Beleiovych V. Choice of the Approach to Beating Heart Surgical Treatment of Combined Occlusive and Stenotic Lesions of Brachiocephalic and Coronary Heart Arteries

The work is based on analysis of treatment of the patients suffering from combined atherosclerotic occlusive and stenotic lesions of carotid and coronary arteries. Depending on the applied surgical approaches, the patients are divided into two groups: group one includessingle-stage surgical interventions (35 cases) of the two vascular territories; group two includes serial surgical treatments (27 cases). The research uses the general and the specialized methods of cardiovascular system research (ultrasound: echocardiography, Doppler scanning with spectral analysis of the Doppler signals; radiological: cardiac ventriculography, angiography of the brachiocephalic blood vessels, multispiral computed tomography of the brain), laboratory (clinical tests, biochemical assays), and variation statistic methods (Student's t-test, Pearson's chi-squared test). The comprehensive analysis of the immediate, medium and long-term results describes efficiency of the surgical treatment of the patients. The research has determined the diagnostic procedures and outlined the decision-making criteria as well as the key indications to the choice of the surgical treatment approaches applicable to the certain patient category. It has been proved that serial surgical treatment may be used for stable progression of coronary heart disease without the clinically significant neurological disorders. It has been established that single-stage surgeries are recommended for the patients with decompensation of the blood circulation in both affected arterial territories disabling safe restoration of blood flow in one separate vascular territory. Simultaneous (single-stage) surgeries with due neuromonitoring do not entail increased risk of ischemic neurological and cardiologic complications.