Pub Date : 2023-09-28DOI: 10.30702/ujcvs/23.31(03)/rg038-99104
Mykola L. Rudenko, Olha M. Unitska, Andrii G. Goriachev, Tetiana A. Andrushchenko, Nataliia M. Verych
The aim. To study and substantiate the new principles of organization in the provision of cardiac surgical care under martial law.
Materials and methods. The article presents an analytical review using reference databases of scientific medical publications and analysis of our own database of cardiac surgical care for the period from 2014 to July 2023. The group of patients consisted of 501 male subjects. The age of the study participants varied from 21 to 58 years (mean age 41.5 ± 2.2 years). The analysis of monitoring results included the most common diseases of the circulatory system, combat injuries of the heart and main vessels.
Results. The article pays attention to the current challenges that have arisen before organization of the system of providing cardiac surgical care under martial law. It is emphasized that the area of cardiac surgical assistance to military personnel is being developed at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine since 2014, when the Anti-Terrorist Operation / Joint Forces Operation began. In cooperation with military doctors, new methods of treatment of patients with gunshot and mine-explosive wounds are being developed and implemented. It was established that among patients with cardiovascular pathology, combat injuries of the heart and main vessels make up 7.9%, which coincides with the frequency of combat injuries of the chest given in literary sources. Moreover, the length of hospital stay of patients with combat injuries of the heart and main vessels does not exceed the number of bed days during surgical treatment of the most common diseases of the circulatory system. It was also established that some of the injured patients had concomitant pathologies that required, in addition to cardiac surgical care, medical care of other specialists: a surgeon, a neurosurgeon, an orthopedic traumatologist, an otolaryngologist, a psychologist, etc.
Conclusions. It has been established that organization of the system of providing cardiac surgical care under martial law is primarily designed to ensure: optimization of resources by strengthening the personnel reserve; cooperation with specialists of other specialties, medical institutions of various subordinates and international partners; changing patient routes taking into account, first of all, their safety; expanding narrow specialization of medical institutions by creating multidisciplinary teams.
{"title":"Issues of Organization of the Cardiac Surgical Care in Ukraine under Martial Law","authors":"Mykola L. Rudenko, Olha M. Unitska, Andrii G. Goriachev, Tetiana A. Andrushchenko, Nataliia M. Verych","doi":"10.30702/ujcvs/23.31(03)/rg038-99104","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(03)/rg038-99104","url":null,"abstract":"The aim. To study and substantiate the new principles of organization in the provision of cardiac surgical care under martial law.
 Materials and methods. The article presents an analytical review using reference databases of scientific medical publications and analysis of our own database of cardiac surgical care for the period from 2014 to July 2023. The group of patients consisted of 501 male subjects. The age of the study participants varied from 21 to 58 years (mean age 41.5 ± 2.2 years). The analysis of monitoring results included the most common diseases of the circulatory system, combat injuries of the heart and main vessels.
 Results. The article pays attention to the current challenges that have arisen before organization of the system of providing cardiac surgical care under martial law. It is emphasized that the area of cardiac surgical assistance to military personnel is being developed at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine since 2014, when the Anti-Terrorist Operation / Joint Forces Operation began. In cooperation with military doctors, new methods of treatment of patients with gunshot and mine-explosive wounds are being developed and implemented. It was established that among patients with cardiovascular pathology, combat injuries of the heart and main vessels make up 7.9%, which coincides with the frequency of combat injuries of the chest given in literary sources. Moreover, the length of hospital stay of patients with combat injuries of the heart and main vessels does not exceed the number of bed days during surgical treatment of the most common diseases of the circulatory system. It was also established that some of the injured patients had concomitant pathologies that required, in addition to cardiac surgical care, medical care of other specialists: a surgeon, a neurosurgeon, an orthopedic traumatologist, an otolaryngologist, a psychologist, etc.
 Conclusions. It has been established that organization of the system of providing cardiac surgical care under martial law is primarily designed to ensure: optimization of resources by strengthening the personnel reserve; cooperation with specialists of other specialties, medical institutions of various subordinates and international partners; changing patient routes taking into account, first of all, their safety; expanding narrow specialization of medical institutions by creating multidisciplinary teams.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135426333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28DOI: 10.30702/ujcvs/23.31(03)/vv032-105110
Oleksandr A. Vladymyrov, Tetiana V. Kurtian, Nataliia I. Vladymyrova, Nataliia M. Verych, Oksana S. Polyanska
Multisymptomatic coronary heart disease (CHD) remains a leading problem in cardiology. A person’s ability to perform physical work determines their quality of life, especially in patients with existing symptoms of damage to the cardiovascular system. The most advanced approach in the physical rehabilitation of patients with CHD is the use of ergometric testing indicators.
The aim. To study the influence of the developed method of cycling training on the indicators of cardiopulmonary exercise (CPX) in patients with CHD.
Materials and methods. We examined 65 men with CHD, I-II functional class stable angina pectoris, mean age 44.6 ± 1.39 years (from 32 to 60 years). The diagnosis was made on the basis of clinical findings, electrocardiography and laboratory examination according to the generally accepted criteria of the European Society of Cardiology.
Results. The treatment results were evaluated two weeks after the completion of the physical rehabilitation program. Qualitative assessment was performed by using the CPX test with the recording of cardiac bioelectric potentials from 12 leads. The criteria for discontinuation of the test were generally accepted provisions based on WHO recommendations.
