The Influence of Operation Duration and Ischemic Time of Artificial Circulation on the Structure of Postoperative Complications in Patients after Surgical Treatment of Multivalvular Defects Combined with Coronary Pathology
The aim. To determinate the influence of the duration of artificial circulation and ischemic time on the structure of complications with one-time combined correction of lesions of two or three heart valves and myocardial revascularization and the possibility of their avoidance.
Materials and methods. The work is based on a comparative analysis of the results of one-step multivalvular correction combined with coronary artery bypass grafting (CABG) in 93 patients, which was performed at the National Amosov Institute of Cardiovascular Surgery from 2014 to 2021. Depending on the tactical approaches and the sequence of surgical manipulations, the patients were divided into three groups. Group I included patients who underwent heart valve correction first and then CABG with the use of cardioplegia (n = 42), group II patients underwent CABG first and then valve correction with the use of cardioplegia (n = 36), and group III patients underwent off-pump CABG first and then correction of the heart valves (n = 15). The groups differed significantly in terms of ischemic time and artificial circulation.
Results. The use of different approaches to achieve high-quality protection of the myocardium during ischemia and to minimize the impact of artificial circulation on the body by improving conditions and reducing ischemic time in the correction of multivalvular lesions and CABG showed significant advantages of the method of off-pump bypass.
Conclusions. Correction of combined valvular and coronary pathology in patients with cardioplegic arrest increases the ischemic time above the critical point, which affects the occurrence of specific complications, especially acute heart failure, which significantly worsens the immediate results of surgery. Complications that occurred in the postoperative period in patients with the correction of valvular defects combined with CABG were due to prolonged cardiovascular failure. The technique proposed in the study group with off-pump bypass surgery was more effective than in groups where bypass was performed with the use of cardioplegic cardiac arrest. This technique requires more time to perform and is more technically complex, but can significantly reduce myocardial ischemic time, which, in turn, significantly reduces the incidence of heart failure and postoperative complications.
- Ahmed OF, Al Kaabi LS, Kakamad FH, Mohammed SH, Salih RQ. Early outcome of combined coronary artery bypass grafting and valve surgery. Edorium J Cardiothorac Vasc Surg. 2018;5(1):100013C04OA2018. https://doi.org/10.5348/100013C04OA2018OA
- Herlitz J, Brandrup-Wognsen G, Caidahl K, Haglid M, Karlsson BW, Karlsson T, Albertsson P, Lindelöw B. Mortality and morbidity among patients who undergo combined valve and coronary artery bypass surgery: early and late results. Eur J Cardiothorac Surg. 1997;12(6):836-46. https://doi.org/10.1016/s1010-7940(97)00278-9
- Trenkwalder T, Nelson CP, Musameh MD, Mordi IR, Kessler T, Pellegrini C, et al. Effects of the coronary artery disease associated LPA and 9p21 loci on risk of aortic valve stenosis. Int J Cardiol. 2019;276:212-7. https://doi.org/10.1016/j.ijcard.2018.11.094
- El Sabbagh A, Nishimura RA. Clinical Conundrum of Coronary Artery Disease and Aortic Valve Stenosis. J Am Heart Assoc. 2017;6(2):e005593. https://doi.org/10.1161/JAHA.117.005593
- Loop FD, Higgins TL, Panda R, Pearce G, Estafanous FG. Myocardial protection during cardiac operations. Decreased morbidity and lower cost with blood cardioplegia and coronary sinus perfusion. J Thorac Cardiovasc Surg. 1992;104(3):608-18. PMID: 1513150.
- Hussain G, Azam H, Baig MA, Ahmad N. Early outcomes of on-pump versus off-pump coronary artery bypass grafting. Pak J Med Sci. 2016;32(4):917-21. https://doi.org/10.12669/pjms.324.9680
- Pinaud F, Corbeau JJ, Baufreton C, Binuani JP, De Brux JL, Fouquet O, Angoulvant D, Furber A, Prunier F. Remote ischemic preconditioning in aortic valve surgery: Results of a randomized controlled study. J Cardiol. 2016;67(1):36-41. https://doi.org/10.1016/j.jjcc.2015.06.007
- Ursulenko VI, Kupchynskyi OV, Naumova LR, Starodub YuS, Semeniv PM, Galyuk VM, Fedorova LS. [Options and ways to protect myocardium in surgical treatment of valvular heart disease combined with coronary pathology]. UMJ Heart & vessels. 2017;2(58):61-8. Russian.
- Kim BJ, Kim YS, Kim HJ, Ju MH, Kim JB, Jung SH, Choo SJ, Chung CH. Concomitant mitral valve surgery in patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting. J Thorac Dis. 2018;10(6):3632-42. https://doi.org/10.21037/jtd.2018.05.148
- Teng Z, Ma X, Zhang Q, Yun Y, Ma C, Hu S, Zou C. Additional mitral valve procedure and coronary artery bypass grafting versus isolated coronary artery bypass grafting in the management of significant functional ischemic mitral regurgitation: a meta-analysis. J Cardiovasc Surg (Torino). 2017;58(1):121-30. https://doi.org/10.23736/S0021-9509.16.08852-2