Ischemic heart disease. Indications and methods of surgical treatment.

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Ischemic heart disease. Indications and methods
of surgical treatment.

• Surgery department ?2

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IHD classification (WHPO)

• 1. Acute blood flow arrest
• 2. Stenocardia
• 3. Myocardial infarction
• 4. Heart failure
• 5. Cardiac rhythm disorders

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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)

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IHD diagnostics

• ECG
• Echocardigraphy
• Coronarography
• Ventriculography

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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

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IHD invasive treatment

• The best revascularization
• is full
  revascularization

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Indications for IHD surgery treatment

• Both PCI and CABG are more effective than medical
  management at relieving symptoms Rihal 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

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IHD surgery treatment

• Coronary-aortic bypass grafting (CABG)
• LIMA to - LAD grafts

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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 lt0.50
  or demonstrable ischemia on noninvasive testing.

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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.

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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.

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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.

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CABG
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CABG
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CABG
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CABG
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CABG
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