Pub Date : 2022-06-24DOI: 10.30702/ujcvs/22.30(02)/kh026-3943
Y. Khrebtiy
The aim. Treatment of venous thromboembolism remains perhaps the most challenging problem of modern phlebology. The aim of our study was to analyze current data and guidelines on the use of surgical and minimally invasive approaches in the treatment of pulmonary embolism (PE) and to compare these with our own results. Materials and methods. The results of treatment of 168 patients with PE, who underwent inpatient treatment at the clinic from 2009 to 2021, were analyzed. Among them, 162 (96%) patients had deep vein thrombosis, in 6 patients the cause of PE could not be identified. Recurrent PE was observed in 2 patients. PE with a high risk of death was observed in 51 (30.3%) patients, with a medium and low risk of death in 117 patients (69.6%). Systemic thrombolysis was performed in 44 (26%) cases. In 5 (2.9%) cases, vena cava filters were implanted. One (0.6%) patient underwent aspiration thrombectomy of the pulmonary artery using an Aspirex catheter. Two (1.1%) patients underwent pulmonary artery thrombectomy using an artificial circulation device. Results. Significant improvement in patients treated with thrombolytic therapy was observed in 40 (92.8%) cases. After surgical treatment of PE, significant improvement was observed in 100% of cases, 2 patients after PE showed complete de-obstruction of the pulmonary artery. No hemorrhagic complications were observed during the study period. No fatalities were reported. No recurrent PE was observed during the study period. Conclusions. The choice of treatment for PE is determined by the degree of the impact on the pulmonary tract, the stability of the patient’s condition, indicators of dysfunction of the right heart, the period from the onset of the disease, the risk of death. The use of aspiration thrombectomy using an Aspirex catheter (Straub, USA) and pulmonary artery embolectomy in the absence of thrombolytic therapy allows to obtain satisfactory results in patients with PE.
{"title":"An Integrated Approach to the Treatment of Pulmonary Embolism: Current State of the Problem","authors":"Y. Khrebtiy","doi":"10.30702/ujcvs/22.30(02)/kh026-3943","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(02)/kh026-3943","url":null,"abstract":" \u0000The aim. Treatment of venous thromboembolism remains perhaps the most challenging problem of modern phlebology. The aim of our study was to analyze current data and guidelines on the use of surgical and minimally invasive approaches in the treatment of pulmonary embolism (PE) and to compare these with our own results. \u0000Materials and methods. The results of treatment of 168 patients with PE, who underwent inpatient treatment at the clinic from 2009 to 2021, were analyzed. Among them, 162 (96%) patients had deep vein thrombosis, in 6 patients the cause of PE could not be identified. Recurrent PE was observed in 2 patients. PE with a high risk of death was observed in 51 (30.3%) patients, with a medium and low risk of death in 117 patients (69.6%). \u0000Systemic thrombolysis was performed in 44 (26%) cases. In 5 (2.9%) cases, vena cava filters were implanted. One (0.6%) patient underwent aspiration thrombectomy of the pulmonary artery using an Aspirex catheter. Two (1.1%) patients underwent pulmonary artery thrombectomy using an artificial circulation device. \u0000Results. Significant improvement in patients treated with thrombolytic therapy was observed in 40 (92.8%) cases. After surgical treatment of PE, significant improvement was observed in 100% of cases, 2 patients after PE showed complete de-obstruction of the pulmonary artery. No hemorrhagic complications were observed during the study period. No fatalities were reported. No recurrent PE was observed during the study period. \u0000Conclusions. The choice of treatment for PE is determined by the degree of the impact on the pulmonary tract, the stability of the patient’s condition, indicators of dysfunction of the right heart, the period from the onset of the disease, the risk of death. \u0000The use of aspiration thrombectomy using an Aspirex catheter (Straub, USA) and pulmonary artery embolectomy in the absence of thrombolytic therapy allows to obtain satisfactory results in patients with PE.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48129709","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 : 2022-06-24DOI: 10.30702/jcvs/22.30(02)/gr027-1721