While developing a physical rehabilitation program and predicting the timing of a functional recovery, several factors have to be taken into account that significantly affect the patient’s motor activity and determine the pace and outcome of the rehabilitation process as a whole. Long-term, regular physical activity in patients with CHD with limited coronary reserve have an impact on the mechanisms of cardiac function regulation, synchronization and optimization of the activity of the muscular, cardiovascular and respiratory systems. Systematic training sessions reduce the volume of drug therapy and can improve the patients’ quality of life.
Conclusions. The use of the proposed individualized uniform interval cycling training combined with the intake of citrulline malate leads to a significant improvement in the achieved load capacity, heart rate, duration of work, total volume of completed work, inotropic reserve index, optimization of coronary blood circulation and improvement of bioenergy metabolism in the myocardium.
{"title":"Features of Application of the Optimized Physical Rehabilitation Program in Patients with Coronary Heart Disease","authors":"Oleksandr A. Vladymyrov, Tetiana V. Kurtian, Nataliia I. Vladymyrova, Nataliia M. Verych, Oksana S. Polyanska","doi":"10.30702/ujcvs/23.31(03)/vv032-105110","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(03)/vv032-105110","url":null,"abstract":"Multisymptomatic coronary heart disease (CHD) remains a leading problem in cardiology. A person’s ability to perform physical work determines their quality of life, especially in patients with existing symptoms of damage to the cardiovascular system. The most advanced approach in the physical rehabilitation of patients with CHD is the use of ergometric testing indicators.
 The aim. To study the influence of the developed method of cycling training on the indicators of cardiopulmonary exercise (CPX) in patients with CHD.
 Materials and methods. We examined 65 men with CHD, I-II functional class stable angina pectoris, mean age 44.6 ± 1.39 years (from 32 to 60 years). The diagnosis was made on the basis of clinical findings, electrocardiography and laboratory examination according to the generally accepted criteria of the European Society of Cardiology.
 Results. The treatment results were evaluated two weeks after the completion of the physical rehabilitation program. Qualitative assessment was performed by using the CPX test with the recording of cardiac bioelectric potentials from 12 leads. The criteria for discontinuation of the test were generally accepted provisions based on WHO recommendations.
 While developing a physical rehabilitation program and predicting the timing of a functional recovery, several factors have to be taken into account that significantly affect the patient’s motor activity and determine the pace and outcome of the rehabilitation process as a whole. Long-term, regular physical activity in patients with CHD with limited coronary reserve have an impact on the mechanisms of cardiac function regulation, synchronization and optimization of the activity of the muscular, cardiovascular and respiratory systems. Systematic training sessions reduce the volume of drug therapy and can improve the patients’ quality of life.
 Conclusions. The use of the proposed individualized uniform interval cycling training combined with the intake of citrulline malate leads to a significant improvement in the achieved load capacity, heart rate, duration of work, total volume of completed work, inotropic reserve index, optimization of coronary blood circulation and improvement of bioenergy metabolism in the myocardium.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135426660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28DOI: 10.30702/ujcvs/23.31(03)/k042-4550
Hanna B. Koltunova
Background. Acute heart failure (AHF) in patients with infective endocarditis (IE) is an independent indication for urgent cardiac surgery according to international guidelines. Preoperative risk factors for AHF in patients with IE empower to build the route of a patient rationally according to clinical status.
The aim. To analyze clinically significant risk factors for AHF in patients with IE.
Materials and methods. A retrospective single-center study was conducted which included clinical data of 311 patients with IE who were treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine for the period from January 1, 2019 to October 22, 2021. The mean age of the patients was 47.9 ± 3.83 (19 to 77) years. The proportion of men in the study was 81.7% (254 patients). The mean duration of IE was 2.6 ± 0.1 (1 to 11) months. Global database for IE patients was divided into separate cohorts with different problems associated with this pathology. Diagnosis of IE was established according to the Duke criteria. The causative agent was identified and results of antibioticogram were evaluated. All the patients were divided into classes according to the New York Heart Association (NYHA) functional scale. Patients with signs of AHF were assigned to NYHA class IV. There were 2 groups of patients: 252 (81.1%) patients without signs of AHF before surgery, 59 (18.9%) patients with preoperative AHF. The risk factors for the occurrence of AHF were analyzed. Statistical significance was set at p < 0.05. The intensive care unit length of stay and hospital length of stay were evaluated.
Results. Risk factors for preoperative AHF in patients with IE: IE of the aortic valve (odds ratio (OR), 2.97 [1.57-6.91]) (p=0.003); concomitant inflammatory pathology of the lungs (OR 3.37 [1.55-7.11]) (р=0.003); linezolid resistance of the pathogen (OR 2.34 [1.07-4.26]) (р=0.026); vancomycin resistance of the pathogen (OR 2.25 [1.13-4.74]) (p=0.032); IE of the prosthetic heart valve (OR 1.155 [1.01-1.1]) (p=0.036); nosocomial nature of the disease (OR 2.14 [0.83-4.37]) (р=0.049). The intensive care unit length of stay was significantly longer in the group of patients with AHF (8.8 ± 0.7 days) than in the group of patients without AHF (4.8 ± 0.2 days) (р˂0.001). For 311 surgical interventions, the number of deaths was 7 (2.3%). The analysis of deaths according to the type of complications revealed that 4 (1.5%) patients died due to cardiac causes (263 cardiac complications). Among them, the largest share was made up of patients with AHF: 3 (1.4%).
Conclusions. In clinical work, it is important to identify preoperative factors that are associated with the tactics of treatment of patients with IE in order to improve the results of cardiac surgery.
