ANALYSIS OF THE FREQUENCY AND NATURE OF CONCOMITANT DISEASES AS A RISK FACTOR FOR COMPLICATIONS AND ADVERSE OUTCOME IN CORONARY ARTERY BYPASS GRAFTING IN ELDERLY AND SENILE PATIENTS

Abstract

Abstract. Objective: to study the frequency of occurrence of concomitant pathology of the circulatory and respiratory system, digestive organs and urogenital system to improve the quality of prognosis of developing complications and adverse outcomes during coronary artery bypass grafting in elderly and senile patients with coronary heart disease, including taking into account gender differences. Materials and methods. 164 patients (70% - men), operated on a planned basis for coronary heart disease in the Altai Regional Clinical Hospital, were under observation. The average age of patients at the time of surgery was 58.7± 7.3 years. Coronary bypass surgery was performed according to indications in conditions of artificial circulation and pharmacoholodic cardioplegia. Results. The Charlson comorbidity index was 5.3 [4.4-5.9] points; in young and middle-aged patients 3.5 [3.0-4.3], in elderly and senile patients - 5.9 [4.9-6.3] (p=0.03). It correlated with the following surgical complications: heart failure that required inotropic support for more than 5 days (r=0.68); perioperative MI (r=0.61); acute cerebrovascular accident confirmed by computed tomography (r=0.52); cardiac arrhythmias (atrial fibrillation, paroxysmal ventricular tachycardia) (r=0.49); respiratory insufficiency, which led to prolonged artificial ventilation of the lungs for more than 5 days (r= 0.45). Conclusions: Comorbidity in CABG is characterized by a high risk of an unfavorable prognosis in elderly and senile patients (survival rate is less than 21% in the next 10 years). The presence of a significant frequency of both multi and comorbid diseases determines a high associated surgical and anesthetic risk, which must be taken into account at the stage of preoperative preparation in gerontological patients, requires additional examination, increased costs and mandatory medical correction.