Analysis of the Perioperative Course of Cardiac Surgery Patients with Coronary Artery Disease and Heart Valve Dysfunction

DOI: https://doi.org/10.30702/ujcvs/24.32(02)/G036-1116
Keywords: mitral insufficiency, left ventricular aneurysm, aortic valve disfunction, artificial blood circulation, heart team

Abstract

The aim. To analyze the perioperative course of cardiac surgery patients with coronary artery disease (CAD) and heart valve dysfunction.

Materials and methods. Retrospective analysis of 41 consecutive cardiac surgery patients (mean age 61.6 ± 7.8 years) with CAD and heart valve dysfunction who were operated on and discharged from the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. All the patients underwent standard clinical and laboratory examinations, coronary angiography, on-pump cardiosurgical intervention.

Results. The patients were divided into three subgroups: patients with post-infarction left ventricular aneurysm (LVA) combined with insufficiency of atrioventricular valves, n = 15 (36.6%); those with ischemic mitral insufficiency (MI), n = 11 (26.8%); and patients with CAD combined with aortic valve disease, n = 15 (36.6%). During echocardiographic study, decreased left ventricular ejection fraction was found in patients with LVA and with ischemic MI: 33 ± 6.4% and 39.4 ± 7.8%, respectively, and in patients with aortic valve disease, left ventricular ejection fraction averaged 48.2 ± 9.9% (p < 0.0001). According to the EuroSCORE II scale, the average risk was 11.8 ± 7.3%. All the patients were discussed by the heart team to choose the optimal method of cardiosurgical correction. In order to reduce the ischemic time, off-pump coronary bypass surgery was performed at the first stage, and the second stage was on-pump correction of valvular dysfunction. The average number of grafts was 2.8 ± 1.4, but the largest number of grafts was in the subgroup of ischemic MI: 4 ± 0.9 (p < 0.005). Mitral valve replacement in patients with LVA was performed through LVA in 12 patients. Acute heart failure, acute renal failure often developed in patients after correction of ischemic MI (p < 0.005). On the 1st day after the operation, there was an increase in average glucose values from 6.6 ± 2.8 to 10.3 ± 2.9 mmol/L (p < 0.0001), a decrease in glomerular filtration rate from 72.1 ± 15.3 to 57 ± 18.8 mL/min/1.73 m2 (p = 0.0001), the above indicators returned to the initial level at discharge (p < 0.0001).

Conclusions. Off-pump myocardial revascularization in patients with CAD and dysfunction of the heart valves can significantly reduce the ischemic time. The method of mitral valve replacement through LVA developed in the department allowed to reduce the perfusion time (p = 0.0023) and the duration of the operation (p < 0.005). Preoperative discussion of examination data of patients by the heart team, thorough preparation for cardiac surgery, timely response to changes in laboratory parameters with correction of drug treatment avoid complications.

References

  1. WHO [Internet]. Geneva: World Health Organization; c2020. Global Health Estimates 2020: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2019. Available from: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death
  2. Matta A, Moussallem N. Coronary artery disease is associated with valvular heart disease, but could it Be a predictive factor? Indian Heart J. 2019;71(3):284-287. https://doi.org/10.1016/j.ihj.2019.07.001
  3. Opolski MP, Staruch AD, Jakubczyk M, Min JK, Gransar H, Staruch M, et al. CT Angiography for the Detection of Coronary Artery Stenoses in Patients Referred for Cardiac Valve Surgery: Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging. 2016;9(9):1059-1070. https://doi.org/10.1016/j.jcmg.2015.09.028
  4. Shu C, Chen S, Qin T, Fu Z, Sun T, Xie M, et al. Prevalence and correlates of valvular heart diseases in the elderly population in Hubei, China. Sci Rep. 2016 Jun 2;6:27253. https://doi.org/10.1038/srep27253
  5. Fukumoto R, Kawai M, Minai K, Ogawa K, Yoshida J, Inoue Y, et al. Conflicting relationship between age-dependent disorders, valvular heart disease and coronary artery disease by covariance structure analysis: Possible contribution of natriuretic peptide. PLoS One. 2017 Jul 20;12(7):e0181206. https://doi.org/10.1371/journal.pone.0181206
  6. El Sabbagh A, Nishimura RA. Clinical Conundrum of Coronary Artery Disease and Aortic Valve Stenosis. J Am Heart Assoc. 2017 Feb 20;6(2):e005593. https://doi.org/10.1161/JAHA.117.005593
  7. Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM, et al. The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. J Thorac Cardiovasc Surg. 2015;149(2):451-460. https://doi.org/10.1016/j.jtcvs.2014.08.073
  8. Molenaar MA, Bouma BJ, Coerkamp CF, Man JP, Išgum I, Verouden NJ, et al. The impact of valvular heart disease in patients with chronic coronary syndrome. Front Cardiovasc Med. 2023 Jul 21;10:1211322. https://doi.org/10.3389/fcvm.2023.1211322
  9. Fazlinezhad A, Dorri M, Azari A, Bigdelu L. Frequency of Ischemic Mitral Regurgitation after First-Time Acute Myocardial Infarction and its Relation to Infarct Location and In-Hospital Mortality. J Tehran Heart Cent. 2014;9(4):160-165.
  10. Ruzza A, Czer LSC, 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
  11. 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
  12. Coisne A, Lancellotti P, Habib G, Garbi M, Dahl JS, Barbanti M, et al.; EuroValve Consortium. ACC/AHA and ESC/EACTS Guidelines for the Management of Valvular Heart Diseases: JACC Guideline Comparison. J Am Coll Cardiol. 2023;82(8):721-734. https://doi.org/10.1016/j.jacc.2023.05.061
  13. 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. Ukrainian. https://doi.org/10.31450/ukrjnd.4(68).2020.08
  14. Rudenko SA, Rudenko AV, Sokur SA, Zhyliak OV, Klimenko LA. [Surgical Treatment of Left Ventricular Aneurysm Combined with Ischemic Mitral Regurgitation Using a Modified Technique]. Ukrainian Journal of Cardiovascular Surgery. 2021;(3(44)):38-42. Ukrainian. https://doi.org/10.30702/ujcvs/21.4409/r.r.037-38-42
Published
2024-06-27
How to Cite
Gogayeva, O. K. (2024). Analysis of the Perioperative Course of Cardiac Surgery Patients with Coronary Artery Disease and Heart Valve Dysfunction. Ukrainian Journal of Cardiovascular Surgery, 32(2), 11-16. https://doi.org/10.30702/ujcvs/24.32(02)/G036-1116
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 32 No 2 2024
Section
ISCHEMIC HEART DISEASE