cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2026-3045cardiotomsk-3045Research ArticleСтатьиВлияние интраоперационного эпиаортального сканирования восходящей аорты на тактику и результаты коронарного шунтирования (обзор литературы)The impact of intraoperative epiaortic scanning of the ascending aorta on the tactics and outcomes of coronary artery bypass grafting (literature review)https://orcid.org/0000-0003-4049-8715АндреевС. Л.AndreevS. L.

Андреев Сергей Леонидович, канд. мед. наук, старший научный сотрудник отделения сердечно-сосудистой хирургии НИИ кардиологии Томского НИМЦ

634012, Российская Федерация, Томск, ул. Киевская, 111а

Sergei L. Andreev, Cand. Sci. (Med.), Senior Research Scientist, Department of Cardiovascular Surgery, Cardiology Research Institute, Tomsk NRMC

111a, Kievskaya str., Tomsk, 634012, Russian Federation

anselen@rambler.ruhttps://orcid.org/0000-0002-7175-4526ВечерскийЮ. Ю.VecherskyYu. Yu.

Вечерский Юрий Юрьевич, д-р мед. наук, профессор, ведущий научный сотрудник, отделения сердечно-сосудистой хирургии НИИ кардиологии Томского НИМЦ

634012, Российская Федерация, Томск, ул. Киевская, 111а

Yuri Y. Vechersky, Dr. Sci. (Med.), Professor, Leading Researcher, Department of Cardiovascular Surgery, Cardiology Research Institute, Tomsk NRMC

111a, Kievskaya str., Tomsk, 634012, Russian Federation

vjj@cardio-tomsk.ruhttps://orcid.org/0000-0003-3952-9983ЗатолокинВ. В.ZatolokinV. V.

Затолокин Василий Викторович, канд. мед. наук, старший научный сотрудник отделения сердечно-сосудистой хирургии НИИ кардиологии Томского НИМЦ

634012, Российская Федерация, Томск, ул. Киевская, 111а

Vasiliy V. Zatolokin, Cand. Sci. (Med.), Senior Research Scientist, Department of Cardiovascular Surgery, Cardiology Research Institute, Tomsk NRMC

111a, Kievskaya str., Tomsk, 634012, Russian Federation

zatolokin@cardio-tomsk.ruhttps://orcid.org/0000-0002-0217-7737КозловБ. Н.KozlovB. N.

Козлов Борис Николаевич, д-р мед. наук, профессор, заведующий отделением сердечно-сосудистой хирургии, НИИ кардиологии Томского НИМЦ

634012, Российская Федерация, Томск, ул. Киевская, 111а

Boris N. Kozlov, Dr. Sci. (Med.), Professor, Head of the Department of Cardiovascular Surgery, Cardiology Research Institute, Tomsk NRMC

111a, Kievskaya str., Tomsk, 634012, Russian Federation

bnkozlov@yandex.ruНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наукРоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian Federation20220209202600Принято в печать3045Copyright © Андреев С.Л., Вечерский Ю.Ю., Затолокин В.В., Козлов Б.Н., 20222022Андреев С.Л., Вечерский Ю.Ю., Затолокин В.В., Козлов Б.Н.Andreev S.L., Vechersky Y.Y., Zatolokin V.V., Kozlov B.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/3045

Обзор посвящен применению интраоперационного эпиаортального сканирования (ИЭС) восходящей аорты при коронарном шунтировании. Рассмотрены диагностические преимущества ИЭС перед традиционной пальпацией и чреспищеводной эхокардиографией, позволяющие выявлять атеросклеротические бляшки, в том числе подвижные и изъязвленные. Приведены данные клинических исследований, в которых продемонстрировано, что применение ИЭС приводит к снижению относительного риска периоперационного инсульта на 38–60% и изменению хирургической тактики в 5–15% случаев – отказ от манипуляций на аорте, применение бесконтактных устройств, конверсия на операцию без искусственного кровообращения. Обсуждаются преимущества специализированных систем (MediStim и аналоги) перед методом чрезпищеводной эхокардиографии, компьютерной томографии аорты, ультразвукового исследования через специальный стерильный рукав, а также роль ИЭС в диагностике ятрогенных повреждений аорты и в комплексной интраоперационной оценке. Сделан вывод о том, что, несмотря на сложности интеграции ИЭС в рутинную практику, его применение позволяет персонализировать хирургическую стратегию и улучшить неврологические результаты пациентов.

This review evaluates the use of intraoperative epiaortic scanning (IES) of the ascending aorta in coronary artery bypass grafting. The diagnostic advantages of IES 3 over traditional palpation and transesophageal echocardiography are discussed, allowing for the detection of atherosclerotic plaques, including mobile and ulcerated ones. Clinical trial data are presented, demonstrating that the use of IES leads to a change in surgical tactics in 5–15% of cases (avoidance of aortic manipulation, use of contactless devices, conversion to off-pump surgery) and a reduction in the relative risk of perioperative stroke by 38–60%. The advantages of specialized systems (MediStim and similar systems) over transesophageal echocardiography, aortic computed tomography, and ultrasound through a special sterile sleeve are discussed, as well as the role of IES in the diagnosis of iatrogenic aortic injuries and in comprehensive intraoperative assessment, which allows for personalized surgical strategy and improved neurological outcomes.

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The authors declare that there are no conflicts of interest present.