The aim – determine the state of cognitive function in the early and late postoperative period in patients with coronary heart disease who underwent on-pump coronary artery bypass grafting.
Маterial and methods. In a retrospective observational one-center study, the data obtained from the clinical and instrumental examination of patients who underwent on-pump coronary artery bypass grafting were analyzed. The analysis group included 84 patients (51.5 %) from the total cohort of 163 patients (68 men (80.9 %) and 16 women (19.1 %), mean age 64.4±7.5 years), in which in the early postoperative period cognitive impairments were detected. Neurocognitive testing was performed 3 days prior to surgery, on the 7th day after the intervention, and 3 months after discharge from the hospital using the MMSE Mini Mental State Examination Scale and the Trial Making Test Part A and B.
Results. Patients in the surveillance group in the preoperative period at the time of passing the MMSE test scored 26.2±2.3 points. At 7 days after surgery, patients gained 23.6±2.2 points (8.2 % less than before the operation – mild cognitive impairment). 3 months after discharge from the hospital, the patients of the study group gained 24.8±2.2 points (improving the cognitive status, but failed to achieve the upward level of testing). The patients spent 32.0±5.0 seconds test for the Trial Making Test Part A series in the preoperative period and 35.6±6.8 seconds on day 7. After 3 months after the operation, the test results amounted 33.3±5.0 seconds, which didn’t differ compared to preoperative indicators. The second part of the Trial Making Test Part B showed similar results.
Conclusion. The results of the cognitive tests for patients undergoing coronary artery bypass grafting demonstrated that cognitive dysfunctions registered in the early postoperative period in 51.5 % of patients (in the form of mild cognitive impairment), significantly decreased to 16.6 % at 3 months after surgery, which is consistent with the results of international studies.
During period from 1 January 2012 to 31 December 2014, 142 procedures of the surgical treatment of mitral valve insufficiency have been performed at the National M.M. Amosov Institute of Cardiovascular Surgery. The average age of the patients was 61.8±7.4 years. Arterial hypertension was diagnosed in 59.9 % (n=85) patients, diabetes mellitus – in 14.8 % (n=21), peripheral arterial disease – in 16.2 % (n=23), anamnestic stroke – in 3.5 % (n=5). Valve preserving surgery of mitral valve (plastic surgery) was performed in 93 (65.5 %) patients, mitral valve prosthesis – in 49 (34.5 %). We studied complications in the early postoperative period. Heart failure was most prevalent in the study group, being diagnosed in 40 (28.2 %) patients, and constituted 71.4 % among all early post surgery complications. Special attention was paid to the protection of the myocardium. Introduction of the myocardial protection method with additional usage of the cardioplegic solution through bypass grafts decreased the prevalence of early post surgery heart failure to 22.1 %.
Success of pediatric cardiology and pediatric cardiac surgery has improved survival of children with congenital heart disease (CHD). This dynamics could increase their survival and life expectancy during adult period.
The aim – to estimate cardiac surgery care activity in adults with CHD through register of all surgical patients older than 16 years with CHD in Ukrainian Children’s Cardiac Centre (UCCC), to create strategy for cardiology care during late postoperative period.
Material and methods. This retrospective review included an analysis of medical case reports of all patients aged 16 years and older during period from 01 Jan 1999 to 31 Dec 2013. The date was analyzed after divided the group in to 3 periods. Period 1 – from 1999 to 2005, Period 2 – from 2006 to 2010, Period 3 – from 2011 to 2013. The anatomical diagnosis of CHD were classified into simple, moderate and severe, according to modified Canadian consensus conference criteria as used by Bethesda conference report. Presurgery status of all patients was assessed by NYHA heart failure classes.
