DIFFERENTIATED APPROACH TO PREVENTION AND TREATMENT OF ACUTE LEFT VENTRICULAR FAILURE IN PATIENTS WHO UNDERWENT CORONARY ARTERY BYPASS GRAFT SURGERY WITH CARDIOPULMONARY BYPASS

Abstract

Introduction. Coronary heart disease (CHD) is the accumulation of atherosclerotic plaques in the blood vessels that supply the heart with oxygen and nutrients. Coronary artery bypass grafting (CABG) is a strategy for myocardial revascularization that is indicated for patients with three or more coronary artery demage, high SYNTAX, diabetes, and left ventricular systolic dysfunction. Despite the tremendous development of equipment, surgical and anesthesia techniques, in the perioperative period, there are still complications. The most formidable complication after such an operation of CABG with cardiopulmonary bypass (CPB) is the development of acute left ventricular failure (ALVF).
 The aim. To study the effectiveness of the principles of a differentiated approach to the prevention and correction of ALVF in patients who underwent surgery - CABG with CPB.
 Materials and methods. 500 cardiac surgery patients with coronary heart disease were operated on at SIS “Research and Practical Center of Preventive and Clinical Medicine” SAD. In all the cases, coronary artery bypass grafting was performed using cardiopulmonary bypass. In order to verify the principles of a differentiated approach to the correction and prevention of ALVF, the study was divided into three stages. At the first stage, the problem of the metabolic component of ALVF correction was studied (60 patients). On the second - the problem of diagnosis and correction of hypophosphatemia (60 patients with preoperative hypophosphatemia). On the third - diagnostic properties of the innovative method "Phasagraphy" (80 patients).
 Results. The introduction of a combination of levocarnitine and arginine, fructose-1,6-diphosphate - in case of hypophosphatemia, in the treatment of ALVF can reduce the recovery time of hemodynamics and reduce the total dose of inotropic drug (dobutamine) needed to achieve stabilization. The LF/HF indicator reliably reflects the ratio of sympathetic and parasympathetic parts of the autonomic nervous system, responds to disturbances and restoration of hemodynamics. The βT index of the phasagraphy method is related to clinical data on myocardial status.
 Conclusions. To prevent the development of ALVF in patients with coronary heart disease requires a differentiated approach: perioperative diagnosis of hypophosphatemia and its correction. In the case of ALVF after CABG surgery in patients with coronary heart disease to stabilize hemodynamics, the use of inotropic support with dobutamine and metabolic support with a combination of levocarnitine and arginine. As monitoring of myocardial condition it is advisable to use LF/HF indicator of variation pulsometry and βT method of phasagraphy.