Abstract
Objective. To assess the functional class of heart failure (FC HF) according to the New York Heart Association (NYHA) in elderly patients before and after surgical correction of valvular heart disease and/without coronary heart disease (VHD±CHD).
Material and methods. Correction of was performed in 240 patients ≥ 60 years old (mean age 69.2±1.3 years). Before surgery (b/s), patients were assessed for FC according to NYHA: 178 (74.2%) elderly were assigned to FC III according to NYHA, and 62 (25.8%) were assigned to FC IV. In 17% of the elderly, the left ventricular ejection fraction (LV EF) b/s was ≤ 35%. The average EuroSCORE II was 15.7±3.3%. Operations performed: correction of defect of the 1 valve was performed in 71 (29.6%) patients, correction of the defect of 2 valves – in 83 (34.6%) elderly patients, combined operations (VHD + coronary artery bypass grafting) – in 54 (22.5%) to patients. Staged treatment (stage I – percutaneous coronary intervention, stage II – correction of VHD) was carried out in 32 (13.3%) elderly patients. Non-lethal complications in the early postoperative (p/o) period were noted in 42.9% of patients, hospital mortality was 7.9%. At discharge from the clinic, there were 143 (64.7%) elderly patients in FC II, and 78 (35.3%) patients in FC III. 50 (22.6%) elderly patients, who were b/s in FC III, remained in NYHA FC III at discharge from the clinic. The mean age of these patients was 72±4.7 years, the mean ES II was 18.6±2.1%, the mean Edmonton frail scale/index (EFI) score was 8.1±5.5, the mean score for the M. Charleson comorbidity index (CCI) was 9.4±2.3. 38 (76%) patients had a complicated p/o period.
Results. According to the analysis of surgical treatment of VHD±CHD in the elderly, the dynamics of FC HF in the early p/o period was influenced by: LV EF ≤ 35% b/s (p=0.002), combined surgery (p=0.01), CCI ≥ 8 (p=0.04), ES II ≥ 5% (p=0.02), EFI “moderately worn” – “worn” (p=0.014), IV FC HF b/s (p=0.013) and artificial blood circulation time ≥ 140 min (p=0.027).
Conclusion. Elderly patients admitted to a cardiac surgery clinic in FC III and IV for the treatment of VHD±CHD are recommended to assess the risk factors of treatment according to EFI, CCI and ES II in order to prevent postoperative complications and improve the results of cardiac surgery.
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About the authors
- Tat’yana G. Nikitina, Dr. Med. Sci., Professor, Head of Department of Cardiosurgery of Acquired Heart Diseases; ORCID
- Dmitriy M. Pelekh, Cand. Med. Sci., Researcher; ORCID
- Knar S. Gulyan, Cand. Med. Sci., Cardiologist; ORCID
- Tat’yana Yu. Filippkina, Cand. Phys.-Math. Sci., Analyst;
- Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of the Russian Academy of Sciences, Director; ORCID