{"title":"Risk Factors for Acute Heart Failure in Patients with Infective Endocarditis","authors":"Hanna B. Koltunova","doi":"10.30702/ujcvs/23.31(03)/k042-4550","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(03)/k042-4550","url":null,"abstract":"Background. Acute heart failure (AHF) in patients with infective endocarditis (IE) is an independent indication for urgent cardiac surgery according to international guidelines. Preoperative risk factors for AHF in patients with IE empower to build the route of a patient rationally according to clinical status.
 The aim. To analyze clinically significant risk factors for AHF in patients with IE.
 Materials and methods. A retrospective single-center study was conducted which included clinical data of 311 patients with IE who were treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine for the period from January 1, 2019 to October 22, 2021. The mean age of the patients was 47.9 ± 3.83 (19 to 77) years. The proportion of men in the study was 81.7% (254 patients). The mean duration of IE was 2.6 ± 0.1 (1 to 11) months. Global database for IE patients was divided into separate cohorts with different problems associated with this pathology. Diagnosis of IE was established according to the Duke criteria. The causative agent was identified and results of antibioticogram were evaluated. All the patients were divided into classes according to the New York Heart Association (NYHA) functional scale. Patients with signs of AHF were assigned to NYHA class IV. There were 2 groups of patients: 252 (81.1%) patients without signs of AHF before surgery, 59 (18.9%) patients with preoperative AHF. The risk factors for the occurrence of AHF were analyzed. Statistical significance was set at p < 0.05. The intensive care unit length of stay and hospital length of stay were evaluated.
 Results. Risk factors for preoperative AHF in patients with IE: IE of the aortic valve (odds ratio (OR), 2.97 [1.57-6.91]) (p=0.003); concomitant inflammatory pathology of the lungs (OR 3.37 [1.55-7.11]) (р=0.003); linezolid resistance of the pathogen (OR 2.34 [1.07-4.26]) (р=0.026); vancomycin resistance of the pathogen (OR 2.25 [1.13-4.74]) (p=0.032); IE of the prosthetic heart valve (OR 1.155 [1.01-1.1]) (p=0.036); nosocomial nature of the disease (OR 2.14 [0.83-4.37]) (р=0.049). The intensive care unit length of stay was significantly longer in the group of patients with AHF (8.8 ± 0.7 days) than in the group of patients without AHF (4.8 ± 0.2 days) (р˂0.001). For 311 surgical interventions, the number of deaths was 7 (2.3%). The analysis of deaths according to the type of complications revealed that 4 (1.5%) patients died due to cardiac causes (263 cardiac complications). Among them, the largest share was made up of patients with AHF: 3 (1.4%).
 Conclusions. In clinical work, it is important to identify preoperative factors that are associated with the tactics of treatment of patients with IE in order to improve the results of cardiac surgery.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":"163 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135427107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28DOI: 10.30702/ujcvs/23.31(03)/kn045-3644
Nataliia I. Kozachyshyn, Vasyl Z. Netiazhenko, Sergii V. Salo
The aim. To analyze changes in the activity of the platelet link of hemocoagulation in patients with chronic coronary syndrome before and after percutaneous coronary intervention (PCI) against the background of prior antiplatelet therapy.
Materials and methods. We examined 67 patients (mean age 65.2±8.6 years) who were undergoing inpatient treatment at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Patients with different regimens of antiplatelet therapy were compared before and after PCI. At the time of hospitalization, patients were receiving both monotherapy and dual antiplatelet therapy (those with a history of myocardial infarction up to 12 months) in standard doses. The control group consisted of 25 people of similar age (62.7±6.5 years). The activity of platelet hemostasis was evaluated by the turbidimetric method and the light transmission fluctuation method. Statistical processing was carried out using the MedStat v.5.2 and Statistica 8.0 software.
Results. Before PCI, dual antiplatelet therapy using aspirin and ticagrelor suppressed the activity of platelet hemostasis, compared to dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. Patients receiving monotherapy did not achieve the desired effect. After PCI, the group of patients who took the combination of aspirin and ticagrelor responded better to the therapy than those who received aspirin and clopidogrel.
Conclusions. The use of dual antiplatelet therapy with acetylsalicylic acid and ticagrelor reduced both spontaneous and induced aggregation.
{"title":"Hemostasiological Aspects of PCI: Periprocedural Changes in the Activity of the Platelet Link of Hemocoagulation on the Background of Prior Double Antiplatelet Therapy in Patients with Chronic Coronary Syndrome","authors":"Nataliia I. Kozachyshyn, Vasyl Z. Netiazhenko, Sergii V. Salo","doi":"10.30702/ujcvs/23.31(03)/kn045-3644","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(03)/kn045-3644","url":null,"abstract":"The aim. To analyze changes in the activity of the platelet link of hemocoagulation in patients with chronic coronary syndrome before and after percutaneous coronary intervention (PCI) against the background of prior antiplatelet therapy.
 Materials and methods. We examined 67 patients (mean age 65.2±8.6 years) who were undergoing inpatient treatment at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Patients with different regimens of antiplatelet therapy were compared before and after PCI. At the time of hospitalization, patients were receiving both monotherapy and dual antiplatelet therapy (those with a history of myocardial infarction up to 12 months) in standard doses. The control group consisted of 25 people of similar age (62.7±6.5 years). The activity of platelet hemostasis was evaluated by the turbidimetric method and the light transmission fluctuation method. Statistical processing was carried out using the MedStat v.5.2 and Statistica 8.0 software.
 Results. Before PCI, dual antiplatelet therapy using aspirin and ticagrelor suppressed the activity of platelet hemostasis, compared to dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. Patients receiving monotherapy did not achieve the desired effect. After PCI, the group of patients who took the combination of aspirin and ticagrelor responded better to the therapy than those who received aspirin and clopidogrel.
