Endovascular revascularization of the heart in combination with stimulation of extracardial neoangiogenesis (Yurleon technique) diffuse coronary atherosclerosis

In modern cardiac surgery practice, there is a significant increase in the number of patients with diffuse multivessel coronary artery disease, which is due to a combination of factors, including the widespread introduction of endovascular revascularization methods, prolonged drug therapy and the expansion of surgical indications. To optimize the treatment of this category of patients, in 2007, Academician Yu.L. Shevchenko proposed an innovative method for stimulating extracardial neoangiogenesis (“YurLeon”), which has received widespread clinical application. Aim. To evaluate the clinical efficacy of hybrid myocardial revascularization using the «YurLeon» and percutaneous coronary intervention in patients with coronary artery disease with diffuse coronary artery disease. Materials and methods. The study included 77 patients with diffuse coronary artery disease who were treated at the St. George Thoracic and Cardiovascular Surgery Clinic at the N.I. Pirogov National Medical and Surgical Center. 64.9% of them were men (n = 50), the median age was 72.00 years (68.00–75.00). Group I (n = 37) – patients who underwent hybrid revascularization (PCI+YurLeon); group II (n = 40) – control (isolated PCI). Clinical data, EchoCG, gated-SPECT, coronary angiography, and quality of life assessment (SAQ-7 questionnaire) were evaluated. Results. The results of a 12-month follow-up demonstrated a significant improvement in the left ventricular ejection fraction from 49% to 58% (p<0.001), a decrease in the volume of hibernated myocardium by 44.4% (from 18% to 10%), (p<0.001) and an improvement in the functional class of angina pectoris in the PCI+YurLeon group. In 67.6% of patients in this group, functional class I–II angina pectoris was achieved. There was a significant improvement in the quality of life in group I patients (p<0.001). Conclusion. The results of the study confirm the prospects of hybrid myocardial revascularization (PCI+YurLeon) in the treatment of patients with diffuse coronary artery disease, while the developed algorithms for patient selection and stratification according to expected effectiveness make it possible to optimize the use of this technique in clinical practice.