Періопераційний період у пацієнтів з ішемічною хворобою серця з високим ризиком

Abstract

The aim – to analyze the perioperative period of high-risk patients with coronary artery disease. Materials and methods. 194 patients (age 64.2 ± 8.9 years) with surgery performed, discharged from the specialized clinic within period from 2009 to 2019. All patients underwent laboratory tests, ECG, echocardiography, coronary angiography and coronary artery bypass grafting (CABG). Results. All patients had hemodynamically significant coronary artery stenosis, which required CABG. Acute myocardial infarction at the time of admission was diagnosed in 12 (6.1 %) patients, unstable angina – in 72 (37.1 %) patients. Among comorbid conditions, type 2 diabetes mellitus was diagnosed in 50 (25.7 %) patients, impaired glucose tolerance – in 82 (42.2 %) patients, obesity – in 74 (38.1 %) patients, 86 (44.3 %) patients were overweight with a body mass index 25–29.9 kg/m2, and 75 (38.6 %) patients were diagnosed with chronic kidney disease. According to coronary angiography, the average number of stenosed coronary arteries was 3.5. The risk assessed by EuroSCORE II scale was 7.78 % (from 5.01 % to 68.25 %). Myocardial revascularization was performed on the working heart in 187 (96.3 %) patients, on-pump in 7 (3.6 %) cases. In the postoperative period, 40 (20.6 %) patients developed paroxysmal atrial fibrillations. Acute kidney injury with increase in creatinine by 50 % occurred in 2 (1.03 %) patients. Conclusions. Despite the high predicted mortality (7.78 % by the EuroSCORE II scale) all the patients were discharged on average in 8.4 ± 3.5 days. Careful preoperative diagnosis, preparation, risk stratification, determination of the term of surgery, choice of CABG method taking into account the anthropometric data, the state of the lower extremities veins, anatomical location of coronary arteries, their diameter and degree of damage, personalized drug therapy, allows to achieve good results with minimal complications. Key words: coronary artery disease, high-risk patients, coronary artery bypass grafting, comorbid conditions, off-pump.