venous shunts in reconstructions under unfavorable hemodynamic conditions.
• Multiple bilateral mammary-coronary shunting of left coronary artery branches emerged as a promising approach.

Conclusions:

• Microsurgical total myocardial revascularization is a highly effective strategy for ischemic heart disease.
• Mammary-coronary grafts are preferable to venous grafts in specific challenging coronary artery reconstructions.
• Bilateral internal mammary artery grafting presents a promising option for left coronary artery revascularization.