 Conclusions. The use of dual antiplatelet therapy with acetylsalicylic acid and ticagrelor reduced both spontaneous and induced aggregation.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":"98 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135426335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28DOI: 10.30702/ujcvs/23.31(03)/vd041-111126
Larysa A. Vozniuk, Olga V. Dzekan, Sergii O. Siromakha
Non-vitamin K antagonist oral anticoagulants (novel oral anticoagulants, NOACs) are important pharmaceuticals for prevention of stroke and systemic embolism in non-valvular atrial fibrillation patients. Vitamin K antagonist warfarin usage is limited due to its pharmacokinetic and pharmacodynamic parameters. In modern conditions, NOACs are widely used. This literature review includes the most interesting clinical studies where anticoagulants were used. Main pharmacological properties of non-vitamin K antagonist oral anticoagulants have been investigated in these clinical studies.
The aim. To answer the question about which anticoagulant is preferable for use in particular clinical situation.
Results. In order to prevent venous thrombosis, conservative and surgical treatment is used. It is the use of anticoagulants during conservative therapy that allows to extend the life expectancy of patients at high risk of thrombosis. Unlike warfarin, the use of NOACs helps to avoid high risk of bleeding. Drugs of this group have short half-life, standard dosage, and predicted pharmacological effect.
Conclusions. New data about comparative efficacy and safety of treatment with NOACs (dabigatran, rivaroxaban, edoxaban, apixaban) in order to prevent thromboembolism in patients with atrial fibrillation are presented. The peculiarities of anticoagulant therapy in elderly patients, patients with coronary artery disease, atrial fibrillation, chronic kidney disease, patients in pre- and postoperative periods are discussed. Prolonged study of drugs of this group will enable doctors to use them without endangering the patients’ lives. NOACs, despite obtained data about their effectiveness and safety, in our opinion, deserve attention and require further study.
{"title":"Non-Vitamin K Antagonist Oral Anticoagulants in Differentiated Approach to the Use in Cardiological Practice: Literature Review","authors":"Larysa A. Vozniuk, Olga V. Dzekan, Sergii O. Siromakha","doi":"10.30702/ujcvs/23.31(03)/vd041-111126","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(03)/vd041-111126","url":null,"abstract":"Non-vitamin K antagonist oral anticoagulants (novel oral anticoagulants, NOACs) are important pharmaceuticals for prevention of stroke and systemic embolism in non-valvular atrial fibrillation patients. Vitamin K antagonist warfarin usage is limited due to its pharmacokinetic and pharmacodynamic parameters. In modern conditions, NOACs are widely used. This literature review includes the most interesting clinical studies where anticoagulants were used. Main pharmacological properties of non-vitamin K antagonist oral anticoagulants have been investigated in these clinical studies.
 The aim. To answer the question about which anticoagulant is preferable for use in particular clinical situation.
 Results. In order to prevent venous thrombosis, conservative and surgical treatment is used. It is the use of anticoagulants during conservative therapy that allows to extend the life expectancy of patients at high risk of thrombosis. Unlike warfarin, the use of NOACs helps to avoid high risk of bleeding. Drugs of this group have short half-life, standard dosage, and predicted pharmacological effect.
 Conclusions. New data about comparative efficacy and safety of treatment with NOACs (dabigatran, rivaroxaban, edoxaban, apixaban) in order to prevent thromboembolism in patients with atrial fibrillation are presented. The peculiarities of anticoagulant therapy in elderly patients, patients with coronary artery disease, atrial fibrillation, chronic kidney disease, patients in pre- and postoperative periods are discussed. Prolonged study of drugs of this group will enable doctors to use them without endangering the patients’ lives. NOACs, despite obtained data about their effectiveness and safety, in our opinion, deserve attention and require further study.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135426477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28DOI: 10.30702/ujcvs/23.31(03)/pbb043-5157
Volodymyr V. Popov, Oleksandr O. Bolshak, Valery Zh. Boukarim, Olena V. Khoroshkovata, Olena M. Trembovetska
Introduction. Coronavirus disease (COVID-19)-associated pneumonia was a dangerous disease at the beginning of 2021. However, there are almost no records of early infectious endocarditis of prosthetic heart valve in the presence of such a disease. We present an interesting clinical case of successful treatment of complicated pathology.
The COVID-19 outbreak involved unique clinical complications that were superimposed on the progressive heart failure due to prosthetic mitral valve dysfunction (its detachment) which did not allow time for active antiinflammatory therapy. Urgent replacement of the prosthesis made it possible to eliminate the infection and paved the way for successful long-term antibacterial, antifungal and antiviral therapy.
The aim. To determine the features of management of patients with complex clinical pathology: prosthetic valve endocarditis associated with COVID-19 and severe lung inflammation in the early postoperative period.
Case report. This work presents rare clinical case. A 46-year old male patient underwent successful surgery (mitral valve replacement with posterior leaflet preservation and left atrium resection) at the Department of Surgical Treatment of Acquired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery and was discharged in satisfactory condition. One month later, he was hospitalized again and diagnosed with an early infectious endocarditis of prosthetic mitral valve and bilateral polysegmental COVID-19-associated pneumonia. After a week of medicinal preparation (antibacterial therapy), the patient underwent repeat mitral valve replacement in the presence of progressive heart insufficiency due to increasing paravalvular insufficiency. Postoperative period elapsed without significant complications. The patient was discharged in satisfactory condition on day 15 after surgery and primary rehabilitation.
