Sharipov I. I.1, Yarbekov R. R.2, Ismatov A. A.2, Muradov M. M.2, Omonov S. K.2, Vakhidov T. Z.2
1Республиканский Специализированный Центр Кардиологии; 2Republican Specialized Center of Cardiology (Tashkent, Uzbekistan);
On-pump myocardal revascularization operations in patients with left ventricular (LV) systolic dysfunction are accompanied by high rates of morbidity and mortality. The wide spread in the last two decades of off-pump myocardial revascularization techniques in patients with low surgical risk showed the safety of such operations. In this regard, the question of the possibility and results of such operations in patients with high risk, in particular, with low contractility of the LV, is especially actual. Aim - to study the results of off-pump myocardial revscularization operations in patients with LV ejection fraction (LVEF) less than 45%. Material and methods. A comparative analysis of the results of surgical treatment of 350 patients with ischemic heart disease, to whom off-pump myocardial revascularization operations were performed, was done. All patients were divided into two groups: Group I - 69 (19.7%) patients with LVEF less than 45%, and II Group-281 (80.3%) patients whos LVEF was more than 45%. Patients of both groups were comparable by sex, age and basic clinical-functional parameters. The majority of patients were male – 85.5% (59 patients) and 82.9% (233 patients) respectively in the I and II groups. The average age of patients in the I group was 60,6 ± 7,1 years, and in group II-58,57 ± 7.8 years. In the first group there were more patients in the acute stage of myocardial infarction – in I group 23.2% (16 patients), and in II Group – in 17.1% (48 patients), although the difference was statistically nonsignificant (p=0,426). The risk of surgery calculated by EuroScore calculator amounted in the I group 6,66±6,9%, and in group II - 3,39±2.9% (p = 0,005). Results and discussion. In the first group, the average number of grafts was 2,92±0,68 per patient (1-5), and in group II - 3,07±0.7 grafts. The duration of the operation in both groups was 241±5.6 and 268±5,46 min respectively. Inotropic support intraoperatively and in the immediate postoperative period was necessary in I group in 59.4% (41 patients), and in II group-in 33.1% (93 patients) (p=0,03). The average time of ventilation in the ICU was in the first group of 6,05±3.6 hours, in the II group - 5,72±3.3 hours. The ICU stay was averaged 63,5±2.5 hours in group I and 50,08±1.5 hours in group II (p=0,07). In the first group hospital mortality amounted to 1.4% (1 patient) - at expected 6.66%, and in II Group - 1.1% (3 patients) -at expected 3.39%. Conclusions. Off-pump myocardial revascularization operations in patients with LV systolic dysfunction are safe and can be performed with low levels of complications and hospital mortality without interfering the completeness of revascularization.
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