Abstract
Objective: to analyze the predictors of complications in the early postoperative period after the correction of valvular heart disease (VHD) ± coronary artery disease (CAD) in the elderly (≥ 60 years).
Material and methods. 240 patients ≥60 years old, mean age – 69.2 ±1.3 years, correction of VHD±CAD was performed. Before surgery, in functional class III (FC) according to the New York Heart Association (NYHA) – 178 (74.2%) elderly, in IV FC – 62 (25.8%). The fraction of choice (EF) of the left ventricle (LV) before surgery ≤ 35% was in 17% of patients. The mean score on the Edmont frail scale/index (EFI) was 8.1 ± 5.5; according to the M. Charlson comorbidity index (CCI) – 9.4 ± 2.3), according to EuroSCORE(ES) II – 15.7 ± 3.3%, The Society of Thoracic Surgeons’ risk model score (STS ) in patients with concomitant coronary artery disease – 5.2 ±3.4. Operations: correction of defect of the 1 valve was performed in 71 (29.6%) patients, two-valves correction – in 83 (34.6%) elderly patients, combined operations (VHD + aortocoronary bypass grafting (CABG)) were performed in 54 (22.5%) patients. Staged treatment (stage I – percutaneous coronary intervention (PCI), stage II – correction of VHD) was performed in 32 (13.3%) patients. Mean time of artificial circulation (AC) – 146 ± 2.3 min, aortic clamping time (Ao) – 52 ± 6.5 min, artificial lung ventilation (LV) time – 34.2 ± 7.9 hours, average duration of treatment in intensive care unit (ICU) – 4.5 ±2.1 days, the average duration of cardiotonic support (CST) after surgery – 5.3 ± 2.7 days.
Results. Non-lethal complications in the early p/o period were noted in 103 (42.9%) patients: acute heart failure (AHF) – 31 (12.9%), pneumonia – in 24 (10%), multiple organ failure syndrome (MOF) – in 14 (5.8%) (hemodialysis (HD) in acute renal failure (ARF)), stroke – in 12 (5%), bleeding – in 10 (4.2%), heart arrythmia (HA) (atrial fibrillation (AF), atrioventricular block (AVB) stage II–III, ventricular tachycardia (VT)) – 6 (2.5%), thrombosis of the superficial femoral artery (SFA) (after intra-aortic balloon counterpulsation (IABP)) – in 2 (0.8%) elderly patients and early prosthetic endocarditis (PE) – in 2 (0.8%) patients. It should be noted that in 12 (5%) elderly people who had a coronavirus infection (COVID-19) in less than 3 months. before VHD ± CAD correction, bilateral pneumonia was diagnosed in the early postoperative period. Hospital mortality – 7.9% (19): AHF – 5, MODS – 4, stroke – 4, pneumonia – 3, bleeding – 2, gastrointestinal bleeding (GI) – 1.
Conclusion. Elderly patients admitted to a cardiac surgery clinic for the surgical treatment of valvukar heart disease ± coronary arterydisease are recommended to conduct thorough preoperative preparation for surgical treatment with an assessment of the risk factors of treatment according to EFI, CCI and ES II in order to prevent complications and improve the results of cardiac surgery
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About the authors
- Tatiana G. Nikitina, Dr. Med. Sci., Professor, Head of the Department; ORCID
- Dmitry M. Pelekh, Cand. Med. Sci., Researcher, Cardiologist; ORCID
- Tatyana Yu. Filippkina, Cand. Phys. Math. Sci., Analyst
- Mikhail M. Rybka, Dr. Med. Sci., Head of the Department of Anesthesiology; ORCID
- Renat M. Muratov, Dr. Med. Sci., Professor, Head of the Department; ORCID
- Vladimir A. Mironenko, Dr. Med. Sci., Head of the Department; ORCID
- Ivan I. Skopin, Dr. Med. Sci., Professor, Director of the Institute; ORCID
- Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of RAS, Director; ORCID