Conclusion. Having a specific etiology, pneumonia significantly damaged mitral prosthesis structures by increasing paravalvular insufficiency. Consequently, the patient underwent life-saving repeat mitral valve replacement in the presence of COVID-19-associated pneumonia and under massive antibacterial treatment which continued for 60 days after the patient’s discharge. An important element of successful treatment of COVID-19-associated pneumonia is the selection of adequate antibacterial, antifungal and antiviral drugs.
{"title":"An Early Prosthetic Valve Endocarditis in Presence of COVID-19-Associated Pneumonia","authors":"Volodymyr V. Popov, Oleksandr O. Bolshak, Valery Zh. Boukarim, Olena V. Khoroshkovata, Olena M. Trembovetska","doi":"10.30702/ujcvs/23.31(03)/pbb043-5157","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(03)/pbb043-5157","url":null,"abstract":"Introduction. Coronavirus disease (COVID-19)-associated pneumonia was a dangerous disease at the beginning of 2021. However, there are almost no records of early infectious endocarditis of prosthetic heart valve in the presence of such a disease. We present an interesting clinical case of successful treatment of complicated pathology.
 The COVID-19 outbreak involved unique clinical complications that were superimposed on the progressive heart failure due to prosthetic mitral valve dysfunction (its detachment) which did not allow time for active antiinflammatory therapy. Urgent replacement of the prosthesis made it possible to eliminate the infection and paved the way for successful long-term antibacterial, antifungal and antiviral therapy.
 The aim. To determine the features of management of patients with complex clinical pathology: prosthetic valve endocarditis associated with COVID-19 and severe lung inflammation in the early postoperative period.
 Case report. This work presents rare clinical case. A 46-year old male patient underwent successful surgery (mitral valve replacement with posterior leaflet preservation and left atrium resection) at the Department of Surgical Treatment of Acquired Heart Diseases of the National Amosov Institute of Cardiovascular Surgery and was discharged in satisfactory condition. One month later, he was hospitalized again and diagnosed with an early infectious endocarditis of prosthetic mitral valve and bilateral polysegmental COVID-19-associated pneumonia. After a week of medicinal preparation (antibacterial therapy), the patient underwent repeat mitral valve replacement in the presence of progressive heart insufficiency due to increasing paravalvular insufficiency. Postoperative period elapsed without significant complications. The patient was discharged in satisfactory condition on day 15 after surgery and primary rehabilitation.
 Conclusion. Having a specific etiology, pneumonia significantly damaged mitral prosthesis structures by increasing paravalvular insufficiency. Consequently, the patient underwent life-saving repeat mitral valve replacement in the presence of COVID-19-associated pneumonia and under massive antibacterial treatment which continued for 60 days after the patient’s discharge. An important element of successful treatment of COVID-19-associated pneumonia is the selection of adequate antibacterial, antifungal and antiviral drugs.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135426654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28DOI: 10.30702/ujcvs/23.31(03)/zk036-6470
Ihor I. Zhekov, Vitalii I. Kravchenko, Oleh I. Sarhosh, Iryna A. Osadovska, Anatoliy V. Rudenko
Introduction. The cohort of patients with aortic dissection and coronary heart disease is very complex, and their surgical treatment remains a relevant and debatable topic to this day. The presence of Marfan syndrome (MS) makes this difficult group of patients even more challenging. In this work, we present our own seven-year experience with the analysis of the impact of MS on the results of surgical treatment of patients with dissecting aortic aneurysm and coronary heart disease.
Materials and methods. Nineteen consecutive cases of dissection of the aorta combined with lesions of the coronary arteries were analyzed. All the patients were operated at the premises of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 2013 to 2022. Among them, 15 operations (78.9%) were performed for type A acute dissection of the aorta, 4 (21.1%) for type A chronic dissection of the aorta. Of the 19 operated patients, 5 (26.3%) had a diagnosed MS, 14 (73.7%) were the control group of patients with aortic dissection correction and aortocoronary bypass without MS.
Results. A comparative analysis of two groups of patients showed more profound structural changes of the aortic wall especially with MS, which may affect the technical features of surgical intervention in this cohort of patients. Analysis of the mean time of perfusion, aortic clamping and intraoperative blood loss showed that the above indicators were not significantly different in both groups (p > 0.05). Indicators such as length of stay in the intensive care unit, length of stay on a ventilator, and the postoperative level of creatine phosphokinase-MB also were not significantly different in the observed groups.
Discussion. In our study, we evaluated the effect of the presence of MS on the results of surgical correction of aortic dissection and coronary artery bypass grafting. According to the results of our study, it can be stated that MS does not significantly affect the results of surgical treatment, provided that careful approach to planning the operation is employed, and all available intraoperative methods that reduce the risk of postoperative complications are used.
Conclusions. MS significantly accelerates the formation of aortic aneurysm, and also makes it more dangerous in the occurrence of acute dissection. In the group of patients with MS, damage to coronary arteries in most cases was associated with their involvement in the process of dissection, and only in some cases with atherosclerotic lesions. The use of all methods of bleeding prevention, as well as myocardial protection, allows to perform surgery in patients with MS with minimal risk.
{"title":"Surgical Correction of Dissecting Aortic Aneurysms Combined with Coronary Bypass Surgery in Marfan Syndrome","authors":"Ihor I. Zhekov, Vitalii I. Kravchenko, Oleh I. Sarhosh, Iryna A. Osadovska, Anatoliy V. Rudenko","doi":"10.30702/ujcvs/23.31(03)/zk036-6470","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(03)/zk036-6470","url":null,"abstract":"Introduction. The cohort of patients with aortic dissection and coronary heart disease is very complex, and their surgical treatment remains a relevant and debatable topic to this day. The presence of Marfan syndrome (MS) makes this difficult group of patients even more challenging. In this work, we present our own seven-year experience with the analysis of the impact of MS on the results of surgical treatment of patients with dissecting aortic aneurysm and coronary heart disease.
