For specialists

Medical error

Medical error – it is a reality that must be avoided!

Medical error is an inevitability that will overtake everyone who uses medical care. Medical personnel, by means of the state-of-the-art techniques and spurred by business, intervene in the patient’s body. And the more aggressive this intervention is, the higher is the cost of an error.

Medical error – the third leading cause of death in the US

Difficult cases. How did we manage?

Echocardiography in cardiology and cardiac surgery

Speckle tracking analysis to determine global longitudinal deformity (GLS) in the management of a patient with heart failure in the long term after CABG.

How we manage it (case report)

Coronary artery bypass grafting (CABG)

Minimally invasive direct coronary artery bypass grafting (MIDCABG)

The main task is to perform the operation without incising the sternum. This will allow to avoid osteomyelitis of the sternum in future, the dehiscence of wire sutures in case of its “inconsistency” and will preserve the “frame” of the chest, which is extremely important for full value breathing in the postoperative period. Full value breathing will avoid the development of atelectasis in the lung, pneumonia, postcardiotomy syndrome, manifested by inflammation of the pleura and pericardium with hyperproduction of exudate.

Dual inflow, total-arterial, anaortic, off-pump coronary artery bypass grafting: how to do it

No-touch aorta technique

Reduced chance of the embolic stroke due to the damage to plaques on the aortic wall.

Current Practice of State-of-the-Art Surgical Coronary Revascularization

Total arterial myocardial revascularization
Acute heart failure

Acute heart failure is a life-threatening condition that requires immediate decision-making and is accompanied by active interventions in the human body. Acute coronary syndrome (ACS), acute myocarditis, pulmonary embolism (right ventricular failure), acute regurgitation on the aortic and mitral valves are the main causes of acute heart failure.

Compared with PCI, CABG is associated with significant lower all-cause mortality in patients with AHF

Vascular surgery

Carotid artery atherosclerosis

Atherosclerosis of the carotid artery is the cause of every third ischemic disorder of cerebral circulation (stroke).

Today, open surgery is always a priority for stenting (see figure 3)

Valve surgery

Minimally invasive aortic valve surgery

Minimally invasive surgery of the aortic valve can be of three types: percutaneous puncture valve implantation (TAVI), implantation through minithoracotomy or through ministernotomy. TAVI is the least traumatic, because with this valve implantation, there is no need for cardiac arrest and any surgical access.

Mini-AVR Right Anterior Thoracotomy, how to do.

Hybrid surgery

Aortic arch reconstruction without circulatory arrest

If the patient has developed aortic dissection, affecting only the region of the arch and the descending aorta, then hybrid surgery may be the method of choice: moving the brachiocephalic arteries into the ascending aorta using the bald arch technique, followed by placing a stentgraft in the dissection zone to eliminate the zone of entry into the dissection and remodeling of the thoracic aorta.

Hybrid coronary revascularization

There’s intraoperative ultrasound of the heart in 100% of cases (remote monitoring of intracardiac hemodynamics).

Minimally invasive approach is utilized for both multivessel bypass grafting and hybrid surgery (stent + LIMA to LAD).

Blood is being preserved by the Cell Saver device (donor blood is not required).

Nerve block anesthesia. There are not narcotic drugs both intraoperatively and in the postoperative period. There’s no pain (full breathing) – no pneumonia.

Standardizing definitions for hybrid coronary revascularization