CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH ISCHEMIC HEART DISEASE AND LOW EJECTION FRACTION



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Abstract

Objectives. Off pump beating heart technique for myocardial revascularization was used successfully both in low and high risk patients. Its application in low ejection fraction patients was limited. The aim of our study was to evaluate the results of this technique application in patients with low ejection fraction and to compare it with the on pump bypass technique. Methods. This retrospective study included 174 patients with ejection fraction below 0.45 who underwent isolated coronary artery bypass surgery. 37 patients underwent myocardial revascularization with the use of conventional coronary artery bypass grafting (cCABG), while 137 patients had off-pump beating heart bypass grafting (OPCAB). Different preoperative, operative and postoperative variables were evaluated in both groups. Results. The patients profiles and risk factors were similar in both groups. The mean EF for patients who underwent cCABG was 43 % (Q1 = 40; Q3 = 44) in comparison with 42 % (Q1 = 38; Q3 = 44) for the OPCAB patients - (U = 2105,5; Z = -1,6; p = 0,11). Predicted risk for surgery according to EuroSCORE was similar in both groups (U = 2004.0; Z = -1.97; p = 0.05). The number of grafts performed per patient was significantly bigger in the patients who underwent cCABG - 4.0 (Q1 = 3.0; Q3 = 4.0) Vs 3.0 (Q1 = 3.0; Q3 = 4.0) in OPCAB; (U = 1625.5; Z = -3.55; p < 0.001). Completeness of revascularization was similar in both groups (U = 2335.5; Z = -1.0; p = 0.316). Incidence of hospital mortality and complications were higher in cCABG in comparison with OPCAB. Incidence of inotropic support, ICU, hospital stay and blood transfusion was significantly bigger among patients who underwent cCABG. Conclusions. OPCAB technique can be used in myocardial revascularization in patients with left ventricular dysfunction. Morbidity and mortality was lower than that in the cCABG group.

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Конец XX и начало XXI века ознаменовались значительным ростом заболеваемости и смертности от болезней сердечно-сосудистой системы населения Российской Федерации. Повышаясь с 60-х годов, показатели смертности от сердечно-сосудистых заболеваний в России в настоящее время достигли уровней, значительно превосходящих уровни соответствующих показателей в экономически развитых странах. Так, показатель смертности от ишемической болезни сердца (ИБС) у мужчин в 3 раза выше, чем в США, в 4,4 раза выше, чем в Италии, и в 5,9 раза выше, чем во Франции. Сердечно-сосудистые заболевания остаются основной причиной высокой смертности населения России. На их долю приходится 53-55 % от общей смертности [3]. Структура смертности от болезней системы кровообращения за последние 30 лет в России почти не изменилась - около 90 % случаев смерти приходится на ИБС и мозговой инсульт, в развитии которых основная роль принадлежит атеросклерозу и артериальной гипертензии [3].
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About the authors

D Olegovich Bystrov

Arkhangelsk Regional Clinical Hospital

Email: dr.bystrov@gmail.com
Arkhangelsk, Russia

A N Shonbin

Arkhangelsk Regional Clinical Hospital

Arkhangelsk, Russia

A S Zavolojin

Arkhangelsk Regional Clinical Hospital

Arkhangelsk, Russia

M V Elizarov

Arkhangelsk Regional Clinical Hospital

Arkhangelsk, Russia

M A Yarkovoy

Arkhangelsk Regional Clinical Hospital

Arkhangelsk, Russia

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Copyright (c) 2012 Bystrov D.O., Shonbin A.N., Zavolojin A.S., Elizarov M.V., Yarkovoy M.A.

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