Comorbidities in Patients before Surgical Myocardial Revascularization: Current State of the Problem. Part IІ
The first part of the article was dedicated to the problem of comorbidities in cardiac surgery patients with coronary artery disease (CAD), considered modern literary sources discussing endocrinopathies, connective tissue diseases, COVID-19-associated autoimmune processes, chronic kidney disease and diseases of the gastrointestinal tract.
The aim. To continue the analysis of current literature data on comorbidities in patients hospitalized for surgical myocardial revascularization.
Results. When assessing the preoperative status of a cardiac surgery patient with CAD, not only their cardiological status and the percentage of stenotic lesion of the coronary arteries are important, but also the presence of concomitant diseases and the degree of their compensation. According to the modern literary sources, 4-20.5% of patients undergoing coronary artery bypass grafting (CABG) have chronic pulmonary disease (COPD). In order to avoid bronchopulmonary complications in the postoperative period, high-quality preoperative diagnosis based on spirometric research is important. When verifying COPD, even of a moderate degree, a course of preventive therapy is required, and in the case of a severe course of COPD with a forced expiratory volume <50%, the involvement of a pulmonologist is necessary. Hemodynamically marked stenoses of brachiocephalic arteries are found in 6-12% of patients before CABG. According to European recommendations, ultrasound screening of carotid arteries is indicated for patients ≥70 years of age with multivessel lesions of the coronary arteries and a history of neurological disorders <6 months before planned cardiac surgery. Dementia is diagnosed in 9.6-20% of patients before CABG and is characterized by a higher rate of mortality and postoperative complications. It was established that the result of the cognitive function assessment using the Mini-Mental State Examination (MMSE) scale <24 is an independent risk factor for in-hospital mortality and postoperative delirium. Concomitant disease of peripheral arteries is diagnosed in 6.1-20.4% of patients before CABG and negatively affects both immediate and long-term results of myocardial revascularization.
Conclusions. Timely verification and compensation of comorbidities is an important point in the perioperative management of cardiac surgery patients with CAD. The systemic nature of the atherosclerotic process leads to multifocal stenotic lesions of the arterial system, which requires from the heart team not only to determine the priority of surgical interventions, but also to choose the optimal method of myocardial revascularization, taking into account comorbidities.
- Gogayeva OK, Drobnich MA, Lytvyn NO, Nastenko OO, Salo RI. [Comorbidities in Patients before Surgical Myocardial Revascularization: Current State of the Problem. Part I]. Ukrainian Journal of Cardiovascular Surgery. 2021;(4 (45)):10-7. Ukrainian. https://doi.org/10.30702/ujcvs/21.4512/GD048-1017
- Gogayeva OK. [Determination of comorbidity index for high-risk patients with coronary artery disease before cardiac surgery]. Zaporozhye medical journal. 2021;23(4):485-91. Ukrainian. https://doi.org/10.14739/2310-1210.2021.4.233643
- Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg. 1999;15(6):816-22; discussion 822-3. https://doi.org/10.1016/s1010-7940(99)00106-2
- O’Boyle F, Mediratta N, Chalmers J, Al-Rawi O, Mohan K, Shaw M, et al. Long-term survival of patients with pulmonary disease undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg. 2013;43(4):697-703. https://doi.org/10.1093/ejcts/ezs454
- Ho CH, Chen YC, Chu CC, Wang JJ, Liao KM. Postoperative Complications After Coronary Artery Bypass Grafting in Patients With Chronic Obstructive Pulmonary Disease. Medicine (Baltimore). 2016;95(8):e2926. https://doi.org/10.1097/MD.0000000000002926
- Magovern JA, Sakert T, Magovern GJ, Benckart DH, Burkholder JA, Liebler GA, et al. A model that predicts morbidity and mortality after coronary artery bypass graft surgery. J Am Coll Cardiol. 1996;28(5):1147-53. https://doi.org/10.1016/S0735-1097(96)00310-5
- Samuels LE, Kaufman MS, Morris RJ, Promisloff R, Brockman SK. Coronary Artery Bypass Grafting in Patients With COPD. Chest. 1998;113(4):878-82. https://doi.org/10.1378/chest.113.4.878
