Влияние интраоперационного эпиаортального сканирования восходящей аорты на тактику и результаты коронарного шунтирования (обзор литературы)

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.

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