Preoperative risk factors of emergency conversion to artificial circulation during off-pump coronary artery bypass grafting in patients with ischemic congestive heart disease
G. G. Khubulava,
A. E. Sukharev,
V. N. Kravchuk,
A. M. Volkov,
A. I. Lyubimov,
E. A. Knyazev,
A. S. Kusay,
D. U. Romanovskiy,
A. V. Birukov,
V. I. Zvoznikov https://doi.org/10.24884/0042-4625-2020-179-1-12-19
Abstract
INTRODUCTION. Coronary artery bypass surgery is the most popular method of surgical treatment of patients with chronic heart failure of ischemic origin. Modern direction of developing the cardiac surgery in treating patients with chronic heart failure of ischemic origin is «off-pump» techniques. However, the high risk of emergency conversion to
«on pump» reduce the availability for using «off pump» techniques with this kind of patients. Preoperative risk factors for unplanned conversion to cardiopulmonary bypass have not been studied.
The OBJECTIVE was to determine preoperative risk factors of urgent conversion to bypass in patients with congestive ischemic heart failure during off-pump coronary artery bypass grafting.
METHODS AND MATERIALS. The results of 44 coronary artery bypass grafting (CABG) off-pump procedures in patients with ischemic cardiomyopathy were retrospectively analyzed. Emergent conversion to artificial circulation was needed due to acute heart failure in 8 (18 %) patients. All patients were divided into 2 groups depending on the necessity for emergency using the cardiopulmonary bypass. Then the patients’ preoperative status was analyzed.
RESULTS. We determined that the risk factors of emergent conversion to cardiopulmonary bypass were observed in the following cases: patients after 70 years old with a combined left main coronary artery lesion and right coronary artery occlusion; left ventricle end-diastolic size more than 70 mm; mild mitral insufficiency; the presence of atrial or ventricle rhythm disturbances; EuroSCORE logistic score more than 4.9 %.
CONCLUSION. The identified risk factors allow to minimize the risk of urgent conversion to bypass circulation during off-pump myocardial revascularization in patients with congestive ischemic heart failure. When these risk factors are present, it is recommended to use on-pump or on-pump beating heart techniques of coronary artery bypass grafting in these patients.
About the Authors
G. G. Khubulava
Military Medical Academy
Russian Federation
Competing Interests: The authors declare no conflict of interest.
Russian Federation
Khubulava Gennadiy G. - Dr. Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Head of the First Department of Surgery (improvements of doctors), Military Medical Academy.
Saint Petersburg.
Competing Interests: The authors declare no conflict of interest.
A. E. Sukharev
Military Medical Academy
Russian Federation
Competing Interests: The authors declare no conflict of interest.
Russian Federation
Sukharev Andrey E. - Head of the Cardiac Surgery Department of the First Clinic of Surgery (improvements of doctors), Military Medical Academy.
6, Academika Lebedeva str., Saint Petersburg, 194044.
Competing Interests: The authors declare no conflict of interest.
V. N. Kravchuk
Military Medical Academy; North-Western State Medical University named after I.I. Mechnikov
Russian Federation
Competing Interests: The authors declare no conflict of interest.
Russian Federation
Kravchuk Vyacheslav N. - Dr. Sci. (Med.), Professor of the First Department of Surgery (improvements of doctors), Military Medical Academy, assistant professor, Head of the Department of Cardiovascular Surgery of North-Western State Medical University named after I.I. Mechnikov.
Saint Petersburg.
Competing Interests: The authors declare no conflict of interest.
A. M. Volkov
Military Medical Academy
Russian Federation
Competing Interests: The authors declare no conflict of interest.
Russian Federation
Volkov Andrey M. - Dr. Sci. (Med.), Deputy Head of the First Department of Surgery (improvements of doctors), Military Medical Academy.
6, Academika Lebedeva str., Saint Petersburg, 194044.
Competing Interests: The authors declare no conflict of interest.
A. I. Lyubimov
Military Medical Academy
Russian Federation
Competing Interests: The authors declare no conflict of interest.
Russian Federation
Lyubimov Aleksandr I. - Cand. Sci. (Med.), Head of the Cardiac Surgery Department of the First Clinic of Surgery (improvements of doctors), Military Medical Academy.
6, Academika Lebedeva str., Saint Petersburg, 194044.
Competing Interests: The authors declare no conflict of interest.
E. A. Knyazev
Military Medical Academy
Russian Federation
Competing Interests: The authors declare no conflict of interest.
Russian Federation
Knyazev Evgeniy A. - chief resident of the Cardiac Surgery Department of the First Clinic of Surgery (improvements of doctors), Military Medical Academy.
6, Academika Lebedeva str., Saint Petersburg, 194044.
Competing Interests: The authors declare no conflict of interest.
A. S. Kusay
Military Medical Academy
Russian Federation
Competing Interests: The authors declare no conflict of interest.
Russian Federation
Kusay Aleksandr S. - Head of Anesthesiology and Resuscitation Department of the First Clinic of Surgery (improvements of doctors), Military Medical Academy.
6, Academika Lebedeva str., Saint Petersburg, 194044.
Competing Interests: The authors declare no conflict of interest.
D. U. Romanovskiy
Military Medical Academy
Russian Federation
Competing Interests: The authors declare no conflict of interest.
Russian Federation
Romanovskiy Dmitriy U. - Cand. Sci. (Med.), teacher of the First Department of Surgery (improvements of doctors), Military Medical Academy.
6, Academika Lebedeva str., Saint Petersburg, 194044.
Competing Interests: The authors declare no conflict of interest.
A. V. Birukov
Military Medical Academy
Russian Federation
Competing Interests: The authors declare no conflict of interest.
Russian Federation
Birukov Andrey V. - Cand. Sci. (Med.), Head of Anesthesiology and Resuscitation Department of the First Clinic of Surgery (improvements of doctors), Military Medical Academy.
6, Academika Lebedeva str., Saint Petersburg, 194044.
Competing Interests: The authors declare no conflict of interest.
V. I. Zvoznikov
Military Medical Academy
Russian Federation
Competing Interests: The authors declare no conflict of interest.
Russian Federation
Zvoznikov Valeriy I. - cardiovascular surgeon of the First Clinic of Surgery (improvements of doctors), Military Medical Academy.
6, Academika Lebedeva str., Saint Petersburg, 194044.
Competing Interests: The authors declare no conflict of interest.
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For citations:
Khubulava G.G., Sukharev A.E., Kravchuk V.N., Volkov A.M., Lyubimov A.I., Knyazev E.A., Kusay A.S., Romanovskiy D.U., Birukov A.V., Zvoznikov V.I. Preoperative risk factors of emergency conversion to artificial circulation during off-pump coronary artery bypass grafting in patients with ischemic congestive heart disease. Grekov's Bulletin of Surgery. 2020;179(1):12-19. (In Russ.) https://doi.org/10.24884/0042-4625-2020-179-1-12-19
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