surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2021-11-3-228-234surgonco-604Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSОсобенности обеспечения гемодинамики во время хирургической реваскуляризации миокарда у пациентов с систолической дисфункцией левого желудочкаHaemodynamics Support during Surgical Myocardial Revascularisation in Patients with Systolic Left Ventricular Dysfunctionhttps://orcid.org/0000-0002-2630-6505ХаритоновН. В.KharitonovN. V.

Харитонов Николай Владимирович – отделение кардиохирургии

Химки

Nikolay V. Kharitonov – Department of Cardiac Surgery

Khimki

xariton27@gmail.comhttps://orcid.org/0000-0002-5588-8727ВицукаевВ. В.VitsukaevV. V.

Вицукаев Виталий Васильевич – к.м.н, отделение кардиохирургии

Химки

Vitaliy V. Vitsukaev – Cand. Sci. (Med.), Department of Cardiac Surgery

Khimki

https://orcid.org/0000-0002-1975-5521ТрофимовН. А.TrofimovN. A.

Трофимов Николай Александрович – д.м.н., кардиохирургическое отделение № 1, кафедра общей хирурги и онкологии, кафедра хирургии

Чувашская Республика, Чебоксары

Nikolay A. Trofimov – Dr. Sci. (Med.), Department of Cardiac Surgery No. 1, Department of General Surgery and Oncology, Department of Surgery

Cheboksary

https://orcid.org/0000-0001-6206-9693МакальскийП. Д.MakalskyP. D.

Макальский Петр Дмитриевич – отделение кардиохирургии

Химки

Petr D. Makalsky – Department of Cardiac Surgery

Khimki

https://orcid.org/0000-0002-4503-1543ЗавгороднийВ. Н.ZavgorodnyV. N.

Завгородний Вячеслав Николаевич – отделение кардиохирургии

Химки

Vyacheslav N. Zavgorodny – Department of Cardiac Surgery

Khimki

Федеральный клинический центр высоких медицинских технологий Федерального медико-биологического агентстваРоссияFederal Clinical Centre for Advanced Medical Technologies, Federal Medical and Biological AgencyRussian FederationРеспубликанский кардиологический диспансер; Институт усовершенствования врачей; Федеральный центр травматологии, ортопедии и эндопротезирования; Чувашский государственный университет имени И. Н. УльяноваРоссияRepublican Cardiology Dispensary; Institute of Advanced Medical Training; Federal Centre for Traumatology, Orthopaedics and Endoprosthetics; I.N. Ulyanov Chuvash State UniversityRussian Federation202101102021113228234Copyright © Харитонов Н.В., Вицукаев В.В., Трофимов Н.А., Макальский П.Д., Завгородний В.Н., 20212021Харитонов Н.В., Вицукаев В.В., Трофимов Н.А., Макальский П.Д., Завгородний В.Н.Kharitonov N.V., Vitsukaev V.V., Trofimov N.A., Makalsky P.D., Zavgorodny V.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surgonco.ru/jour/article/view/604

Ишемическая болезнь сердца остается ведущей причиной смерти во всем мире, а коронарное шунтирование остается стандартом медицинской помощи при лечении многососудистого и/или стволового гемодинамически значимого стеноза коронарных артерий. В настоящее время вопрос обеспечения интраоперационной гемодинамики во время операции коронарного шунтирования пациентам со сниженной фракцией выброса остается дискутабельным. Существуют многочисленные исследования в пользу выполнения аортокоронарного шунтирования (АКШ) без использования искусственного кровообращения у пациентов с более высоким риском, чтобы избежать частых осложнений экстракорпорального кровообращения, таких как: необходимость в переливании крови, почечная недостаточность, кровотечения, инфицирование раны, цереброваскулярные события, гуморальные нарушения. С другой стороны, АКШ с искусственным кровообращением и остановка сердца предполагают бескровное операционное поле и позволяют выполнить полную реваскуляризацию в большинстве, часто в очень сложных случаях. Считается, что количество осложнений и результаты коронарного шунтирования на работающем сердце напрямую зависят от опыта хирурга и клиники в проведении таких операций. Поэтому многие хирурги отстраняются от этой методики операции ввиду отсутствия опыта выполнения подобных операций. Данная статья представляет обзор современного состояния проблемы, обсуждение новых систематических исследований по вопросу обеспечения интраоперационной гемодинамики у пациентов со сниженной фракцией выброса левого желудочка и затрагивает обсуждение влияния опыта оперирующего хирурга на исход операции.

Coronary heart disease remains a leading cause of death worldwide, and coronary bypass surgery -- the treatment standard in haemodynamically significant multivessel and/or trunk coronary stenosis. Intraoperative haemodynamics support during coronary artery bypass grafting (CABG) in patients with reduced ejection fraction currently remains controversial. Manifold evidence favours CABG with no extracorporeal circulation in higher risk patients to avoid the system’s frequent complications of blood transfusion, renal failure, bleeding, wound infection, cerebrovascular events and humoral disturbances. On the other hand, CABG with extracorporeal circulation and heart arrest allows a bloodless operating field and complete revascularisation in most, often very complex, cases. The complication rate and outcome in beating-heart surgery are reckoned to depend directly on the relevant surgeon’s and clinic experience, which makes many relinquish the technique due to a limited history of skill. This essay overviews the current state of the art, discussions of recent systematic studies on intraoperative haemodynamics support in patients with reduced left ventricular ejection fraction and touches upon the importance of surgeon’s experience for the operation outcome.

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