Gogayeva O. Perioperative management of patients with comorbidity and high risk in cardiac surgery of coronary artery disease.

The dissertation research is devoted to the study of perioperative management of high-risk patients with comorbidity in cardiac surgery for coronary artery disease (CAD). This is the first scientific work in Ukraine, that contains a detailed analysis of cardiac surgeries, and course of the perioperative period in high-risk patients with CAD and comorbidity, as well as scientifically proved strategies and actions algorithms for patient’s management were developed. It was found that high-risk patients with CAD have a high Charlson comorbidity index that averaged 5.7 ± 1.7. The most effective prognostic scale in cardiac surgery of CAD was identified and it was found that the scales are necessary for preoperative risk stratification and understanding of the initial severity of the patient. The negative effect of artificial circulation was found on the course of the postoperative period while comparing the data of patients with complicated CAD and isolated CAD by the duration of mechanical ventilation - 12.2 h and 7.4 h (p = 0.0386), the occurrence of acute heart failure (p = 0.0002), acute kidney injury (p = 0.0249), the level of blood transfusions (p <0.0001). However, the influence of comorbidity was proved on the occurrence: atrial fibrillation (p = 0.1667), Stroke p = 0.2542), TIA (p = 0.5030), pneumonia (p = 0.9000) and deep sternal wound infection (р=0,3720). It was determined that postoperative AKI occurred more often in patients with type 2 DM (p = 0.0109), and among intraoperative proved the importance of performing on-pump operations (p = 0.0333), using cardioplegia (p = 0.0164 ), longer operation time (p = 0.0007) and higher blood loss (p = 0.0001).