Cardiac Surgery of Complicated Forms of Coronary Artery Disease: Features of the Perioperative Period in High-Risk Patients

DOI: https://doi.org/10.30702/ujcvs/21.4306/g020014-022/005.4-089
Keywords: coronary artery disease, complicated forms of CAD, high-risk patient, cardiac surgery, resection of the left ventricular aneurysm

Abstract

The aim. To analyze the features of the perioperative period in high-risk patients with complicated forms of coronary artery disease (CAD).

Material and methods. Retrospective analysis of 160 patients with CAD who were operated and discharged from the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine in the period from January 2009 to December 2019. All the patients underwent electrocardiography, echocardiography, coronary ventriculography and surgical revascularization with correction of concomitant cardiac pathology.

Results. One hundred thirty two (37.2%) patients were diagnosed with postinfarction left ventricular aneurysm (LVA), 12 (3.3%) with mitral regurgitation of ischemic origin, 16 (4.5%) patients had combination of CAD with aortic valve stenosis. Risk stratification by the ES II scale revealed the average risk of death of 10.08%. Surgery was performed in all the patients on day 5.7±4.7 of hospitalization. In 159 (99.3%) patients the operations were on-pump. There weak was direct correlation (r =0.29) between the dependence of the length of stay in the intensive care unit and the initial severity of the patient’s condition by the ES II scale. A weak direct correlation was found between the severity of the patient’s condition by the scales ES II (r =0.24, p=0.0022), STS (r =0.16, p=0.0325) and the time of discharge which was on 9.5±5.06 days in average. All the interventions were performed by experienced cardiac surgeons, with 25.3±14.1 years of experience in surgical treatment of CAD.

Conclusions. Despite the high predicted mortality, 10.08% by the ES II scale, mortality in the studied group was 0%. In order to prevent complications, the management of patients in the perioperative period requires a clear algorithm of action and timely compensation of comorbidity at all stages of the patient’s stay in the cardiac surgery facility.

