USE OF THE RADIAL ARTERY IN CORONARY SURGERY IN PATIENTS WITH MULTIVESSEL LESIONS OF THE CORONARY ARTERIES

Aim. To analyze literature data on the methods and methods of using the radial artery as an arterial graft for coronary artery bypass grafting in patients with multivessel coronary artery disease. Results. The literature data on ways and methods of arterial revascularization with the use of the radial artery in patients with multivessel coronary artery disease were reviewed and analyzed. Conclusions. Complete arterial revascularization with the use of the radial artery in patients with multivessel lesion of the coronary bed is a promising direction of coronary surgery and enables to achieve better long-term results

EXPERIENCE OF LARGE SAPHENOUS VEIN HARVESTING BY METHOD OF "SKIN BRIDGES" IN AORTO-CORONARY ARTERY BYPASS SURGERY

Background. This article focuses on the experience of great saphenous vein (GSV) harvesting by the method of "skin bridges" in operations of coronary artery bypass grafting (CABG). Objective. To show the possibility of using minimally invasive GSV harvesting in CABG operations. Material and methods. We applied the two methods of BPV harvesting in patients with ischemic heart disease (standard and open method of "skin bridges"). Results. Comparative evaluation of these methods enables to make a preliminary judgment about their advantages and disadvantages. The results obtained were compared with those of other clinics in endoscopic vein harvesting (EVH). Conclusions. A method of "skin bridges" harvesting in the hands of a competent surgeon is comparable to the EE way of vein harvesting

Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism.

BACKGROUND: Whether the oral factor Xa inhibitor edoxaban can be an alternative to warfarin in patients with venous thromboembolism is unclear. METHODS: In a randomized, double-blind, noninferiority study, we randomly assigned patients with acute venous thromboembolism, who had initially received heparin, to receive edoxaban at a dose of 60 mg once daily, or 30 mg once daily (e.g., in the case of patients with creatinine clearance of 30 to 50 ml per minute or a body weight below 60 kg), or to receive warfarin. Patients received the study drug for 3 to 12 months. The primary efficacy outcome was recurrent symptomatic venous thromboembolism. The principal safety outcome was major or clinically relevant nonmajor bleeding. RESULTS: A total of 4921 patients presented with deep-vein thrombosis, and 3319 with a pulmonary embolism. Among patients receiving warfarin, the time in the therapeutic range was 63.5%. Edoxaban was noninferior to warfarin with respect to the primary efficacy outcome, which occurred in 130 patients in the edoxaban group (3.2%) and 146 patients in the warfarin group (3.5%) (hazard ratio, 0.89; 95% confidence interval [CI], 0.70 to 1.13; P<0.001 for noninferiority). The safety outcome occurred in 349 patients (8.5%) in the edoxaban group and 423 patients (10.3%) in the warfarin group (hazard ratio, 0.81; 95% CI, 0.71 to 0.94; P=0.004 for superiority). The rates of other adverse events were similar in the two groups. A total of 938 patients with pulmonary embolism had right ventricular dysfunction, as assessed by measurement of N-terminal pro-brain natriuretic peptide levels; the rate of recurrent venous thromboembolism in this subgroup was 3.3% in the edoxaban group and 6.2% in the warfarin group (hazard ratio, 0.52; 95% CI, 0.28 to 0.98). CONCLUSIONS: Edoxaban administered once daily after initial treatment with heparin was noninferior to high-quality standard therapy and caused significantly less bleeding in a broad spectrum of patients with venous thromboembolism, including those with severe pulmonary embolism. (Funded by Daiichi-Sankyo; Hokusai-VTE ClinicalTrials.gov number, NCT00986154.)