3 research outputs found
Predictors of Mid-Term AVNeo Insufficiency
ABSTRACT Introduction: Aortic stenosis (AS) is the most common valvular heart disease and the most common indication for aortic valve replacement in adults. Aortic valve neocuspidization (AVNeo) with fixed autologous pericardium, also known as the Ozaki procedure, is a possible alternative treatment of AS. Autopericardial valves save the dynamics and physiological anatomy of the aortic root, however, the service life of autopericardial leaflets is limited. There is no data about factors that may influence the development of AVNeo insufficiency. Here, we assessed the effect of autopericardial leaflet symmetry on the development of aortic insufficiency after Ozaki procedure. Methods: This study included 381 patients with AS who underwent Ozaki procedure. Patients were divided into group 1 (171 patients with symmetric aortic root) and group 2 (210 patients with asymmetric aortic root). Results: The maximum observation period was up to 65 months. Sixteen cases of aortic insufficiency were detected in group 1, and 33 cases were detected in group 2. Based on the results of Cox regression, the predictors of aortic insufficiency in the late postoperative period are age and asymmetry of neocusps. According to results of KaplanβMeier analysis, insufficiency of AVNeo in the maximum follow-up period after surgical correction of AS for group 1 patients was significantly lower than for group 2 patients (P=0.006). Conclusion: Asymmetric neocusps increase the risk of aortic insufficiency in the mid-term period after Ozaki procedure. And the older the patients at the time of surgery, the less likely they develop AVNeo insufficiency
ΠΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΡΡ ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ ΡΡΠΊΠΎΡΠ΅Π½ΠΈΡ ΠΈ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΡ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ ΡΡΠΊΠΎΡΠ΅Π½ΠΈΡ ΠΊ ΠΎΠ±ΡΠ΅ΠΌΡ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ Π²ΡΠ±ΡΠΎΡΠ° Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ° Π² ΠΎΡΠ΅Π½ΠΊΠ΅ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ Π°ΠΎΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ΅Π½ΠΎΠ·Π° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΠΎΠΉ ΡΡΠ°ΠΊΡΠΈΠ΅ΠΉ Π²ΡΠ±ΡΠΎΡΠ° Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ°
Objectives: 1) to evaluate the diagnostic capabilities of AT and AT/ET in determining severe AS in patients with reduced LV EF and low stroke volume.2) to determine the threshold values for AT and AT/ET in the diagnosis of severe AS in patients with low stroke volume and low transaortic gradient.Materials and methods. This is prospective single center study included 70 patients with low transaortic pressure gradient, reduced LV ejection fraction was and severe aortic stenosis. All patients have been examined from 2017 to 2022. Inclusion criteria for the study are: isolated AV stenosis with, reduced LV RF, low transaortic