Surgical Treatment of Patients with Valvular Heart and Coronary Artery Disease

Ivan Skopin , Pavel Kakhktsyan , Alim Otarov, Tigran Asatryan, Aleksandr Dremin , Khachatur Paronyan

Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objective.The results of surgical treatment of patients with combined pathology of the heart valves and coronary arteries, depending on the method of myocardial revascularization have analyzed.

Methods. Since 2015 january a 280 patients with heart valves and coronary artery disease are operated. The mean age of the patients was 65.1±8.1 years. The average EuroSCORE rate was 5.8±4.6%. CABG in combination with correction of the valve disease was performed in 224 cases. 56 patients underwent percutaneous coronary intervention with the subsequent open heart operation upon valves. The group of patients with CABG were divided into three subgroups depending on the method of myocardial revascularization: with complete cardiopulmonary bypass, beating heart bypass grafting with parallel normothermic perfusion, OPCAB.

Results. In the postoperative period died 22 patients, in-hospital mortality was 7.8%. After the hybrid treatment, 4 patients died (7.1%), while in 3 cases the reason of death was acute heart failure caused by thrombosis of the stents. In-hospital mortality in aortic valve replacement combined with CABG was 3.7%, the correction of mitral valve 10.1%.

Conclusion. CABG according to standard technique is applicable with success in the majority of patients with combined pathology. Elderly patients with a large volume of surgical intervention, significant concomitant diseases and risk factors more preferred method for parallel normothermic perfusion CABG, which allows not only to safely CABG, but also to reduce the time of ischemia of the myocardium, which has a positive effect on the outcome of surgical treatment. The hybrid method can be considered as an alternative to the standard technique in patients with high preoperative risk of hospital mortality, as well as for mitral patients with affected EF.