Khusan Khalikulov1, Abrol Mansurov1, Saidorifkhon Murtazaev1, Sandjar Babadjanov1, Sherzod Aliev1, Khondamir Mirzaev1

1Republican Specialized Scientific Practical Medical Center of Surgery, Tashkent, Uzbekistan

Background:
Estimation of the direct and short-term results of the coronary bypass operations of ischemic heart disease at patients with the unstable angina.

Method(s):
we have analyzed 110 patients with the ischemic heart disease who have the multivessel coronary artery disease with the unstable condition. By the period of 2018 – 2019 we performed coronary revascularization for these group of patients. The effectiveness of operations was evaluated by the following criteria: absence of angina symptoms after an operation, myocardial infarction, neuro-cerebral complications, mortality, echocardiographic data. All patients had the unstable angina (progressive angina, early postinfarction angina, acute coronary syndrome). In all cases preoperatively we tried to stabilize the condition of patients with the purpose of improvement the results of surgical intervention.

Result(s):
At 78,8% cases patients had postinfarction cardiosclerosis, at 64,7% arterial hypetension, at 11,2% diabetes mellitus. 12 (10,9%) patients were diagnosed with acute coronary syndrome and 3 patients among these patients had the S-T myocardial infarction. The other 98 patients had unstable angina (66 (60%) patients with progressive angina and 32 (29,1%) patients with early postinfarction angina. Coronaryangiographic data was following: two-vessel disease – 33,6% cases, three-vessel disease – 53,6%, left main disease – 12,8% cases. The most frequent lesions were revealed of left anterior descending artery at 109 (99,09%) cases. EchoCG data showed following: ejection fraction of left ventricle preoperatively was average 45,5±1,2% (range from 36% to 62%). At the short time of period after operation the average ejection fraction has increased to the 47,3±1,3%. Among the three patients with the acute coronary syndrome two of them had negative troponin I test and one with the positive test. Perioperative myocardial infarction was developed at 2 (1,8%) patients.

In all 110 cases were performed various types of coronary bypass grafting operations. Quantity of grafts: 41 cases – two grafts, 55 cases – three grafts, 14 cases – 4 grafts. Coronary bypass grafting on beating heart was performed at 17 patients, due to very unstable condition and low contractility function of the heart with the means of decrease the unfavorable effect of cardiopulmonary bypass. Mortality rate was 0,9%, this patient was operated on the acute stage of myocardial infarction, due to unavailability of interventional treatment.

Conclusion(s):
direct and short time results after operations of coronary revascularization at patients with unstable angina showed good clinical effect of surgical treatment. There should be stabilized the condition of patients prior to expected operation and in case of urgent situation (impossibility of conservative stabilization of condition and inability of interventional treatment) coronary bypass surgery has shown encouraging results at this type of group patients.