 Materials and methods. Nineteen consecutive cases of dissection of the aorta combined with lesions of the coronary arteries were analyzed. All the patients were operated at the premises of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 2013 to 2022. Among them, 15 operations (78.9%) were performed for type A acute dissection of the aorta, 4 (21.1%) for type A chronic dissection of the aorta. Of the 19 operated patients, 5 (26.3%) had a diagnosed MS, 14 (73.7%) were the control group of patients with aortic dissection correction and aortocoronary bypass without MS.
 Results. A comparative analysis of two groups of patients showed more profound structural changes of the aortic wall especially with MS, which may affect the technical features of surgical intervention in this cohort of patients. Analysis of the mean time of perfusion, aortic clamping and intraoperative blood loss showed that the above indicators were not significantly different in both groups (p > 0.05). Indicators such as length of stay in the intensive care unit, length of stay on a ventilator, and the postoperative level of creatine phosphokinase-MB also were not significantly different in the observed groups.
 Discussion. In our study, we evaluated the effect of the presence of MS on the results of surgical correction of aortic dissection and coronary artery bypass grafting. According to the results of our study, it can be stated that MS does not significantly affect the results of surgical treatment, provided that careful approach to planning the operation is employed, and all available intraoperative methods that reduce the risk of postoperative complications are used.
 Conclusions. MS significantly accelerates the formation of aortic aneurysm, and also makes it more dangerous in the occurrence of acute dissection. In the group of patients with MS, damage to coronary arteries in most cases was associated with their involvement in the process of dissection, and only in some cases with atherosclerotic lesions. The use of all methods of bleeding prevention, as well as myocardial protection, allows to perform surgery in patients with MS with minimal risk.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135427110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28DOI: 10.30702/ujcvs/23.31(03)/sc034-127133
Dmytro V. Shchehlov, Oleh Ye. Svyrydiuk, Mykola B. Vyval, Svitlana V. Chebanyuk, Igor V. Altman, Maryna Yu. Mamonova
Treatment options for cerebral arteriovenous malformations (cAVMs) may include radiosurgery, endovascular embolization, microsurgical removal, or a combination thereof. However, treatment of high-grade (Spetzler–Martin grades IV and V) cAVMs remains extremely challenging when aiming complete occlusion.
The aim. To study the safety of the endovascular embolization in patients with high-grade cAVMs and its impact on the quality of life (QoL).
Materials and methods. Between 2012 and 2022, 174 patients with cAVMs were endovascularly treated at Research and Practical Center for Endovascular Neuroradiology of the National Academy of Medical Sciences of Ukraine with an average follow-up of more than 9 months. Of these patients, 11 (6.3%) and 6 (3.4%) had Spetzler–Martin grade IV and grade V cAVM, respectively. Outcomes after surgical procedures were assessed and QoL was evaluated using standardized EQ-5D-3L questionnaire.
Results. Five (29.4%) patients had intracerebral hemorrhage, 6 (35.3%) had seizures, 5 (29.4%) had other non-hemorrhagic manifestations and 1 (5.9%) patient had a neurological deficit as a result of cerebral steal. In 17 patients, 28 embolization sessions were performed, and in nearly all of them (96%) N-butyl cyanoacrylate was used as the preferred embolic agent. There were no procedural complications. After embolization, three (17.6%) patients had neurologic deterioration (temporary in 2 patients and persistent in 1 patient).
All the patients were alive at the nearest follow-up. After embolization, 2 (11.7%) patients had recurrent hemorrhage, but without additional morbidity. Two of the five patients after cAVM rupture had some degree of disability. With regard to non-hemorrhagic debut, 8 (72%) patients reported symptom reduction. QoL assessment with EQ-5D-3L questionnaire revealed that severe problems were present in 2 (33.3%) of 6 patients after intracerebral hemorrhage and 2 (18.2%) of 11 patients with non-hemorrhagic manifestation. The mean Visual Analogue Scale score for the hemorrhagic group was 76.4 ± 15 points, while the non-hemorrhagic group’s score was 85.2 ± 14 points.
Conclusions. Endovascular embolization, which aims to occlude the bleeding site or improve cerebral steal with a manageable consequence profile, can be used safely in carefully selected patients with high-grade cAVMs. Our experience shows that QoL can be satisfactory in 3/4 of patients after high-grade cAVM embolization, and more data from real-world practice are highly needed to determine the best method and time for improving patient outcomes.
{"title":"Results of the Treatment and Evaluation of Quality of Life in Patients with High-Grade Cerebral Arteriovenous Malformations after Endovascular Embolization","authors":"Dmytro V. Shchehlov, Oleh Ye. Svyrydiuk, Mykola B. Vyval, Svitlana V. Chebanyuk, Igor V. Altman, Maryna Yu. Mamonova","doi":"10.30702/ujcvs/23.31(03)/sc034-127133","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(03)/sc034-127133","url":null,"abstract":"Treatment options for cerebral arteriovenous malformations (cAVMs) may include radiosurgery, endovascular embolization, microsurgical removal, or a combination thereof. However, treatment of high-grade (Spetzler–Martin grades IV and V) cAVMs remains extremely challenging when aiming complete occlusion.
 The aim. To study the safety of the endovascular embolization in patients with high-grade cAVMs and its impact on the quality of life (QoL).
