Polishchuk D. Application of autoarterial transplants for direct myocardial revasculization

The thesis deals with peculiarities of autoarterial transplants atherosclerotic damage in patients with ischemic heart disease as well as with working out the most optimal autoarterial transplant of direct myocardium revascularization aimed at improvement of treatment results. The most predominant transplant is the internal thoracic artery, because its stenosing atherosclerosis involvement was 16,7%. Stenosing atherosclerosis in the right gastroepiploic artery is detected in 63,3% of cases and in the radial artery in 58,1% of cases. Two methods of internal thoracic artery excision in the layer of surrounding tissues are proposed: thermal-electric and ultrasonic. Characteristics of optimal power that is supplied to tissues during their dissection and coagulation are worked out. The optimum thickness of surrounding layer of paravasal tissue, muscles, accompanying veins and lymph ducts is determined. In the nearest postoperative period a paradoxical contraction of interventricular septum in 92% of patients is a mean sign of satisfactory functioning of mammarocoronary anastomosis. In a year 83,3 % of patients had I-II functional class, after 2 years a majority of patients (52 %) had II functional class, after more than 3 years 28,8 % had I functional class of angina pectoris. The repeated angiographic study showed that in the term of 10 years after operation the mammarocoronary anastomosis was passable in 90% of patients. Long-term results of operative treatment of ischemic heart disease depended much on atherosclerosis progress in native coronary bed. The work is a new contribution to the solving of scientific problem that is a choice of the most optimal autoarterial transplant direct myocardial revascularization.