Kondratenko S. Rationale for management of patients with acute calculous cholecystitis and concomitant ischemic heart disease

The thesis is devoted to the improvement of the results of treatment of patients with calculous cholecystitis (ACC) and concomitant ischemic heart disease (IHD) by justifying and developing algorithms for perioperative management of patients. The research was conducted in the Surgery Department No. 4 (Oleksandrivska Clinical Hospital of Kyiv) in the period from 2014 to 2018. The subject matter of the thesis is the development of perioperative management tactics for patients with АСС with concomitant IHD, which should be based on the principles of early laparoscopic cholecystectomy (ELCE) implementation, irrespective of the severity of coronary artery disease (due to the proved decrease in the efficiency of preoperative preparation lasting for more than 12 hours - deterioration of gas exchange, acid-base state, increase in the percentage of destructive forms of cholecystitis in case of concomitant coronary artery disease), application the developed algorithms of bridging therapy and cardiotropic therapy, as well as performing the operation with the use of combined inhal-transformational anesthesia administering inhaled anesthetic as sevoflyurane (sevorane) and the conduct of BIS monitoring. The improved pathogenetically grounded differentiated cardioprotective therapy applied at all stages of the perioperative period, along with the early surgical interventions and developed antithrombotic therapy, significantly reduced the incidence of cardiac events in patients with ACC and concomitant IHD, compared with conventional therapy, in particular myocardial ischemia during anesthesia is 4.9 % vs 21.5 %, and its duration is 8.8±1.3 min. against 14.9±1.1 minutes; decrease in systolic blood pressure less than 70 mm Hg. Art. -29.0 % against 6.1 %; reduction of saturation of 17.1 % against 46.7 %; paroxysm of atrial fibrillation 1.2 % vs. 8.4 %; myocardial infarction 0 % versus 5.6 %. It has also allowed to reduce the number of patients with complications in the postoperative period according to the Clavien-Dindo classification from 57.0 % to 18.3 %, p=0.001, and the frequency of conversion in patients with destructive ACC.