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Ischemic heart disease . Indications and methods of surgical treatment. Surgery department № 2. IHD classification (WHPO). 1. Acute blood flow arrest 2. Stenocardia 3. Myocardial infarction 4. Heart failure 5. Cardiac rhythm disorders. IHD clinical picture.
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Ischemic heart disease. Indications and methods of surgical treatment. Surgery department №2
IHD classification (WHPO) 1. Acute blood flow arrest 2. Stenocardia 3. Myocardial infarction 4. Heart failure 5. Cardiac rhythm disorders
IHD clinical picture • Angina pectoris: (chest pain on exertion, in cold weather or emotional situations) • Acute chest pain: acute coronary syndrome, unstable angina or myocardial infarction("heart attack", severe chest pain unrelieved by rest associated with evidence of acute heart damage) • Heart failure: (difficulty in breathing or swelling of the extremities due to weakness of the heart muscle)
IHD diagnostics • ECG • Echocardigraphy • Coronarography • Ventriculography
IHD treatment • Non-invasive surgical treatment (could help to turn up the heart on working in conditions of decreased coronary circulation) • Percutaneus coronary intervention (PCI) (balloon angioplasty or coronary stenting) • Open heart operation
IHD invasive treatment The best revascularization – is full revascularization
Indications for IHD surgery treatment • Both PCI and CABG are more effective than medical management at relieving symptomsRihal C, Raco D, Gersh B, Yusuf S (2003) • CABG is superior to PCI in multivessel coronary disease (SoS trial) • Patients treated with CABG had lower rates of death and of death or myocardial infarction than treatment with a coronary stent
IHD surgery treatment • Coronary-aortic bypass grafting (CABG) • LIMA–to-LAD grafts
Indications for CABG(Guidelines for CABG Surgery the American College of Cardiology and the American Heart Association, 1999) • Significant left main coronary artery stenosis. • Left main equivalent: significant (70 %) stenosis of the proximal LAD and proximal left circumflex arteries. 3. Three-vessel disease. 4. Two-vessel disease with significant proximal LAD stenosis and either ejection fraction <0.50 or demonstrable ischemia on noninvasive testing.
Indications for CABG(Guidelines for CABG Surgery the American College of Cardiology and the American Heart Association, 1999) 5. One- or 2-vessel stenosis without significant proximal LAD stenosis, but with a large area of viable myocardium and high-risk criteria on noninvasive testing . 6. Disabling angina despite maximal noninvasive therapy, when surgery can be performed with acceptable risk.
2004 ACC/AHA CABG guidelines • Disease of the left main coronary artery (LMCA) • Disease of all three coronary vessels (LAD,LCX and RCA). • Diffuse disease not amenable to treatment with a PCI.
CABG history • In 1952, Demikhov pioneered surgical myocardial revascularization with the internal mammary artery in canines. • However, the invention of beating-heart or off-pump CABG surgery is often attributed to Kolessov, who, in 1967, used a minithoracotomy incision, anastomosing the left internal mammary artery (LIMA) to the left anterior descending artery (LAD). • Later pioneers of the off-pump technique include Favoloro, Garrett, and associates (in the United States); Trapp and Bisarya (in Canada); and Ankeney (in the United States)—all of whom performed off-pump CABG surgery from 1968 to 1975.