pressure gradient. Severity of AS was identified based on dobutamine stress echocardiography and aortic valve area (AVA). Severe stenosis was defined as AVA< 1 cm2.Result. A statistically significant and high negative correlation was found between the AVA and AT/ET ratio, (r = 0.77, p < 0.001) and weak correlation with the AT indicator (r = 0.41, p = 0.01). The RoC-analysis showed the greatest predictive ability in the differential diagnosis of severe AS for the ratio AT/ET (AUC = 0.84 Β± 0.54, p < 0.001) and the lower predictive ability for the indicator AT (AUC = 0.63 Β± 0.72, p < 0.02). The optimal threshold value for determining severe AS for the AT / ET > 0.32 (sensitivity of 92%, specificity of 70%), for AT > 99 (sensitivity of 81%, specificity of 88%). Multiple logistic regression analysis revealed that the AT/ET ratio is the only echocardiographic parameter that has a significant impact on the differential diagnosis of severe AS in patients with reduced LV EF (OR 1.5; 95% CI 1.2β1.9, p = 0.001). There was low interobserver variability in measurements of AT score (intraclass correlation coefficient was 0.93 [95% CI, 0.80-0.97] and AT/ET ratio (intraclass correlation coefficient was 0.88 [95% CI, 0.75β0.95]).Conclusions.In patients with AS and reduced LV stroke volume the AT/ET ratio is highly sensitive and well reproducible in the diagnosis of severe AS. The AT index has a weak diagnostic ability of severe AS in that patients.The threshold value of AT/ET >0.32 can diagnose severe AS with a high degree of probability in patients with reduced LV stroke volume and reduced transaortic gradients with reduced LV EF.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: 1) ΠΎΠΏΡΠ΅Π΄Π΅Π»ΠΈΡΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΡΡ
ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ AT ΠΈ AT/ET Π² ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠΈ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ Π°ΠΎΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ΅Π½ΠΎΠ·Π° (ΠΠ‘) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π½ΠΈΠ·ΠΊΠΈΠΌ ΡΠ΄Π°ΡΠ½ΡΠΌ ΠΎΠ±ΡΠ΅ΠΌΠΎΠΌ (Π£Π) ΠΈ Π½ΠΈΠ·ΠΊΠΈΠΌ ΡΡΠ°Π½ΡΠ°ΠΎΡΡΠ°Π»ΡΠ½ΡΠΌ Π³ΡΠ°Π΄ΠΈΠ΅Π½ΡΠΎΠΌ Π΄Π°Π²Π»Π΅Π½ΠΈΡ ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΠΎΠΉ ΡΡΠ°ΠΊΡΠΈΠ΅ΠΉ Π²ΡΠ±ΡΠΎΡΠ° Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ° (Π€Π ΠΠ);2) ΠΎΠΏΡΠ΅Π΄Π΅Π»ΠΈΡΡ ΠΏΠΎΡΠΎΠ³ΠΎΠ²ΡΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΡ Π΄Π»Ρ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΠ’ ΠΈ ΠΠ’/ΠΠ’ Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΠ‘ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π½ΠΈΠ·ΠΊΠΈΠΌ Π£Π ΠΈ Π½ΠΈΠ·ΠΊΠΈΠΌ ΡΡΠ°Π½ΡΠ°ΠΎΡΡΠ°Π»ΡΠ½ΡΠΌ Π³ΡΠ°Π΄ΠΈΠ΅Π½ΡΠΎΠΌ Π΄Π°Π²Π»Π΅Π½ΠΈΡ ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΠΎΠΉ Π€Π ΠΠ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎ Ρ 2017 ΠΏΠΎ 2022 Π³. ΡΠΎΠ±ΡΠ°Π½Π° Π±Π°Π·Π° Π΄Π°Π½Π½ΡΡ