- Angouras DC, Anagnostopoulos CE, Chamogeorgakis TP, Rokkas CK, Swistel DG, Connery CP, et al. Postoperative and Long-Term Outcome of Patients With Chronic Obstructive Pulmonary Disease Undergoing Coronary Artery Bypass Grafting. Ann Thorac Surg. 2010;89(4):1112-8. https://doi.org/10.1016/j.athoracsur.2010.01.009
- Manganas H, Lacasse Y, Bourgeois S, Perron J, Dagenais F, Maltais F. Postoperative Outcome after Coronary Artery Bypass Grafting in Chronic Obstructive Pulmonary Disease. Can Respir J. 2007;14(1):19-24. https://doi.org/10.1155/2007/378963
- Zhao H, Li L, Yang G, Gong J, Ye L, Zhi S, et al. Postoperative outcomes of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass grafting surgery: A meta-analysis. Medicine (Baltimore). 2019;98(6):e14388. https://doi.org/10.1097/MD.0000000000014388
- Ried M, Unger P, Puehler T, Haneya A, Schmid C, Diez C. Mild-to-Moderate COPD as a Risk Factor for Increased 30-Day Mortality in Cardiac Surgery. Thorac Cardiovasc Surg. 2010;58(7):387-91. https://doi.org/10.1055/s-0030-1249830
- Savas Oz B, Kaya E, Arslan G, Karabacak K, Cingoz F, Arslan M. Pre-treatment before coronary artery bypass surgery improves post-operative outcomes in moderate chronic obstructive pulmonary disease patients. Cardiovasc J Afr. 2013;24(5):184-7. https://doi.org/10.5830/CVJA-2013-034
- Viceconte M, Rocco IS, Pauletti HO, Vidotto M, Arena R, Gomes WJ, et al. Chronic obstructive pulmonary disease severity influences outcomes after off-pump coronary artery bypass. J Thorac Cardiovasc Surg. 2018;156(4):1554-61. https://doi.org/10.1016/j.jtcvs.2018.04.092
- Gogayeva O, Rudenko A, Lazoryshynets V. [Neurological Complications after Coronary Artery Bypass Grafting for High-Risk Patients: Current State of the Problem]. Ukrainian Journal of Cardiovascular Surgery. 2020;(2(39)):15-7. Ukrainian. https://doi.org/10.30702/ujcvs/20.3905/022015-017
- Gogayeva OK, Rudenko AV, Lazoryshynets VV. [Postoperative cerebrovascular complications in high-risk patients with coronary artery disease in cardiac surgery]. Ukr Neurosurg J. 2021;27(2):49-55. Ukrainian. https://doi.org/10.25305/unj.228425
- Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, et al.; ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763-816. https://doi.org/10.1093/eurheartj/ehx095
- Naylor AR, Mehta Z, Rothwell PM, Bell PR. Carotid Artery Disease and Stroke During Coronary Artery Bypass: a Critical Review of the Literature. Eur J Vasc Endovasc Surg. 2002;23(4):283-94. https://doi.org/10.1053/ejvs.2002.1609
- Schoof J, Lubahn W, Baeumer M, Kross R, Wallesch CW, Kozian A, et al. Impaired cerebral autoregulation distal to carotid stenosis/occlusion is associated with increased risk of stroke at cardiac surgery with cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2007;134(3):690-6. https://doi.org/10.1016/j.jtcvs.2007.03.018
- Stamou SC, Hill PC, Dangas G, Pfister AJ, Boyce SW, Dullum MK, et al. Stroke After Coronary Artery Bypass: Incidence, Predictors, and Clinical Outcome. Stroke. 2001;32(7):1508-13. https://doi.org/10.1161/01.str.32.7.1508
- Naylor AR. Delay May Reduce Procedural Risk, But at What Price to the Patient? Eur J Vasc Endovasc Surg. 2008;35(4):383-91. https://doi.org/10.1016/j.ejvs.2008.01.002
- Naylor AR, Bown MJ. Stroke after Cardiac Surgery and its Association with Asymptomatic Carotid Disease: An Updated Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg. 2011;41(5):607-24. https://doi.org/10.1016/j.ejvs.2011.02.016
- Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et al.; CORONARY Investigators. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med. 2012;366(16):1489-97. https://doi.org/10.1056/NEJMoa1200388
- Gogayeva O, Rudenko A, Lazoryshynets V. [Comparison of On-Pump and Off-Pump Coronary Artery Bypass Grafting. Our experience of participation in the international study]. Ukrainian Journal of Cardiovascular Surgery. 2020;(4(41)):9-14. Ukrainian. https://doi.org/10.30702/ujcvs/20.4112/048009-014/1.53
- Terazawa S, Narita Y, Fujimoto K, Mutsuga M, Tokuda Y, Ito H, et al. Dementia and Cognitive Impairment on Coronary Artery Bypass Grafting Patients in Aging Society. Journal of Coronary Artery Disease. 2019;25(3):66-71. https://doi.org/10.7793/jcad.25.010
