Introduction. The number of patients with severe ischemic left ventricular dysfunction (ILVD), who undergo coronary artery bypass, increasing each year. ILVD is an established risk factor for mortality in patients after myocardial revascularization during the early and late postoperative periods.Aim of study. To evaluate the early results of surgical myocardial revascularization in patients with coronary artery disease (CAD) and severe ILVD.Material and methods. The study included 149 patients with coronary artery disease with severe left ventricular dysfunction (ejection fraction (EF) ≤39%), operated from January 2002 to December 2018. different variables were assessed (pre- and postoperative), including LV ejection fraction and end systolic volume index (ESVI).Results. The average age of the patients was 59.36±8.97 years (from 30 to 78 years), 93% of the patients were men. In 28 patients (19%), ILVD developed against the background of myocardial infarction (MI) and in 121 (81%) due to ischemic cardiomyopathy (ICMP) with a history of myocardial infarction. The mean EF before surgery was 36.64±3.17 (from 21 to 39%). In the postoperative period, there was an increase in EF, which averaged 44.92±4.92 (from 36 to 59%) (p value <0.001). The mean LV ESVI before surgery was 60.23±11.52 ml/m2. In the immediate postoperative period ESVI decreased to 46.26±12.40 ml/m2 (the value of p<0.001). The average number of bypass coronary arteries in one patient was 3.9±0.87. There was also a decrease in the degree of mitral regurgitation in most patients after coronary artery bypass grafting (CABG) (p value <0.001). Hospital mortality was 2% (3 patients).Conclusion. Coronary artery bypass grafting in patients with severe ischemic left ventricular dysfunction can be performed with low mortality. Surgical myocardial revascularization can be considered a safe and effective operation for patients with coronary artery disease with a satisfactory condition of the distal coronary arteries, low ejection fraction, and with a predominance of viable myocardium.
Aim To study the relationship between the type of circulation, severity and localization of atherosclerotic damage of coronary arteries, results of laboratory and instrumental tests, and historical data in patients with multivascular coronary lesions and atrial fibrillation (AF) that developed after coronary bypass surgery.Material and methods This was a novel, retrospective study of data of patients after elective coronary bypass surgery at the Cardiac Surgery Department #1 of the N.V. Sklifosofsky Research Institute of Emergency Care from December, 2018 through December, 2020. The study included 100 patients. The main group consisted of 20 patients whose early postoperative period (first 7 days after surgery) was complicated with postoperative atrial fibrillation (POAF) (mean age, 65.15±9.7 years). The comparison group included 80 patients without the POAF complication during the early postoperative period (mean age, 62.0±9.16 years). Prior to the coronary bypass surgery, all patients underwent clinical, laboratory, and instrumental examination. Based on data of selective coronary angiography, localization, severity of coronary atherosclerotic damage (according to angiographic classification), number of affected arteries, and the type of circulation were taken into account.Results Intergroup differences in the incidence and localization of myocardial infarctions in history, severity of arterial hypertension in history, class of chronic heart failure (according to the New York Heart Association, NYHA, classification), and heart rate were absent. 100 % of patients had left atrial (LA) dilatation not correlated with the development of AF in the early postoperative period. According to data of coronary angiography, there was no statistically significant association between the type of circulation and the development of POAF. The right type of myocardial blood supply prevailed in patients of both groups. There was no correlation between the severity and localization of coronary atherosclerotic lesions and the development of AF in the early postoperative period.Conclusion The development of AF following coronary bypass surgery was not associated with features of coronary atherosclerotic lesions, which may indicate active development of inter- and intra-systemic anastomoses in patients with long-term history of chronic coronary atherosclerosis.
ВАБК-внутриаортальная баллонная контрпульсация ИБС-ишемическая болезнь сердца ИК-искусственное кровообращение ИМ-инфаркт миокарда КАГ-коронароангиография КШГ-коронарошунтография КШ-коронарное шунтирование ЛВГА-левая внутренняя грудная артерия ЛЖ-левый желудочек ЛКА-левая коронарная артерия ОКС-острый коронарный синдром УЗИ-ультразвуковое исследование ФВД-функция внешнего дыхания ЭКГ-электрокардиография ЭхоКГ-эхокардиография отдалеННые РеЗультаты коРоНаРНоГо ШуНтиРоВаНия у пациеНтоВ с остРым коРоНаРНым сиНдРомом
Atrial fibrillation (AF) after coronary bypass surgery is recorded in 20- 60% of patients and increase the early and long-term postoperative mortality. The aim of the review is to analyze the studies on causal relationships between damaging factors and the development of myocardial inflammation at each stage of surgical treatment in patients with multivessel coronary artery disease. In the review, myocardial inflammation is considered from the point of view of a continuum — a chronic process that originates from the coronary endothelium damage and continuously proceeds within the AF pathogenesis after coronary bypass surgery. For the first time, the concept of inflammatory continuum for postoperative AF is introduced. The review discusses the main and latest laboratory and instrumental markers of local and systemic inflammatory response, which are informative in terms of severity and promising for improving approaches to the diagnosis and prevention of postoperative AF. The review was prepared using available materials from Russian and foreign library databases (PubMed, Medline, Web of Science and Cochrane Library). The search depth was >25 years since 1996. Based on the analysis of available studies, we concluded that inflammation is not just evidence of AF, but plays a causal role in its pathogenesis at each stage of surgical myocardial revascularization.
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