 Materials and methods. Between 2012 and 2022, 174 patients with cAVMs were endovascularly treated at Research and Practical Center for Endovascular Neuroradiology of the National Academy of Medical Sciences of Ukraine with an average follow-up of more than 9 months. Of these patients, 11 (6.3%) and 6 (3.4%) had Spetzler–Martin grade IV and grade V cAVM, respectively. Outcomes after surgical procedures were assessed and QoL was evaluated using standardized EQ-5D-3L questionnaire.
 Results. Five (29.4%) patients had intracerebral hemorrhage, 6 (35.3%) had seizures, 5 (29.4%) had other non-hemorrhagic manifestations and 1 (5.9%) patient had a neurological deficit as a result of cerebral steal. In 17 patients, 28 embolization sessions were performed, and in nearly all of them (96%) N-butyl cyanoacrylate was used as the preferred embolic agent. There were no procedural complications. After embolization, three (17.6%) patients had neurologic deterioration (temporary in 2 patients and persistent in 1 patient).
 All the patients were alive at the nearest follow-up. After embolization, 2 (11.7%) patients had recurrent hemorrhage, but without additional morbidity. Two of the five patients after cAVM rupture had some degree of disability. With regard to non-hemorrhagic debut, 8 (72%) patients reported symptom reduction. QoL assessment with EQ-5D-3L questionnaire revealed that severe problems were present in 2 (33.3%) of 6 patients after intracerebral hemorrhage and 2 (18.2%) of 11 patients with non-hemorrhagic manifestation. The mean Visual Analogue Scale score for the hemorrhagic group was 76.4 ± 15 points, while the non-hemorrhagic group’s score was 85.2 ± 14 points.
 Conclusions. Endovascular embolization, which aims to occlude the bleeding site or improve cerebral steal with a manageable consequence profile, can be used safely in carefully selected patients with high-grade cAVMs. Our experience shows that QoL can be satisfactory in 3/4 of patients after high-grade cAVM embolization, and more data from real-world practice are highly needed to determine the best method and time for improving patient outcomes.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135427112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28DOI: 10.30702/ujcvs/23.31(03)/md025-8386
Maryna S. Meshkova, Oleksandr V. Doronin
Introduction. The use of high-power radiofrequency current is considered to be a promising alternative to the currently used technique of catheter ablation of atrial fibrillation (AF) with radiofrequency current of normal power. To date, there are no studies on the application of this technique using catheters without external irrigation.
The aim. To study direct results of application of high-power radiofrequency current in AF catheter ablation using non-irrigated catheters.
Materials and methods. We analyzed 30 consecutive patients who underwent primary catheter ablation (12 women and 18 men, mean age of the patients was 57.6 ± 11.7 years). Concomitant pathology (coronary heart disease, hypertension, diabetes mellitus) was observed in 19 (63.3%) patients.
Wide isolation of pulmonary veins was performed, and in nonparoxysmal forms, applications were added in the places where fragmented activity was registered or in the line of applications between ipsilateral pulmonary veins and inferior left pulmonary vein and mitral valve annulus. The applications were made with a 4 mm electrode without irrigation function with wiping it after every 30 applications. Application parameters were 40-45 Watt power, application time 10 seconds, target temperature 55°C.
Results. The mean left atrial catheter dwelling time was 1.6 ± 0.3 hours. The mean time of X-ray exposure was 8.2 ± 2.3 minutes. The average number of applications was 127.8 ± 23.6. It was not possible to isolate 3 pulmonary veins in three patients: one superior left pulmonary vein and two inferior right pulmonary veins (2.5% of all pulmonary veins).
No complications related to the procedure were observed. The occurrence of AF in the early postoperative period was observed in 4 (13.3%) patients.
Conclusions. The immediate results of applying the radiofrequency current of 40-45 W with the application duration of 10 seconds and the target temperature of 55°C during AF catheter ablation using non-irrigated catheters indicate the safety of this technique. It is necessary to study a larger contingent of patients and long-term results.
{"title":"Catheter Ablation of Atrial Fibrillation with Short Duration Radiofrequency Current using Non-Irrigated Catheters","authors":"Maryna S. Meshkova, Oleksandr V. Doronin","doi":"10.30702/ujcvs/23.31(03)/md025-8386","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(03)/md025-8386","url":null,"abstract":"Introduction. The use of high-power radiofrequency current is considered to be a promising alternative to the currently used technique of catheter ablation of atrial fibrillation (AF) with radiofrequency current of normal power. To date, there are no studies on the application of this technique using catheters without external irrigation.
 The aim. To study direct results of application of high-power radiofrequency current in AF catheter ablation using non-irrigated catheters.
 Materials and methods. We analyzed 30 consecutive patients who underwent primary catheter ablation (12 women and 18 men, mean age of the patients was 57.6 ± 11.7 years). Concomitant pathology (coronary heart disease, hypertension, diabetes mellitus) was observed in 19 (63.3%) patients.
 Wide isolation of pulmonary veins was performed, and in nonparoxysmal forms, applications were added in the places where fragmented activity was registered or in the line of applications between ipsilateral pulmonary veins and inferior left pulmonary vein and mitral valve annulus. The applications were made with a 4 mm electrode without irrigation function with wiping it after every 30 applications. Application parameters were 40-45 Watt power, application time 10 seconds, target temperature 55°C.
 Results. The mean left atrial catheter dwelling time was 1.6 ± 0.3 hours. The mean time of X-ray exposure was 8.2 ± 2.3 minutes. The average number of applications was 127.8 ± 23.6. It was not possible to isolate 3 pulmonary veins in three patients: one superior left pulmonary vein and two inferior right pulmonary veins (2.5% of all pulmonary veins).
