Biomedical subjects
Publications and source records attributed to V S Rabotnikov.
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Experience with the detection and surgical treatment of combined lesions of brachiocephalic arteries in coronary patients is reported. Noninvasive screening of 500 coronary patients detected brachiocephalic arterial lesions with transitory ischemic attacks or without cerebral ischemic symptoms in 82 patients. Simultaneous reconstructions are recommended for severe lesions of the main cerebral vessels and coronary arteries, and two-step operations, with cerebral flow recovery as the priority, for cases of mild clinical anginal manifestations. Forty-one operations were performed, 18 of them being simultaneous. One (2.4%) patient died. Cerebral and coronary symptoms were largely improved in discharged patients.
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Two hundred patients with unstable angina were examined. Of those, 100 were on medication only, while another 100 had undergone aortocoronary shunting. Five-year survival rate was higher, and the quality of life was better, in the surgical patients, as compared to conservative cases.
Survival rates were evaluated in 3 groups of patients: those with an isolated lesion of the anterior interventricular branch of the left coronary artery (group 1), multiple coronary arterial lesions (group 2) and a more than 50% narrowing of the left coronary-arterial trunk (group 3) following autovenous aortocoronary shunting of 1 to 5 coronary arteries. Drug-treated patients with similar coronary arterial lesions and clinical manifestations were taken as controls. Long-term survival rates of surgical patients were significantly higher, as compared to those of medication-treated patients in groups 2 and 3. There was no significant difference in survival rates of first-group patients. Long-term survival was dependent on the scope of revascularization and pretreatment myocardial contractility.
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The results of surgical treatment of post-infarction left ventricular aneurysms (PILVA) in 121 patients are analyzed. 64 patients underwent resection of the aneurysm, in 57 the resection was combined with aortocoronary shunt. Hospital mortality amounted to 11.6%. Analysis of mortality in relation to the initial values of the clinical, haemodynamic and contractility indicators has shown that the results of surgical treatment depend on the contractile function of the viable part of the left ventricle, on the blood flow in the left ventricular lateral wall and on the cardiac output. After surgery, signs of heart failure diminished or disappeared in 81% of the patients. The postoperative clinical course depended on the preoperative value of the ejection fraction of the contracting part of the left ventricle. Stenocardial pain disappeared or its frequency decreased in 91% of the patients. The patients' survival rate in the five-year postoperative period was 68%. The main factors of long-term prognosis were the degree of the coronary affection and the contraction capacity of the viable myocardium.
A clinical and anatomic study was conducted in 50 patients with myocardial infarction aggravated by cardiogenic shock in order to substantiate the practicability and possibility of aortal-coronary shunting in such cases. Gross stenosing and occluding lesions one and more coronary arteries, localized in proximal vascular segments, were present in all the cases. Anatomical conditions in most patients with cardiogenic shock were conducive to reconstructive surgery.
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The condition of the distal bed of the cardiac coronary arteries was studied in 150 patients with ischemic heart disease. It proved to be affected with stenotic atherosclerosis in 20,6% of cases. The distal bed in patients with the chronic stage of ischemic heart disease hardly differed from that in patients with acute myocardial infarction. Total revascularization may be accomplished in 33% of cases with affection of three vessels of the cardiac coronary bed with stenotic atherosclerosis and in 96,5% of cases with affection of one vessel.
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