ΠΈΠ· 70 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΡΠΌ ΠΠ‘ Ρ Π½ΠΈΠ·ΠΊΠΈΠΌ Π£Π ΠΈ Π½ΠΈΠ·ΠΊΠΈΠΌ ΡΡΠ°Π½ΡΠ°ΠΎΡΡΠ°Π»ΡΠ½ΡΠΌ Π³ΡΠ°Π΄ΠΈΠ΅Π½ΡΠΎΠΌ Π΄Π°Π²Π»Π΅Π½ΠΈΡ ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΠΎΠΉ Π€Π ΠΠ. ΠΡΠΈΡΠ΅ΡΠΈΠΈ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΡ Π² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅: ΠΈΠ·ΠΎΠ»ΠΈΡΠΎΠ²Π°Π½Π½ΡΠΉ ΠΠ‘ Ρ ΡΡ
ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠ°ΠΌΠΈ, ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΡΡΡΠΈΠΌΠΈ ΡΡΠΆΠ΅Π»ΠΎΠΌΡ ΡΡΠ΅Π½ΠΎΠ·Ρ Ρ Π½ΠΈΠ·ΠΊΠΈΠΌ Π£Π ΠΈ Π½ΠΈΠ·ΠΊΠΈΠΌ ΡΡΠ°Π½ΡΠ°ΠΎΡΡΠ°Π»ΡΠ½ΡΠΌ Π³ΡΠ°Π΄ΠΈΠ΅Π½ΡΠΎΠΌ Π΄Π°Π²Π»Π΅Π½ΠΈΡ ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΠΎΠΉ Π€Π ΠΠ. ΠΠ°ΡΠΈΠ΅Π½ΡΡ Ρ ΠΈΡΡΠΈΠ½Π½ΠΎ ΡΡΠΆΠ΅Π»ΡΠΌ ΠΠ‘ ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΠΎΠΉ Π€Π ΠΠ Π±ΡΠ»ΠΈ ΠΈΠ΄Π΅Π½ΡΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Ρ Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ ΡΡΡΠ΅ΡΡ-ΡΡ
ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΡΠΈΠΈ Ρ Π΄ΠΎΠ±ΡΡΠ°ΠΌΠΈΠ½ΠΎΠΌ ΠΈ ΡΠ°ΡΡΠ΅ΡΠΎΠΌ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΡΠ΅ΠΌΠΎΠΉ ΠΏΠ»ΠΎΡΠ°Π΄ΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΠΎΡΠ²Π΅ΡΡΡΠΈΡ Π°ΠΎΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠ»Π°ΠΏΠ°Π½Π° (AVAΠ roj). Π’ΡΠΆΠ΅Π»ΡΠΉ ΡΡΠ΅Π½ΠΎΠ· ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ»ΠΈ ΠΏΠΎ Π·Π½Π°ΡΠ΅Π½ΠΈΡ AVAΠ rojΛ 1 ΡΠΌ2.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΡΠ²Π»Π΅Π½Π° ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠ°Ρ ΠΈ Π²ΡΡΠΎΠΊΠ°Ρ ΠΎΡΡΠΈΡΠ°ΡΠ΅Π»ΡΠ½Π°Ρ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΠΎΠ½Π½Π°Ρ ΡΠ²ΡΠ·Ρ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ AVAΠ roj Ρ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ΠΌ ΠT/ET (r = 0,77, Ρ < 0,001), Π½ΠΎ ΡΠ»Π°Π±Π°Ρ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΠΎΠ½Π½Π°Ρ ΡΠ²ΡΠ·Ρ Ρ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΌ ΠT (r = 0,41, Ρ = 0,01). ΠΡΠΈΠ²Π°Ρ ROC-Π°Π½Π°Π»ΠΈΠ·Π° ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π»Π° Π½Π°ΠΈΠ±ΠΎΠ»ΡΡΡΡ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΡΠΏΠΎΡΠΎΠ±Π½ΠΎΡΡΡ Π² Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΠ‘ Π΄Π»Ρ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΡ AT/ET (Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΏΠ»ΠΎΡΠ°Π΄ΠΈ ΠΏΠΎΠ΄ ΠΊΡΠΈΠ²ΠΎΠΉ AUC 0,84 Β± 0,54, Ρ < 0,001) ΠΈ ΠΌΠ΅Π½ΡΡΡΡ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΡΠΏΠΎΡΠΎΠ±Π½ΠΎΡΡΡ Π΄Π»Ρ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΠ’ (Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΏΠΎΠ΄ ΠΊΡΠΈΠ²ΠΎΠΉ ΠUC 0,63 Β± 0,72, Ρ < 0,02). ΠΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠ΅ ΠΏΠΎΡΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΠ‘ Π΄Π»Ρ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΡ AT/ET ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΎ >0,32 (ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ 92% ΠΈ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΡ 70%), Π΄Π»Ρ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΠ’ > 99 ΠΌΡ (ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ 81% ΠΈ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΡ 88%). ΠΠ½Π°Π»ΠΈΠ· ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π»ΠΎΠ³ΠΈΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅Π³ΡΠ΅ΡΡΠΈΠΈ Π²ΡΡΠ²ΠΈΠ», ΡΡΠΎ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΠΠ’/ΠΠ’ ΡΠ²Π»ΡΠ΅ΡΡΡ Π΅Π΄ΠΈΠ½ΡΡΠ²Π΅Π½Π½ΡΠΌ ΡΡ
ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠΌ, ΠΎΠΊΠ°Π·ΡΠ²Π°ΡΡΠΈΠΌ Π·Π½Π°ΡΠΈΠΌΠΎΠ΅ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π½Π° Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΡΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΡ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΠ‘ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΠΎΠΉ Π€Π ΠΠ (OΠ¨ 1,5; 95% ΠΠ 1,2β1,9, Ρ = 0,001). ΠΡΡΠ²Π»Π΅Π½Π° Π½ΠΈΠ·ΠΊΠ°Ρ ΠΌΠ΅ΠΆΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΡΠΊΠ°Ρ Π²Π°ΡΠΈΠ°Π±Π΅Π»ΡΠ½ΠΎΡΡΡ Π² ΠΈΠ·ΠΌΠ΅ΡΠ΅Π½ΠΈΡΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ AT (ΠΊΠΎΡΡΡΠΈΡΠΈΠ΅Π½Ρ Π²Π½ΡΡΡΠΈΠΊΠ»Π°ΡΡΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ» 0,93 (95% ΠΠ, 0,80β0,97)) ΠΈ ΠT/ET (ΠΊΠΎΡΡΡΠΈΡΠΈΠ΅Π½Ρ Π²Π½ΡΡΡΠΈΠΊΠ»Π°ΡΡΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ» 0,88 (95% ΠΠ, 0,75β0,95)).ΠΡΠ²ΠΎΠ΄Ρ.Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠ‘ ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΡΠΌΠΈ Π£Π ΠΠ ΠΈ ΡΡΠ°Π½ΡΠ°ΠΎΡΡΠ°Π»ΡΠ½ΡΠΌΠΈ Π³ΡΠ°Π΄ΠΈΠ΅Π½ΡΠ°ΠΌΠΈ ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΠΎΠΉ Π€Π ΠΠ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΠΠ’/ΠΠ’ ΡΠ²Π»ΡΠ΅ΡΡΡ Π²ΡΡΠΎΠΊΠΎΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΡΠΌ ΠΈ Ρ
ΠΎΡΠΎΡΠΎ Π²ΠΎΡΠΏΡΠΎΠΈΠ·Π²ΠΎΠ΄ΠΈΠΌΡΠΌ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΌ Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΠ‘. ΠΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΠ’ ΠΈΠΌΠ΅Π΅Ρ Π½ΠΈΠ·ΠΊΡΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΡΡ ΡΠΏΠΎΡΠΎΠ±Π½ΠΎΡΡΡ Π² ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠΈ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΠΠ‘ Ρ Π΄Π°Π½Π½ΠΎΠΉ Π³ΡΡΠΏΠΏΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ².ΠΠΎΡΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΠΠ’/ΠΠ’ > 0,32 ΠΌΠΎΠΆΠ΅Ρ Ρ Π²ΡΡΠΎΠΊΠΎΠΉ Π΄ΠΎΠ»Π΅ΠΉ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°ΡΡ ΡΡΠΆΠ΅Π»ΡΠΉ ΠΠ‘ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΡΠΌ Π£Π ΠΠ ΠΈ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΡΠΌΠΈ ΡΡΠ°Π½ΡΠ°ΠΎΡΡΠ°Π»ΡΠ½ΡΠΌΠΈ Π³ΡΠ°Π΄ΠΈΠ΅Π½ΡΠ°ΠΌΠΈ ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½Π½ΠΎΠΉ Π€Π ΠΠ
Coronary-Coronary Bypass Grafting
This work is devoted to the original method of myocardial revascularizationβcoronary-coronary bypass grafting. Coronary artery bypass grafting can be considered as an independent method in an exceptional case or as an addition to the standard coronary artery bypass grafting technique. This paper presents the technique for performing CCBG, as well as the early and long-term results of the main studies. Attention is also paid to the advantages and disadvantages of this method from the standpoint of physiology and physics