 No complications related to the procedure were observed. The occurrence of AF in the early postoperative period was observed in 4 (13.3%) patients.
 Conclusions. The immediate results of applying the radiofrequency current of 40-45 W with the application duration of 10 seconds and the target temperature of 55°C during AF catheter ablation using non-irrigated catheters indicate the safety of this technique. It is necessary to study a larger contingent of patients and long-term results.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135427154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-26DOI: 10.30702/ujcvs/23.31(02)/pd021-5867
Y. Plechysta, Serghii O. Dubrov
Over the past decades, many approaches have been changed in intensive care and in anesthesiology. Most of these changes were included in the guidelines now well known as fast-track protocols (protocols for enhanced recovery after surgery). Cardiac anesthesiology was not an exception. Preoperative, intraoperative and postoperative management of the patient are the main components of these protocols, which are aimed at reducing the length of stay (LOS) of patients in the hospital and intensive care units (ICU). The aim. To detect the relationship between the sedation strategy and the duration of the hospital LOS and the ICU LOS. Materials and methods. This was a randomized, controlled, parallel study. We analyzed 194 patients over 18 years of age who underwent cardiac surgical treatment using artificial blood circulation. Statistical data processing was carried out on the basis of GraphPad Prism 9.0 software. Results. According to our research, the average hospital LOS was 7.779 ± 2.844 days in the propofol group (n = 95), 7.188 ± 1.601 days in the dexmedetomidine group (n = 16). In the group where patients were sedated with a combination of drugs (n = 83), the average length of hospitalization was 5.904 ± 1.535 days. The average ICU LOS was 2.463 ± 1.090 days in the propofol group and 2.375 ± 1.360 days in the dexmedetomidine group. In the group where patients were sedated with a combination of drugs (n = 83), the average ICU LOS was 2.361 ± 0.8776 days. The hospital LOS of patients who were sedated with a combination of drugs was lower (p < 0.0001). When comparing the ICU LOS, no difference was found in all three sedation groups (p = 0.3903). According to the analysis conducted in the propofol group, the ICU LOS was shorter in patients who did not receive vasoactive therapy (p = 0.0299). In the dexmedetomidine sedation group, no difference was found between the ICU LOS in patients with or without vasoactive support (p = 0.5289). In the group of patients who underwent sedation with a combination of drugs, the ICU LOS was shorter in the group of patients who underwent correction with vasoactive drugs (p < 0.0001). Conclusion. Sedation with a drug combination (dexmedetomidine and propofol) may reduce hospital LOS (p < 0.0001). There was no influence of any sedation strategy on the ICU LOS (p = 0.3903). Early initiation of vasoactive support with sedative drug combination (dexmedetomidine and propofol) shortens the ICU LOS (p < 0.0001).
{"title":"Effect of Sedation Strategy on the Hospital Length of Stay and ICU Length of Stay after On-Pump Cardiac Surgeries","authors":"Y. Plechysta, Serghii O. Dubrov","doi":"10.30702/ujcvs/23.31(02)/pd021-5867","DOIUrl":"https://doi.org/10.30702/ujcvs/23.31(02)/pd021-5867","url":null,"abstract":"Over the past decades, many approaches have been changed in intensive care and in anesthesiology. Most of these changes were included in the guidelines now well known as fast-track protocols (protocols for enhanced recovery after surgery). Cardiac anesthesiology was not an exception. Preoperative, intraoperative and postoperative management of the patient are the main components of these protocols, which are aimed at reducing the length of stay (LOS) of patients in the hospital and intensive care units (ICU). \u0000The aim. To detect the relationship between the sedation strategy and the duration of the hospital LOS and the ICU LOS. \u0000Materials and methods. This was a randomized, controlled, parallel study. We analyzed 194 patients over 18 years of age who underwent cardiac surgical treatment using artificial blood circulation. Statistical data processing was carried out on the basis of GraphPad Prism 9.0 software. \u0000Results. According to our research, the average hospital LOS was 7.779 ± 2.844 days in the propofol group (n = 95), 7.188 ± 1.601 days in the dexmedetomidine group (n = 16). In the group where patients were sedated with a combination of drugs (n = 83), the average length of hospitalization was 5.904 ± 1.535 days. The average ICU LOS was 2.463 ± 1.090 days in the propofol group and 2.375 ± 1.360 days in the dexmedetomidine group. In the group where patients were sedated with a combination of drugs (n = 83), the average ICU LOS was 2.361 ± 0.8776 days. The hospital LOS of patients who were sedated with a combination of drugs was lower (p < 0.0001). When comparing the ICU LOS, no difference was found in all three sedation groups (p = 0.3903). \u0000According to the analysis conducted in the propofol group, the ICU LOS was shorter in patients who did not receive vasoactive therapy (p = 0.0299). In the dexmedetomidine sedation group, no difference was found between the ICU LOS in patients with or without vasoactive support (p = 0.5289). In the group of patients who underwent sedation with a combination of drugs, the ICU LOS was shorter in the group of patients who underwent correction with vasoactive drugs (p < 0.0001). \u0000Conclusion. Sedation with a drug combination (dexmedetomidine and propofol) may reduce hospital LOS (p < 0.0001). There was no influence of any sedation strategy on the ICU LOS (p = 0.3903). Early initiation of vasoactive support with sedative drug combination (dexmedetomidine and propofol) shortens the ICU LOS (p < 0.0001).","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48315218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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