METHOD OF COMPLETE MINIMALLY INVASIVE ENDOSCOPICALLY ASSISTED MYOCARDIAL REVASCULARIZATION IN MULTIVASCULAR ATHEROSCLEROTIC CORONARY BED LESION

摘要

FIELD: medicine.;SUBSTANCE: invention refers to medicine, namely to cardiovascular surgery and perfusion. Method comprises sequential isolation of internal thoracic arteries of a patient by a semi-skeletal technique, using endovideososcopic instruments and superimposition of anastomoses with coronary arteries in conditions of minimal extracorporeal circulation in direct myocardial imaging through a left-sided anterolateral mini thoracotomy approach, made in IV-V intercostal space 1 cm to the left of median-clavicular line 5 cm long. At that, the thoracoports for internal thoracic arteries are separated symmetrically from the right and left sides: one in IV-v intercostal space along antero-axillary line for insufflation of carbon dioxide and two in III and V intercostal spaces along mid-clavicular line for endoscopic instrument. In III and IV intercostal space along a parasternal line on the right, thoracoports of diameter 11.2 mm and 14 mm, respectively, are installed, intended for drainage of aorta root and feed of cardioplegic solution. Larrey point is used to insert an endoscopic grasper with a fixed gauze tissue. After achieving complete cardioplegic asystole, the heart is rotated so as to provide optimal visualization and localization of a myocardial portion with a shunted coronary artery in a mini-thoracic incision. Cardioplegia is initiated each time after completion of the next coronary anastomosis, except for the last one.;EFFECT: method enables reducing the risk of complications and unfavourable outcomes of complete myocardial revascularization in the patients with multivascular coronary disease by using the shunts of the patient's own internal thoracic arteries recovered by the semi-skeletal method, using endovideososcopic instruments and superimposition of anastomoses with coronary arteries in direct imaging of myocardium through anterior-lateral left-sided mini thoracotomy approach in conditions of minimal extracorporeal circulation.;1 cl, 1 ex