Optimal periods for coronary artery bypass surgery on working heart in patients with stenosis of left main coronary artery and acute coronary syndrome
- Authors: Staroverov I.N.1,2, Staroverov I.N.1, Churakov S.O.1,2, Lonchakova O.M.1,2
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Affiliations:
- Yaroslavl Regional Clinical Hospital
- Yaroslavl State Medical University
- Issue: Vol 29, No 4 (2021)
- Pages: 513-520
- Section: Original study
- URL: https://journals.rcsi.science/pavlovj/article/view/65223
- DOI: https://doi.org/10.17816/PAVLOVJ65223
- ID: 65223
Cite item
Abstract
Introduction: The treatment strategies of patients with stenosis of the left main coronary artery (LMCA) and acute coronary syndrome (ACS) is being debated. One of the key problems is the selection of the optimal time for coronary artery bypass surgery (CABS) in these patients.
Aim: To analyze different periods of revascularization of the myocardium by CABS on a working heart in patients with LMCA stenosis and ACS.
Materials and methods: A prospective analysis of treatment of 112 patients with LMCA stenosis (> 50%) and ACS was performed. Patients were divided to three groups depending on the time of surgical treatment: upto 7 days after occurrence of ACS, 18 (16.1%, group1) patients; 8–14 days, 38 (33.9%, group2) patients; > 14 days, 56 (50%, group3) patients. The average time of ACS-CABS in all patients was 15 days. The groups were comparable in terms of the main preoperative parameters, except for EuroSCORE II and GRACE scale that were predominant in the early periods of CABS.
Results: LMCA subocclusion (stenosis > 90%) with coexistence of anginal syndrome at rest was observed in more than half of patients with surgery upto 7 days (56%, p=0.019). The surgery duration, blood loss through drains, number of days in the resuscitation unit, duration of artificial lung ventilation, and use of vasopressor support were not significantly different. The revascularization index was higher in surgeries conducted within 7 days than in surgeries performed within 8–14 days (2.33 ± 0.59 versus 1.89 ± 0.65, p=0.02). The evaluation of the dynamics of the functional parameters of the myocardium showed a greater increase in ejection fraction in group1 when compared with group3 after surgery (p=0.036). In the evaluation of the end-diastolic volume of the left ventricle, the average reductions were 16 mL, 14 mL, and 8.5 mL, respectively, without any significant differences among the groups. The rate of intrahospital lethality was highest in group3 (.4%), followed by group2 (2.6%). No fatal outcomes were noted in surgeries conducted in upto 7 days (p> 0.050).
Conclusion: Early CABS performed upto 7 days have similar immediate results to delayed ones and considerably improves the contractile ability of the myocardium in patients with ACS and LMCA stenosis.
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##article.viewOnOriginalSite##About the authors
Ilia N. Staroverov
Yaroslavl Regional Clinical Hospital; Yaroslavl State Medical University
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; YaroslavlIvan N. Staroverov
Yaroslavl Regional Clinical Hospital
Email: ivstaroverov@mail.ru
ORCID iD: 0000-0001-9961-7024
SPIN-code: 1995-6930
ResearcherId: A-9281-2019
Head of the Cardiac Surgery Department
Russian Federation, YaroslavlStanislav O. Churakov
Yaroslavl Regional Clinical Hospital; Yaroslavl State Medical University
Email: churakov-stas@mail.ru
ORCID iD: 0000-0003-4589-0898
SPIN-code: 4126-4927
ResearcherId: A-7221-2019
Clinical Resident
Russian Federation, Yaroslavl; YaroslavlOksana M. Lonchakova
Yaroslavl Regional Clinical Hospital; Yaroslavl State Medical University
Author for correspondence.
Email: omloncha@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; YaroslavlReferences
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