Preoperative planning of on-pump beating-heart coronary artery bypass grafting based on prediction of intraoperative complications

Abstract

The aim — to improve the results of coronary artery bypass grafting in patients with ischemic heart disease by determining indications for direct myocardial revascularization on a beating­heart in conditions of parallel blood circulation based on the study of risk factors of intraoperative complications.Materials and methods. A retrospective analysis was performed of case histories of 4068 patients who underwent an isolated coronary artery bypass grafting on a working heart in 2009 — 2013 in the department of surgical treatment of coronary artery disease in M. M. Amosov National Institute of Cardiovascular Surgery. Were analyzed clinical­anamnestic and instrumental data.Results and discussion. Postoperative complications were frequently associated with intraoperative — unstable hemodynamics, cardiac rhythm disturbances, myocardial ischemia, bleeding and thrombosis of shunts, which are the cause of an emergency on­pump conversion. Emergency conversion significantly worsens the results of surgical intervention. The optimal way of its prevention is preoperative planning with the identification of patients with a high risk of intraoperative complications. A through pre­operative examination allows to identify potential predictors of intraoperative complications, and their complex evaluation makes it possible to optimize the definition of indications to on­pump beating­heart coronary artery bypass grafting, which will prevent an emergency conversion by reasonable planning of surgery.Conclusions. The proposed regression model of the probability of development of intraoperative complications is an effective help in deciding on the use of on­pump beating­heart coronary artery bypass grafting.