Abstract
Objective: analysis of the results of operations in elderly patients with combined pathology of heart valves and coronary
arteries, optimization of surgical treatment tactics.
Material and methods. The results of surgical treatment of 388 patients over 60 years of age with valvular heart disease
and concomitant coronary disease were analyzed. Patients were operated on the basis of the Department of
Reconstructive Surgery of Heart Valves and Coronary Arteries of the Bakoulev National Medical Research Center
for Cardiovascular Surgery in the period from 2011 to 2018 inclusive. In all cases, simultaneous replacement and/or
reconstruction of the heart valves in combination with coronary artery bypass grafting was performed. Depending on
the coronary artery bypass grafting (CABG) technique, all patients were divided into two groups: group I – patients
who underwent myocardial revascularization according to the standard technique (on-pump CABG); group II – onpump
beating-heart CABG.
Results. Hospital mortality was 8.2%. Hospital mortality in the standard method and On-pump beating-heart CABG
groups was the same: 8% and 8.6%, respectively. Hospital mortality in 2011–2014 was 11.6%, and in 2015–2018 –
5.5% (p<0.05). In the first group, CABG was most often performed with cardioplegia and cardiopulmonary bypass
(87.7%), and in 2015–2018 the distribution was the same (53 and 47%).
Conclusion. In elderly patients with low left ventricular ejection fraction, with severe comorbidities, with multi-vascular
coronary artery and multiple valvular diseases involving prolonged aortic clamping, the method of revascularization
on-pump beating-heart is preferred. This approach allows not only to safely perform the stage of coronary
bypass surgery, but also to reduce the time of myocardial ischemia, which favorably affects the outcome of surgical
treatment in patients with a large volume of surgery.
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About the authors
- Dovran B. Kakabaev, Cardiovascular Surgeon, Postgraduate, orcid.org/0000-0003-3125-8744
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Ivan I. Skopin, Dr. Med. Sc., Professor, Head of the Department, Director of Institute for Coronary and Vascular Surgery, orcid.org/0000-0001-7411-202X
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Pavel V. Kahkktsyan, Cand. Med. Sc., Senior Researcher, Cardiovascular Surgeon, orcid.org/0000-0002-8781-5012
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Alim M. Otarov, Cand. Med. Sc., Junior Researcher, orcid.org/0000-0001-5648-7194
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Inessa V. Slivneva, Cand. Med. Sc., Researcher, orcid.org/0000-0001-7935-7093
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Aleksandr V. Vavilov, Researcher, Cardiovascular Surgeon, orcid.org/0000-0002-0488-5630
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Artur S. Chukalin, Junior Researcher, Cardiologist, orcid.org/0000-0002-1415-3919
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Shikhmagomed M. Kurbanov, Cardiologist, orcid.org/0000-0003-3146-7503
