ФАКТОРЫ РИСКА РАЗВИТИЯ ПОСТКАРДИОТОМНОГО СИНДРОМА МАЛОГО СЕРДЕЧНОГО ВЫБРОСА У ПАЦИЕНТОВ ПОСЛЕ АОРТОКОРОНАРНОГО ШУНТИРОВАНИЯ В УСЛОВИЯХ ИСКУССТВЕННОГО КРОВООБРАЩЕНИЯ

Abstract

Aim. To determine the risk factors for postcardiotomy syndrome of low cardiac output in patients after on-pump coronary artery bypass grafting. Methods. The study included 157 patients who underwent on-pump coronary artery bypass grafting. Intraoperatively and in the early postoperative period, 25 patients developed postcardiotomy low cardiac output syndrome (PLCOS), which was refractory to drug therapy and followed by mechanical circulatory support (MCS). 132 patients did not develop PLCOS and did not require MCS (comparison group). Results. A retrospective, observational case-control study was carried out. Based on a univariate analysis, risk factors for the development of PLCOS were identified: preoperative left ventrical ejection fraction (LVEF) (B-mode) < 45%, OR = 4.7 (95% CI 1.9–11.5, p = 0.001), open heart surgery during the acute period of myocardial infarction (10 days) OR = 20.5 (95% CI 3.8-109, p = 0.001), aorta reclumping OR = 5.8 (95% CI 1.1 – 30.9, p = 0.049), dysfunction of coronary bypass grafts detected by bypass imaging in the early postoperative period OR = 54.7 (95% CI 13.6-219, p = 0.001). Conclusions. Postcardiotomy syndrome of low cardiac output is a severe complication after open-heart surgery, leading to multiple organ failure due to systemic hypoperfusion of organs and tissues and is characterized by a high hospital mortality rate of up to 80%. Mechanical support of blood circulation (MCS) in this case is the only method of treatment for this cohort of patients.