Lupine Publishers - Journal of Surgery

Mammarokoronarny Shunting on the Working Heartby the “Midcab» Method and Gene Status: The FirstExperience in Uzbekistan by Alexander Nagay in Surgery & Case Studies Open Access Journal in Lupinepublishers

Surgical methods are often applied in treatment of patients with coronary heart disease. The modern direction in development of coronary surgery today became the transition to mini-accesses and to an arterial revascularization. For lifetime of the coronary shunting (CS) enough experience was accumulated of its performance in the conditions of artificial blood circulation. Material and Methods: Minimally Invasive Direct Coronary Artery Bypass MIDCAB. The patient arrived with the diagnosis: Coronary heart disease, stenocardia. EH-III stage, risk 4 very high. A concrement in the right kidney, heart failure IIA stage. Functional class- III NYHA. Genotyping of the SNP was performed by polymerase chain reaction Real-Time PCR. (essential hypertension panel (9 genes); Coronary heart disease panel (8 genes)).The operation by a technique of “MIDCAB” was executed in our center in September 2017, for the first time in Uzbekistan. The patient had a high genetic risk of predisposition to hypertension and thrombophilia. Surgery was carried out in conditions - high chest epidural anesthesia in combination with an endo- tracheal anesthesia. Artificial ventilation of lungs was carried out through an intubation tube in the two-pulmonary mode of ventilation. The patient was stacked on a back with a body tilt 15-30°. Access to heart was made through a left-side front side thoracotomy in the fifth midrib. Length of a skin section was 12 cm. Owing to small experience, a section was made long - 12 cm. Surgery time, also was long. Now performance of MIDCAB is carried out in 135 min. Blood losses are also reduced. Gradual understanding of advantages MIDCAB operation by most of surgeons, led to a revascularization alternative through a sternotomy. Thus, using MIDCAB technology is the effective strategy of treatment patients with coronary heart disease. It allows to reduce injury of surgery, to improve the postoperative period, to reduce quantity of complications. However, there are still many surgeons who skeptical about this operation, because of fears about the early and remote postoperative results. The clinical picture coincided with the genetic status of the patient. It is worth noting that the disease has variable expressivity and penetration, with the presence of additional genetic and environmental factors being important in many cases.

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