PECULIACORONARY ARTERY BYPASS GRAFTING AND COMPLETE REVASCULARIZATION IN WOMEN OF DIFFERENT AGES

Introduction. Between 2010 and 2020, Ukraine lost nearly 4.6 million people due to circulatory system diseases. The leading cause of death was ischemic heart disease (IHD), which accounted for 46.1% of all deaths and 69.7% of deaths attributed to circulatory diseases. In the majority of cases (76.4%), death from IHD was associated with stenosing atherosclerosis. One of the most debated issues in contemporary cardiac surgery is sexual dimorphism in the treatment of ischemic heart disease. While sexual dimorphism is traditionally defined as the anatomical differences between sexes within a species, in a broader clinical context, it also encompasses differences in the physiological and pathological progression of disease, as well as in treatment outcomes. Objectives: To identify the anatomical characteristics of stenosing atherosclerosis and evaluate the outcomes of revascularization in women of different age groups. Participants and methods. The study included exclusively female patients with IHD who underwent coronary artery bypass grafting on a beating heart. A total number of participants was 613 women, whose average age was 63.4±1.9 years. The material for the study was obtained from 613 protocols of coronary artery bypass grafting operations for the period from 2015 to 2021. All participants are under dispensary observation of the State Institution “Amosov National Institute of Cardiovascular Surgery, National Academy of Medical Sciences of Ukraine” and the municipal non-profit enterprise “Cherkasy Regional Cardiology Center”. To standardize the approaches, the success of revascularization was assessed for three main branches of the coronary arteries: the circumflex branch of the left coronary artery, the right coronary artery, and the anterior interventricular branch of the left coronary artery. Results. The frequency of coronary artery involvement by stenosing atherosclerosis was analyzed in relation to patient age. It was found that singleand two-vessel atherosclerosis lesions were significantly more common in younger women compared to other age groups (χ² = 21.51; p = 0.0001; χ² = 22.76; p = 0.0001; χ² = 19.52; p = 0.0001). In contrast, the prevalence of multi-vessel disease increased progressively with age. Among middle-aged women, three-vessel coronary artery disease was observed in 44.7% of cases, a significantly lower rate compared to 57.1% in elderly women (χ² = 18.59; p = 0.0001). Furthermore, the incidence of diffuse coronary artery lesions also showed an age-related increase, reaching the highest frequency of 7.1% among elderly patients. The study also identified the main anatomical patterns of coronary artery involvement in women. The most commonly affected vessels were: anterior interventricular artery (left anterior descending, LAD) – 92.8%, the circumflex branch – 73.6%, and the right coronary artery (RCA) – 72.9%. Based on these anatomical patterns, the study proceeded to assess the completeness of revascularization in relation to the indications for coronary artery bypass grafting (CABG). Conclusion. The study has found that the highest occurrence rate of stenosing coronary atherosclerosis is observed in the anterior interventricular branch (92.8%), the circumflex branch (73.6% of all cases), and the right coronary artery (72.9%). Analysis of the completeness of revascularization has shown that it was in anterior interventricular branch (87.3% of all cases); circumflex branch (79.1%), and right coronary artery (49.3%). The total completeness of revascularization was achieved in 71.9% of women.