vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2018-15-3-354-362vestim-444Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEОДНОМОМЕНТНАЯ ХИРУРГИЧЕСКАЯ КОРРЕКЦИЯ ПРИ СОЧЕТАННОМ ПОРАЖЕНИИ СОННЫХ И КОРОНАРНЫХ АРТЕРИЙONE-STAGE SURGICAL CORRECTION IN CASE OF COMBINED LESIONS OF THE CAROTID AND CORONARY ARTERIESЯнушкоВ. А.YanushkoV. A.

Янушко Вячеслав Алексеевич – д-р мед. наук, профессор, заведующий лабораторией

ул. Р. Люксембург, 110Б, 220036, г. Минск

Viacheslav A. Yanushko – D. Sc. (Med.), Рrofessor, Head of the Laboratory

R. Luxembourg Str., 110B, 220036, Minsk

yanushkova@mail.ruРеспубликанский научно-практический центр «Кардиология»Republican Scientific and Practical Centre «Cardiology»201816092018153354362Copyright © Янушко В.А., 20182018Янушко В.А.Yanushko V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/444

Работа выполнена с целью определения эффективного и безопасного подхода к лечению пациентов с сочетанными патологиями сонных и коронарных артерий.

В период с 2006 по 2016 г. в ГУ РНПЦ «Кардиология» было прооперированно 207 пациентов c сочетанными патологиями сонных и коронарных артерий. Клинические данные пациентов включали: стенокардию напряжения функционального класса III, хроническую сердечную недостаточность NYHA III, одно- или двустороннее поражение внутренней сонной артерии, хроническую артериальную недостаточность нижних конечностей, сахарный диабет, хроническую болезнь почек. При выявлении конкурирующей патологии сонных и коронарных артерий пациентам выполняли одномоментную коррекцию для снижения количества периоперационных осложнений и во избежание летальности (каротидную эндартерэктомию сочетали с операцией на сердце), а при наличии соответствующих показаний аортокоронарное шунтирование дополняли коррекцией клапанного аппарата и/или пластикой аневризмы левого желудочка.

Анализ результатов хирургической коррекции патологий коронарных и сонных артерий при сочетанном их поражении показал безопасность и эффективность применяемого тактического подхода. Летальность и послеоперационные осложнения не превышали аналогичные показатели у пациентов, прооперированных только по поводу ишемической болезни сердца (летальность 2,9 %).

Таким образом, получен положительный результат при использовании данной тактики в лечении пациентов с ишемической болезнью и патологией сонной артерии.

The aim of the work is to determine the most effective and safe approach to treatment of patients with combined pathologies of the carotid and coronary arteries.

For the period from 2006 to 2016 in the RSPC “Cardiology” was operated on 207 patients with concomitant pathologies of the carotid and coronary arteries. Clinical data of patients included: angina of FC III, chronic heart failure NYHA III, one – or 2-sided lesions of the internal carotid artery, chronic arterial insufficiency of the lower extremities, diabetes mellitus, chronic kidney disease. Оne-stage correction was performed in patients in cases of concominant pathology of carotid and coronary arteries to reduce the number of perioperative complications and mortality: carotid endarterectomy combined with heart operation. Coronary artery bypass grafting was supplemented by correction of the valvular apparatus and/or left ventricular aneurysm plasty in identifying the relevant evidence.

We have analyzed the results of surgical correction of abnormalities of the coronary and carotid arteries combined with their defeat. It was shown the safety and effectiveness of tactical approach in the group of concomitant lesions in both arterial basins. Mortality and postoperative complications did not exceed those in patients operated just about ischemic heart disease (mortality of 2.9 %). This fact allows the authors to make a conclusion about the legality of the use of this tactic, with good immediate results.

A positive result is obtained with the simultaneous approach in the treatment of patients with coronary artery disease and pathology of the carotid artery

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The authors declare that there are no conflicts of interest present.