Operations on working heart in lesion of left main coronary artery in acute coronary syndrome

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Abstract

Aim. To study safety and effectiveness of operations on the working heart in patients with damage to the left main coronary artery (LMCA) and with acute coronary syndrome (ACS), to determine the optimal time for operation.

Materials and Methods. The work was based on the analysis of examination and treatment of 62 patients with damage to LMCA. Patients were divided to 2 groups depending on the kind of surgery: in the first group of patients (n=31) the operation was performed under cardiopulmonary bypass (CPB), in the second group (n=31) – on the working heart. The groups were comparable by the main clinico-demographic parameters. The risk for unfavorable outcome was determined on EuroSCORE II scale.

Results. Operation on the working heart in patients with damage to LMCA and ACS permitted to reduce the time of operation (253.44±36.84 against 188.13±45.37 min, p=0.0001), blood loss in postoperative period (607.00±432.34 ml against 413.21±167.08 ml, р=0.03), frequency of use of blood preparations (47.62% against 18.18%, р=0.04). However, the revascularization efficiency was higher in the group operated under CPB (2.93±0.8 against 2.29±0.82, р=0.005). Operations under CPB performed at later time (14-30 days) were associated with increased lethality. In operations on the working heart no lethal outcomes were reported.

Conclusion. Operations on the working heart are safe and effective in the early period after development of ACS. The optimal operation time under CPB is 7-14 days. Lethality and postoperative complications in operation on the working heart before 7 days, within 7-14 days, and after 14 days did not differ.

About the authors

Ilia N. Staroverov

Yaroslavl Regional Clinical Hospital; Yaroslavl State Medical University

Author for correspondence.
Email: istaroverov@mail.ru
ORCID iD: 0000-0001-9855-9467
SPIN-code: 8011-7176
ResearcherId: М-8174-2014

MD, PhD, Head of the Vascular Surgery Department of Regional Clinical Hospital; Head of the Surgery Department of the Postgraduate Education Institute

Russian Federation, Yaroslavl

Ivan N. Staroverov

Yaroslavl Regional Clinical Hospital

Email: istaroverov@mail.ru
ORCID iD: 0000-0001-9961-7024
SPIN-code: 1995-6930
ResearcherId: A-9281-2019

Head of the Cardiac Surgery Department

Russian Federation, Yaroslavl

Stanislav O. Churakov

Yaroslavl State Medical University

Email: istaroverov@mail.ru
ORCID iD: 0000-0003-4589-0898
SPIN-code: 4126-4927
ResearcherId: A-7221-2019

Clinical Resident

Russian Federation, Yaroslavl

Oksana M. Lonchakova

Yaroslavl Regional Clinical Hospital; Yaroslavl State Medical University

Email: istaroverov@mail.ru
ORCID iD: 0000-0003-4507-6693
SPIN-code: 8360-6161
ResearcherId: A-9321-2019

MD, PhD, Assistant of the Surgery Department of the Postgraduate Education Institute

Russian Federation, Yaroslavl

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Copyright (c) 2019 Staroverov I.N., Staroverov I.N., Churakov S.O., Lonchakova O.M.

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