6 курс / Кардиология / 30_лет_поиска_медикаменты,_ангиопластика_или_хирургия

Частота направлений на различные типы лечения ИБС

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СООТНОШЕНИЕ ЧКИ/АКШ В США В 2000 ГОДУ

(Smith et al. JACC, 2001, vol. 37, No. 8; pp. 1-66)

62%

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ИНВАЗИВНЫЕ ПРОЦЕДУРЫ В США (2005г.)

Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty.

Grüntzig AR, Senning A, Siegenthaler WE.

N Engl J Med Jul 1979; 301(2):61-8

Abstract

In percutaneous transluminal coronary angioplasty, a catheter system is introduced through a systemic artery under local anesthesia to dilate a stenotic artery by controlled inflation of a distensible balloon. Over the past 18 months, we have used this technic in 50 patients. The technic was successful in 32 patients, reducing the stenosis from a mean of 84 to 34 per cent (P less than 0.001) and the coronary-pressure gradient from a mean of 58 to 19 mm Hg (P less than 0.001). Twenty-nine patients showed improvement in cardiac function during follow-up examination. Because of acute deterioration in clinical status, emergency bypass was later

necessary in five patients; three showed electrocardiographic evidence of infarcts. Patients with single-vessel

disease appear to be most suitable for the procedure, and a short history of pain indicates the presence of a soft (distensible) atheroma likely to respond to dilatation. We estimate that only about 10 to 15 per cent of candidates for bypass surgery have lesions suitable for this procedure. A

prospective randomized trial will be necessary to evaluate its usefulness in comparison with surgical and medical management.

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Cardiac surgeon Mike Bauer, right, and his team repair one heart valve and replace another for Troy Sanders at St. Vincent Infirmary Medical Center in Little Rock, Ark.

By Julie Appleby, USA TODAY

It was almost a given: Go to medical school, spend an additional 10 years to become a

heart surgeon, then you've got it made. But new ways of treating heart disease have changed that outlook: Cardiac surgeons are having a tougher time finding work.

The use of artery-opening stents has helped lead to a sharp drop in the number of patients having cardiac bypass surgery and contributed to a tight job market for cardiac surgeons and

falling interest in the specialty by medical school graduates.

"If you look at the market right now, it's like everyone is at a big fancy ball, but the cardiac surgeons are the ones not getting asked to dance," says Kurt Mosley, a vice president at Merritt Hawkins & Associates, a health care staffing firm. "Ten years ago, they were right up there."

A survey of 88 cardiothoracic residents finishing their training

found that 12% received no job offers in 2004, according to a 2006 article in the Annals of Thoracic Surgery. At the same time, the number of applicants choosing to pursue one of the 140 training spots each year has also declined. In 2005, there were only 104 applicants filling 100 of the 139 available spots, according to the article.

"In general, graduating residents were extremely disappointed with job opportunities," says co-author Richard Lee, assistant director of residency programs at St. Louis

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АКШ БОЛЬШЕ НЕ НУЖНА?

ИЛИ КТО ВОЗМЕТСЯ СТЕНТИРОВАТЬ ЭТУ АРТЕРИЮ?

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