Sas S. The effectiveness of coronary bypass surgery in a working heart depending on the clinical and anatomical characteristics of the coronary channel

The dissertation contains a theoretical generalization and proposed a new vision of the problem in the field of cardiovascular surgery to improve the efficiency of coronary bypass surgery on a working heart by introducing a differentiated approach to the choice of operative treatment tactics depending on the anatomical and functional characteristics of the coronary bed. The scientific novelty of the research lies in the fact that, for the first time in Ukraine, theoretical propositions have been obtained that shed light on the clinical and anatomical features of the coronary bed during coronary bypass surgery on a working heart: - a systematic study was conducted to study the effectiveness of coronary bypass surgery on a working heart on a large number of observations taking into account the gender, age of the patient and comorbid pathology in the conditions of one cardiac surgical center; - determined highly reliable cardiovascular factors and their features that can cause clinical and anatomical changes in the coronary arteries, such as: excess body weight, obesity, smoking, arterial hypertension, type II diabetes; - analyzed echocardiography indicators: left ventricular ejection fraction and end-diastolic volume before and after performing coronary bypass surgery on a working heart, which made it possible to evaluate the results of treatment by determining the effectiveness of myocardial revascularization in patients with various degrees of coronary artery damage; - with the help of multifactorial analysis, their combined influence on the occurrence of intraoperative features during coronary bypass surgery on a working heart was assessed. - the choice of coronary bypass tactics on a working heart is optimized by determining highly reliable predictors that can cause clinical and anatomical changes in coronary arteries. The theoretical significance of the obtained results is a significant addition to the solution of theoretical provisions in the field of cardiovascular surgery regarding the problem of choosing the tactics of coronary bypass surgery on a working heart in patients with ischemic heart disease, depending on the clinical and anatomical features of the coronary bed and taking into account individual cardiovascular factors, which can lead to changes in the coronary arteries. The practical significance of the research results is that its results became the basis for choosing surgical tactics for performing coronary bypass surgery on a working heart, depending on the anatomical and functional features of the structure of the coronary arteries, which contributed to: - study of the influence of cardiovascular (medical-social and medical-biological) factors in patients with coronary heart disease on the result of coronary bypass surgery in a working heart; - the study of the features of coronary shunting on a working heart, depending on the anatomical and functional features of the coronary bed; - determination of the impact of features of the structure of coronary arteries on perioperative complications in coronary bypass surgery on a working heart; - to study the effectiveness of the results of surgical treatment of coronary heart disease during coronary bypass surgery on a working heart, taking into account the anatomical and functional features of the structure of the coronary arteries; - the obtained results became the basis for the development of a prognostic mathematical model regarding the choice of surgical tactics of myocardial revascularization depending on the anatomical and functional features of the coronary arteries.