- Gondim AS, Coelho Filho JM, Cavalcanti AA, Roriz Filho JS, Nogueira CB, et al. Prevalence of functional cognitive impairment and associated factors in Brazilian community-dwelling older adults. Dement Neuropsychol. 2017;11(1):32-9. https://doi.org/10.1590/1980-57642016dn11-010006
- Mahon S, Parmar P, Barker-Collo S, Krishnamurthi R, Jones K, Theadom A, et al. Determinants, Prevalence, and Trajectory of Long-Term Post-Stroke Cognitive Impairment: Results from a 4-Year Follow-Up of the ARCOS-IV Study. Neuroepidemiology. 2017;49(3-4):129-34. https://doi.org/10.1159/000484606
- Xing YL, Chen MA, Sun Y, Neradilek MB, Wu XT, Zhang D, et al. Atherosclerosis, its risk factors, and cognitive impairment in older adults. J Geriatr Cardiol. 2020;17(7):434-40. https://doi.org/10.11909/j.issn.1671-5411.2020.07.006
- Yang Z, Edwards D, Burgess S, Brayne C, Mant J. Association of Prior Atherosclerotic Cardiovascular Disease with Dementia After Stroke: A Retrospective Cohort Study. J Alzheimers Dis. 2020;77(3):1157-67. https://doi.org/10.3233/jad-200536
- Liang X, Huang Y, Han X. Associations between coronary heart disease and risk of cognitive impairment: A meta-analysis. Brain Behav. 2021;11(5):e02108. https://doi.org/10.1002/brb3.2108
- Greaves D, Psaltis PJ, Ross TJ, Davis D, Smith AE, Boord MS, et al. Cognitive outcomes following coronary artery bypass grafting: A systematic review and meta-analysis of 91,829 patients. Int J Cardiol. 2019;289:43-9. https://doi.org/10.1016/j.ijcard.2019.04.065
- Chen H, Mo L, Hu H, Ou Y, Luo J. Risk factors of postoperative delirium after cardiac surgery: a meta-analysis. J Cardiothorac Surg. 2021;16(1):113. https://doi.org/10.1186/s13019-021-01496-w
- Ali I, Shokri H, Abd Al Jawad M. Assessment of carotid artery stenosis and lower limb peripheral ischemia before coronary artery bypass grafting operations: a non-randomized clinical trial. J Cardiothorac Surg. 2020;15(1):283. https://doi.org/10.1186/s13019-020-01340-7
- Nakamura T, Toda K, Miyagawa S, Yoshikawa Y, Fukushima S, Saito S, et al. Symptomatic peripheral artery disease is associated with decreased long-term survival after coronary artery bypass: a contemporary retrospective analysis. Surg Today. 2016;46(11):1334-40. https://doi.org/10.1007/s00595-016-1379-4
- Bonacchi M, Parise O, Matteucci F, Tetta C, Moula AI, Micali LR, et al. Is Peripheral Artery Disease an Independent Predictor of Isolated Coronary Artery Bypass Outcome? Heart Lung Circ. 2020;29(10):1502-10. https://doi.org/10.1016/j.hlc.2020.01.013
- Biancari F, Kangasniemi OP, Mahar MA, Ylönen K. Need for Late Lower Limb Revascularization and Major Amputation after Coronary Artery Bypass Surgery. Eur J Vasc Endovasc Surg. 2008;35(5):596-602. https://doi.org/10.1016/j.ejvs.2007.11.015
- Micali LR, Bonacchi M, Weigel D, Howe R, Parise O, Parise G, et al. The use of both internal thoracic arteries for coronary revascularization increases the estimate of postoperative lower limb ischemia in patients with peripheral artery disease. J Cardiothorac Surg. 2020;15(1):266. https://doi.org/10.1186/s13019-020-01315-8
- Caesar-Peterson S, Bishop MA, Qaja E. Subclavian Artery Stenosis. 2022 Jun 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
- Sadek MM, Ravindran A, Marcuzzi DW, Chisholm RJ. Complete occlusion of the proximal subclavian artery post-CABG: Presentation and treatment. Can J Cardiol. 2008;24(7):591-2. https://doi.org/10.1016/s0828-282x(08)70642-1
- Ursulenko V, Gogayeva O, Dzakhoieva L. [Occlusion of the left subclavian artery as a reason of angina pectoris recurrence after coronary artery bypass grafting]. Cardiac surgery and Interventional cardiology. 2017;(3):48-52. Russian.
- Abdul Jabbar A, Houston J, Burket M, Il’Giovine ZJ, Srivastava BK, Agarwal A. Screening for subclinical subclavian artery stenosis before coronary artery bypass grafting: Should we do it? Echocardiography. 2017;34(6):928-33. https://doi.org/10.1111/echo.13528
- Hwang HY, Kim JH, Lee W, Park JH, Kim KB. Left Subclavian Artery Stenosis in Coronary Artery Bypass: Prevalence and Revascularization Strategies. Ann Thorac Surg. 2010;89(4):1146-50. https://doi.org/10.1016/j.athoracsur.2010.01.007
- Zhang J, Wang L, Chen Y, Wang S, Xing Y, Cui L. Color Doppler Ultrasonography for the Evaluation of Subclavian Artery Stenosis. Front Neurol. 2022;13:804039. https://doi.org/10.3389/fneur.2022.804039