Results. 501 surgical procedures were performed in 451 patients over the study period. There were 5 deaths (surgical mortality at 30 days was 1.1 %). Age at surgery was from 16 to 70 years, average 23.42±0.60 years. During period 1 there were 110 procedures, period 2 – 163 procedures, period 3 – 228 procedures. Surgical mortality at 30 days was 1.92 % in period 1; 1.33 % in period 2; 0.51 % in period 3. There was prevalence of cardiac surgery (99 %) in period 1. In period 2 cardiac surgery was performed in 139 patients (85 %) angio procedures – in 21 (13 %), arrhythmia procedures – in 3 (2 %). In period 3 surgery was performed in 164 patients (72 %) angio procedures – in 46 (20 %), arrhythmia procedures – in 18 (8 %). In period 1 there were 48 adults with simple CHD (46 %), 34 – with moderate CHD (32 %) and 22 with severe CHD (21 %), in period 2 – 60 adults with simple CHD (39 %), 40 – with moderate CHD (26 %) and 53 with severe CHD (35 %), in period 3 – 72 adults with simple CHD (37 %), 48 – with moderate CHD (24 %) and 74 with severe CHD (39 %). Cardiac surgery in septal defects was performed in period 1 in 45 %, in period 2 – 43 %, in period 3 – 34 %; LVOT procedures – in 27; 32 and 32 %, RVOT – in 2; 4 and 9 %, correspondingly.
Conclusions. Improving surgical care in adult CHD increases the number of patients undergoing surgery, number of procedures, along with decreasing mortality (from 1.92 to 0.51 %). More than one third of all surgical patients had complex severe heart defects requiring special training and knowledge of medical specialists for ACHD. The percentage of simple CHD in a structure of all defects was decreased, along with increased number of procedures and operations in LVOT and RVOT. Most of these procedures are reoperations
In one-and-a-half ventricle repair in patients with hypoplasia of right ventricle with intact ventricle septum the inability to close atrial septum defect can be predicted pre- or intraoperatively before cardiopulmonary bypass on basis of hemodynamic data. In congenital heart diseases with hypoplasia of right ventricle and ventricular septum defect component decision can be made on base of tricuspid valve diameter and balloon occlusion test.
The chronic coronary artery disease takes a leading place in the structure of general morbidity and mortality of world population, including Ukraine. Apart from medical therapy, coronary artery bypass grafting and stenting are used for the treatment of this pathology. All these direct methods of myocardial revascularization can’t influence the cause of atherosclerosis and don’t stop its pathogenesis. The aim of our research was study the influence of surgical treatment on frequency, extent and speed of coronary atherosclerosis development after and without operation. The research included 243 patients, among them 103 patients after coronary stenting, 105 patients with coronary bypass without extracorporeal circulation and 35 patients after coronary artery bypass grafting with extracorporeal circulation. The median follow-up period was 29 months. The research of 729 coronary arteries in 243 patients showed progression of coronary atherosclerosis (appearance of new and progression of “old” stenoses) in 363 vessels (49.8 %). After coronary bypass the progression of coronary atherosclerosis was evident in 183 (58.1 %) shunted coronary arteries without extracorporeal circulation and in 47 (44.8 %) shunted coronary arteries with extracorporeal circulation, as well as in 29 (9.4 %) stented arteries. In conclusion, coronary bypass, as a protracted traumatic factor, is associated with progression of coronary atherosclerosis in shunted coronary arteries five times more often than in patients after coronary stenting. It means that coronary stenting, as a transitory traumatic factor, influences less the progression of coronary atherosclerosis than coronary bypass grafting.
Prognosis of heart failure development in patients with the history of acute myocardial infarction (AMI) depends on changes of left ventricular (LV) volume and geometrical form. Involvement of epicardial and subepicardial layers results in significant distortion of architectonics of ventricular walls, сonsequently impairs the coordinated process of contraction of myocardial fibers. The changes of their length and ratio on the background of decreased conductivity contribute to development of asynergic contraction. Normal ellipsoid ventricular form is transformed into spheroid cavity where fiber contraction vector becomes more transversally directed. Involvement of the interventricular septum and posterior wall into process significantly accelerates geometrical changes and decreases contractile ability of entire myocardium to critical level. Alterations in the geometrical intracavitary proportions also impairs transformation of myocardial tension to pressure and leads to transforming of normal spiral blood flow into turbulent one, predisposing to LV thrombus formation. It is well known that the incidence of LV thrombosis is high in patients with AMI and left ventricular aneurysm (LVA). Mural thrombi present in about half of all LVAs. The main complication of the thrombosis process is embolization. Thrombotic endocarditis occurs more rarely in patients with LVA. Bacteraemia and thrombotic endocarditis may also lead to myocardial abscesses, intracardiac fistulae and even generalized sepsis development. We present the experience of surgical treatment of LVA complicated with thrombotic endocarditis.