[Association of aortocoronary bypass and intraoperative laser recanalization of the coronary arteries in ischemic heart disease. Initial clinical results].

The work discusses the results of intraoperative laser recanalization (LR) of the coronary arteries (CA). It is shown that the method facilitates increase of the degree of myocardial revascularization after a combined operation--aortocoronary shunting and intraoperative CA LR. The intervention was carried out on 10 patients, in 9 of them retrograde CA LR was conducted for recanalization of proximal affection of the CA and one patient underwent retrograde LR of a distally occurring stenosis of the anterior interventricular artery. Among the 10 interventions 7 were successful: in 5 patients the narrowed CA lumen was completely restored without residual stenosis, in 2 patients the stenosis reduced by 50-60% with a residual stenosis of no more than 30-40%. Perforation of the CA wall occurred in 2 cases and was repaired surgically. Still in another case an attempt to perform laser recanalization of the right CA failed because of technical reasons. Reocclusion of the recanalized CA segment was encountered in the late-term period in 2 of 4 patients. The conclusion may be drawn that CA LR is an effective auxiliary method in the formation of an aortocoronary shunt. The presence of diffuse, multiple lesions of the shunted CA and occlusion of the vascular lumen, affection of the distal arterial channel of the CA are the main indications for the use of intraoperative CA LR.