Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2013 Vol. 21 No 4

GENERAL AND SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2013.4.25   |  

A.A. ZIANKOU1,2

APPLICATION OF THE EXTRACORPORAL BLOOD CIRCULATION IN THE MINIMALLY INVASIVE MYOCARDIAL REVASCULARIZATION

ME Vitebsk Regional clinical hospital 1,
EE Vitebsk State Medical University2
The Republic of Belarus

Objectives. To analyze the causes of the conversion to the extracorporeal circulation (ECC) during the full minimally invasive coronary surgery (MICS) for optimization of the surgical treatment results of the coronary heart disease (CHD).
Methods. From 2011 up to 2012 yrs at the cardiac surgery department of ME Vitebsk regional clinical hospital 104 patients with the CHD underwent full minimally invasive coronary surgery. MICS strategy is to perform a functionally complete myocardial revascularization from the left-sided minithoracotomy without application of artificial blood circulation (ABC) and manipulation on the ascending aorta. In 8 (7,7%) patients the ECC was employed during the main operation stage.
Results. Myocardial ischemia with hypotension (12,5%), ventricle fibrillation (37,5%), hemodynamic disturbances during the heart enucleation (12,5%), impediment of the heart enucleation and coronary artery positioning due to cardiomegaly (37,5%) were considered to be the causes of the conversion to the ECC during the full MICS. The postoperative period in patients after MICS with emergency connection of ECC was accompanied by a large loss of blood, a slow recovery of the functions of the respiratory and cardiovascular systems. In the case of a planned conversion to the ECC the more stable postoperative course was observed compared with the emergency conversion.
Conclusions. Predictors of the conversion to the ECC were the left coronary artery body stenosis, enlarged left ventricle volumes, apparent hypertrophy of the left ventricle and increased local index of contractility (LIC). The emergency conversion to the ECC during the complete MICS promotes increasing of perioperative complications, extension of the operation time, period of ICU stay and hospital length of stay in comparison with patients without conversion to the ECC. The planned application of ECC to achieve the necessary completeness of revascularization is considered to be justified in high risk patients. In case of the conversion need to the ECC the femoral cannulation can be successfully used without sternotomy.

Keywords: minimally invasive myocardial revascularization, extracorporeal circulation, conversion
p. 25 32 of the original issue
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Address for correspondence:
210037, Respublika Belarus', g. Vitebsk, ul. Voinov-internatsionalistov, d. 37, UZ Vitebskaia oblastnaia klinicheskaia bol'nitsa, otdelenie kardiokhirurgii,
e-mail: Zenkov_Al@rambler.ru,
Ziankou Aleksandr Aleksandrovich
Information about the authors:
Ziankou A.A. PhD, a head of cardiac surgery chair of ME Vitebsk regional clinical hospital, associate professor of the surgery chair of the faculty of training and retraining of the staff of EE Vitebsk State Medical University.
Contacts | ©Vitebsk State Medical University, 2007