International Medical Journal, Vol. 27., Iss. 3, 2021, P. 10−14.
PREOPERATIVE VERIFICATION OF COMORBIDITY IN PATIENTS WITH HIGH-RISK CORONARY HEART DISEASE ON THE EVE OF SURGICAL MYOCARDIAL REVASCULARIZATION
SI Amosov National Institute of Cardiovascular Surgery, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
Advances in drug therapy and interventional cardiology, availability of cardiac surgery have led not only to increased life expectancy in patients, but also to a rise in their risk profile due to comorbidity. When stratifying the risk of patients on the eve of coronary artery bypass grafting according to available risk calculators, concomitant diseases are taken into account, decompensation of which is considered as a prognostic factor of adverse outcome of surgery. The data from 194 high−risk patients who underwent surgery at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine within 2009−2019 were retrospectively analyzed. All the patients underwent electrocardiography, echocardiography, coronary ventriculography and coronary shunt. Risk stratification on the EuroSCORE II scale averaged 7,78 %, indicating a high probability of death. All the patients had hemodynamically marked coronary artery stenosis and required coronary artery bypass grafting. Analysis of patients at high risk of coronary heart disease who were hospitalized for surgical revascularization of the myocardium showed that they were overweight, having an obesity I−III, Diabetes mellitus type 2, impaired glucose tolerance, chronic kidney disease, concomitant atherosclerosis, varicose veins of the lower extremities, gouty arthritis, chronic obstructive pulmonary disease. The developed algorithm for searching for comorbid conditions makes it possible to detect the concomitant diseases in the patients on the eve of cardiac surgery. Management of cardiac surgery patients with high−risk ischemic heart disease in the perioperative period requires a personalized approach, taking into account not only the cardiac features, but also the compensation of comorbid conditions.
Key words: coronary heart disease, high−risk patient, comorbidity, coronary artery bypass grafting.
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