The dissertation study is devoted to the analysis of the effectiveness and safety of
the hybrid approach to the treatment of coronary heart disease and aortic valve defects.
The study included 130 patients who met the inclusion criteria and who, due to
aortic valve pathology and coronary heart disease, underwent surgical aortic valve
replacement along with myocardial revascularization. Depending on the method of
myocardial revascularization, all patients were divided into two groups: the first group (
n =51) – myocardial revascularization by stenting; the second group ( n =79) –
revascularization by coronary artery bypass grafting (CABG).
At the first stage, we conducted a comparative analysis of the indicators of the
perioperative period during aortic valve prosthetics depending on different methods of
myocardial revascularization. As our study showed, there was no significant difference
between the study groups in terms of age (p=0.189), male gender (p=0.675), body mass
index (BMI) (p=0.198), operative risk assessment by EuroSCORE II (p =0.242) . It
should be noted that arterial hypertension ( 90.2% vs. 93.7%, p=0.965), diabetes millitus
(31.3% vs. 27.8%, p=0.666) and atrial fibrillation (25, 5% against 20.3%, p=0.483).
Analysis of the results of coronary angiography showed that the frequency of lesions of
LAD (p=0.666), LCx (p=0.072) and RCA (p=0.716) did not differ between the study
groups, while lesions of LM were recorded significantly less often by 5.60 times (
p=0.018) in patients of the first group compared to patients of the second group. In
general, in patients of the first group, one-vessel lesion of CA was recorded significantly
13
more often in 2.06 times compared to patients of the second group (16 (31.4%) vs. 12
(15.2%), p=0.047).
Later, the analysis of intraoperative data showed that in patients of the first group,
the median number of used stents was 2 (1; 2.5) stents, and in most cases one (43.1%) or
two stents (31.4%), three and more stents were used in 25.5% of cases. As for the patients
of the second group, AVR was most often combined with the imposition of two (48.1%)
or one (35.4%) coronary-aortic anastomoses, less often three anastomoses (16.5%) (Fig.
3.3).
Given the absence of the need for aortocoronary anastomoses in patients of the first
group, the duration of cardiopulmonary bypass was recorded in 1.5 times significantly
lower compared to the second group (77.0 ± 18.0 min vs. 113.1 ± 31.6 min, p=0, 0001) .
Similar results were determined regarding the duration of aortic clamping. In particular,
in patients of the first group, this indicator was recorded 1.4 times significantly lower
compared to the second group (56.1 ± 13.5 min vs. 75.7 ± 20.6 min, p=0.0001).
At the second stage we conducted an analysis of the early postoperative period in
patients after aortic valve replacement and myocardial revascularization. Analysis of
biochemical indicators in the early postoperative period did not reveal significant
differences between the study groups for markers of kidney or liver damage. Thus, there
was no significant difference between the study groups regarding the levels of creatinine
and urea both on the 2nd postoperative day (p=0.720 and p=0.367, respectively) and at
the time of discharge (p=0.708 and p=0.187, respectively). A similar pattern was also
observed regarding the level of bilirubin and albumin. In particular, no significant
differences between these biochemical indicators were observed between the study
groups both on the 2nd postoperative day (p=0.207 and p=0.115, respectively) and at the
time of discharge (p=0.353 and p=0.187, respectively). At the same time, the patients of
the first group had significantly higher hemoglobin levels by 6.19% (p=0.017) on the 2nd
postoperative day and by 9.47% (p=0.001) at the time of discharge compared to the
second group.
As for the results of ECHO-CG in the early postoperative period, there were also
no significant changes between the study groups. In particular, there was no significant
14
difference between the study groups after the operation of LVEF (55.3 ± 8.03 vs. 54.4 ±
8.5, p=0.0574), LV EDV (125.9 ± 38.7 ml vs. 118, 1 ± 33.6 ml, p=0.574) , the maximum
pressure gradient on the aortic valve in the early postoperative period (17.6 ± 8.49 mm
Hg vs. 19.9 ± 8.87 mm Hg, p =0.135) and the mean pressure gradient on the aortic valve
(8.41 ± 5.05 mm Hg vs. 9.65 ± 5.52 mm Hg, p=0.196).
In order to analyze the effectiveness of the application of each of the methods of
myocardial revascularization in aortic valve prosthetics, we analyzed the frequency of the
main complications observed in this type of surgical intervention in the early
postoperative period. Thus, in the patients of the first group, in the early postoperative
period, a significantly lower level of blood loss was observed by 25.4% (p=0.028)
compared to the patients of the second group.