References

  1. Global Health Estimates 2020: deaths by cause, age, sex, by country and by region, 2000-2019 [Internet]. Geneva: World Health Organization; c2020 [cited 2020 Oct 5]. Available from: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-lead-ing-causes-of-death
  2. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999;16(1):9-13. https://doi.org/10.1016/s1010-7940(99)00134-7.
  3. Kar P, Geeta K, Gopinath R, Durga P. Mortality prediction in Indian cardiac surgery patients: Validation of European System for Cardiac Operative Risk Evaluation II. Indian J Anaesth. 2017;61(2):157-162. https://doi.org/10.4103/ija.IJA_522_16.
  4. Alhan C, Toraman F, Karabulut EH, Tarcan S, Dağdelen S, Eren N, et al. Fast track recovery of high risk coronary bypass surgery patients. Eur J Cardiothorac Surg. 2003 May;23(5):678-683. https://doi.org/10.1016/S1010-7940(03)00027-7.
  5. Plümer H, Markewitz A, Marohl K, Bernutz C, Weinhold C. Early extubation after cardiac surgery: a prospective clinical trial including patients at risk. Thorac Cardiovasc Surg. 1998 Oct;46(5):275-80. https://doi.org/10.1055/s-2007-1010238.
  6. de Arenaza DP, Pepper J, Lees B, Rubinstein F, Nugara F, Roughton M, et al.; ASSERT (Aortic Stentless versus Stented valve assessed by Echocardiography Randomised Trial) Investigators. Preoperative 6-minute walk test adds prognostic information to Euroscore in patients undergo-ing aortic valve replacement. Heart. 2010 Jan;96(2):113-117. https://doi.org/10.1136/hrt.2008.161174.
  7. Hartz AJ, Manley JC, Walker JA, Gale HH, He Z, Assa J. Trends during 25 years of coronary artery bypass opera-tion at St. Luke’s Medical Center in Milwaukee, Wisconsin. Ann Thorac Surg. 2000 Mar;69(3):829-833. https://doi.org/10.1016/s0003-4975(99)01418-6.
  8. Ferguson TB Jr, Hammill BG, Peterson ED, DeLong ER, Grover FL; STS National Database Committee. A decade of change--risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990-1999: a report from the STS National Database Committee and the Duke Clinical Research Institute. Society of Thoracic Surgeons. Ann Thorac Surg. 2002 Feb;73(2):480-9; discussion 489-90. https://doi.org/10.1016/s0003-4975(01)03339-2.
  9. D’Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW, et al. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 update on outcomes and quality. Ann Thorac Surg. 2018;105(1):15-23. https://doi.org/10.1016/j.athoracsur.2017.10.035
  10. Tcheng JE, Jackman JD, Nelson CL, Gardner LH, Smith LR, Rankin JS, et al. Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction. Ann Intern Med. 1992 Jul 1;117(1):18-24. https://doi.org/10.7326/0003-4819-117-1-18.
  11. Fazlinezhad A, Dorri M, Azari A, Bigdelu L. Frequency of ischemic mitral regurgitation after first-time acute myo-cardial infarction and its relation to infarct location and in-hospital mortality. J Tehran Heart Cent. 2014;9(4):160-165.
  12. Albuquerque KS, Indiani JMC, Martin MF, Cunha BMER, Nacif MS. Asymptomatic apical aneurysm of the left ventricle with intracavitary thrombus: a diagnosis missed by echocardiography. Radiol Bras. 2018 Jul-Aug;51(4):275-276. https://doi.org/10.1590/0100-3984.2016.0199.
  13. Ruzza A, Czer L, Arabia F, Vespignani R, Esmailian F, Cheng W, et al. Left ventricular reconstruction for postinfarction left ventricular aneurysm: review of surgical techniques. Tex Heart Inst J. 2017;44(5):326-335. https://doi.org/10.14503/THIJ-16-6068.
  14. Prifti E, Bonacchi M, Baboci A, Giunti G, Veshti A, Demiraj A, et al. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies. Ann Med Surg (Lond). 2017;16:44-51. https://doi.org/10.1016/j.amsu.2017.03.013.
  15. Dzakhoieva LS, Gogayeva OK, Rudenko AV, Lazoryshy-nets VV. [The value of perioperative ECG in patients with complicated forms of coronary artery disease]. Zaporo-zhye Medical Journal. 2021;23(1):11-16. https://doi.org/10.14739/2310-1210.2021.1.224977.
  16. Ursulenko V, Gogayeva O, Yakob L, inventors; Amosov Na-tional Institute of cardiovascular surgery of the NAMS of Ukraine, assignee. Process for aneurysmectomy and plas-tics of left ventricle in patients with giant posterobasal an-eurysms. Ukraine patent UA 93006. 2010 Dec 27. Ukrai-nian.
  17. Rudenko AV, Bagirov MM, Gogayeva OK, Seykovsky OV, Dzahoyeva LS, Zakharova VP, et al. [Simultaneous coro-nary bypass surgery with resection of left ventricular aneurysm and hemithyroidectomy]. Heart & vessels. 2014;2:106-111. Russian.
  18. Gogayeva O, Lazoryshynets V, Rudenko A, Dzakhoieva L, Yuvchyk O. [Perioperative evaluation of kidney function for patients with complicated forms of coronary artery disease]. Ukr J Nephr Dial. 2020;4(68):52-58. https://doi.org/10.31450/ukrjnd.4(68).2020.08.
  19. Rudenko A, Gogayeva O, Rudenko M, inventors; Amosov National Institute of cardiovascular surgery of the NAMS of Ukraine, assignee. [Method of prevention of gastroin-testinal complications in patients after coronary bypass grafting surgery]. Ukraine patent UA 99209. 2012 Jul 25. Ukrainian.
Published
2021-06-29
How to Cite
Gogayeva, O. (2021). Cardiac Surgery of Complicated Forms of Coronary Artery Disease: Features of the Perioperative Period in High-Risk Patients. Ukrainian Journal of Cardiovascular Surgery, (2 (43), 14-22. https://doi.org/10.30702/ujcvs/21.4306/g020014-022/005.4-089
Issue
Ukrainian Journal of Cardiovascular Surgery No 2 (43) 2021
Section
ISCHEMIC HEART DISEASE