O. Gogayeva, A. Rudenko, Larysa A. Klymenko, V. Lazoryshynets
The aim. To analyze the features of the perioperative period in cardiac surgery patients with stable and unstable angina. Materials and methods. Retrospective analysis of random 194 cardiac surgery patients with coronary artery disease (CAD) and EuroSCORE II > 5%, who were operated and discharged from the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine from 2009 to 2019. All the patients underwent standard clinical, laboratory and functional tests, coronary angiography and coronary artery bypass grafting (CABG). Results. When assessing the initial clinical picture of randomized patients, 110 (56.7%) were diagnosed with stable angina, and 84 (43.2%) with unstable. On admission, acute myocardial infarction (AMI) was diagnosed in 12 (14.3%) patients (p < 0.0001), and among patients with stable angina 91 (82.7%) had a history of AMI (p = 0.0158). All the patients had polymorbidity: the Charlson comorbidity index was 5.7 ± 1.8 in patients with unstable angina and 5.9 ± 1.9 in stable CAD (p = 0.4583). Patients with unstable angina were more likely to have subocclusive-occlusive lesions of the left main coronary artery (p = 0.0083), left anterior descending artery (p = 0.0392) and left circumflex artery (p = 0.0387). All the patients were discussed by the cardiac team prior to surgery which was performed by experienced cardiac surgeons with 24 ± 12.5 years of experience. Emergency surgery was performed in 43 (51.1%) patients with unstable angina and 12 (10.9%) with stable angina (p <0.0001), off-pump CABG was performed in 82 (97.6%) and 105 (95.4%) patients, respectively (p = 0.4231). The postoperative period in patients with unstable angina was almost no different from that in patients with stable CAD. The patients with unstable angina were discharged on average on day 8.7 ± 4.04, and those with stable CAD were discharged on day 8.2 ± 3.2 (p = 0.3373). Conclusions. The outcome of the operation depends on the quality of the heart team work and requires a highly qualified cardiac surgeon with sufficient experience. Performing CABG on a working heart minimizes the occurrence of perioperative complications in patients with both unstable and stable CAD.
{"title":"Comparative Analysis of the Perioperative Period in High-Risk Cardiac Surgery Patients with Stable and Unstable Angina Pectoris","authors":"O. Gogayeva, A. Rudenko, Larysa A. Klymenko, V. Lazoryshynets","doi":"10.30702/jcvs/22.30(02)/gr027-1721","DOIUrl":"https://doi.org/10.30702/jcvs/22.30(02)/gr027-1721","url":null,"abstract":" \u0000The aim. To analyze the features of the perioperative period in cardiac surgery patients with stable and unstable angina. \u0000Materials and methods. Retrospective analysis of random 194 cardiac surgery patients with coronary artery disease (CAD) and EuroSCORE II > 5%, who were operated and discharged from the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine from 2009 to 2019. All the patients underwent standard clinical, laboratory and functional tests, coronary angiography and coronary artery bypass grafting (CABG). \u0000Results. When assessing the initial clinical picture of randomized patients, 110 (56.7%) were diagnosed with stable angina, and 84 (43.2%) with unstable. On admission, acute myocardial infarction (AMI) was diagnosed in 12 (14.3%) patients (p < 0.0001), and among patients with stable angina 91 (82.7%) had a history of AMI (p = 0.0158). All the patients had polymorbidity: the Charlson comorbidity index was 5.7 ± 1.8 in patients with unstable angina and 5.9 ± 1.9 in stable CAD (p = 0.4583). Patients with unstable angina were more likely to have subocclusive-occlusive lesions of the left main coronary artery (p = 0.0083), left anterior descending artery (p = 0.0392) and left circumflex artery (p = 0.0387). All the patients were discussed by the cardiac team prior to surgery which was performed by experienced cardiac surgeons with 24 ± 12.5 years of experience. Emergency surgery was performed in 43 (51.1%) patients with unstable angina and 12 (10.9%) with stable angina (p <0.0001), off-pump CABG was performed in 82 (97.6%) and 105 (95.4%) patients, respectively (p = 0.4231). The postoperative period in patients with unstable angina was almost no different from that in patients with stable CAD. The patients with unstable angina were discharged on average on day 8.7 ± 4.04, and those with stable CAD were discharged on day 8.2 ± 3.2 (p = 0.3373). \u0000Conclusions. The outcome of the operation depends on the quality of the heart team work and requires a highly qualified cardiac surgeon with sufficient experience. Performing CABG on a working heart minimizes the occurrence of perioperative complications in patients with both unstable and stable CAD.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46006028","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 : 2022-06-24DOI: 10.30702/ujcvs/22.30(02)/mg017-2226
A. Mazur, A. Gabriyelyan, P. V. Hurin, M. M. Babich, Vladyslav V. Antonenko, V. Shevelukha
Changes in hemodynamics and coagulation hemostasis during the use of protamine sulfate to neutralize heparin in a ratio of 0.5:1 in coronary artery bypass graft surgery have been studied. A comparative analysis of hemodynamic abnormalities, postoperative blood loss, and the need for blood transfusion in patients receiving protamine sulfate at the above dose has been carried out. The study included 70 patients who were successively operated on at the Shalimov National Institute of Surgery and Transplantation due to coronary heart disease, in whom coronary artery bypass grafting was performed on a working heart. The study group included 30 patients in whom heparin was neutralized with protamine in a ratio of 1:0.5. The comparison group included patients in whom heparin was neutralized with protamine in a ratio of 1:1. Statistical processing of the material was performed using the software StatPlus professional 2007. Both parametric and non-parametric methods of statistical analysis were used. The parametric method (Student’s t-test) was used to test the hypothesis of the equality of the mean values of two samples from different general sets. Pearson’s criterion was used to compare the two sets by qualitative features. Statistically significant differences in the obtained results were considered at p <0.05, which indicated a 95% probability of discrepancies. Changes in blood pressure, central venous pressure, electrocardiogram, cardiac output, cardiac index, coagulogram, complete blood count, biochemical blood test, electrolyte, acid-base and gas composition of blood during surgery and in the postoperative period were analyzed. The results showed that reduction in the dose of protamine to neutralize heparin is effective and safe in patients undergoing coronary artery bypass grafting. However, changes in hemodynamics and coagulogram in patients treated with 50% protamine dose were insignificant and did not increase perioperative blood loss and blood transfusion needs.
研究了在冠状动脉搭桥术中以0.5:1的比例使用硫酸鱼精蛋白中和肝素对血流动力学和凝血止血的影响。对接受上述剂量硫酸鱼精蛋白患者的血流动力学异常、术后失血和输血需求进行了比较分析。该研究包括70名因冠心病在沙利莫夫国家外科和移植研究所先后接受手术的患者，他们在工作心脏上进行了冠状动脉旁路移植术。研究组包括30例肝素与鱼精蛋白以1:0.5的比例中和的患者。对照组包括肝素与鱼精蛋白以1:1的比例中和的患者。使用StatPlus professional 2007软件对材料进行统计处理。采用参数和非参数两种统计分析方法。采用参数化方法(Student’s t检验)检验来自不同一般集的两个样本的均值相等的假设。使用Pearson标准比较两组的定性特征。所得结果有统计学意义的差异被认为p <0.05，表明差异的概率为95%。分析术中及术后血压、中心静脉压、心电图、心输出量、心指数、凝血图、全血细胞计数、血液生化试验、血液电解质、酸碱、气体组成的变化。结果表明，减少鱼精蛋白剂量中和肝素对冠状动脉搭桥术患者是有效和安全的。然而，50%鱼精蛋白治疗患者的血流动力学和凝血图变化不显著，也没有增加围手术期出血量和输血需求。
{"title":"The Choice of Protamine Sulfate Dosing Regimen for Coronary Artery Bypass Graft Surgery","authors":"A. Mazur, A. Gabriyelyan, P. V. Hurin, M. M. Babich, Vladyslav V. Antonenko, V. Shevelukha","doi":"10.30702/ujcvs/22.30(02)/mg017-2226","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(02)/mg017-2226","url":null,"abstract":"Changes in hemodynamics and coagulation hemostasis during the use of protamine sulfate to neutralize heparin in a ratio of 0.5:1 in coronary artery bypass graft surgery have been studied. A comparative analysis of hemodynamic abnormalities, postoperative blood loss, and the need for blood transfusion in patients receiving protamine sulfate at the above dose has been carried out. The study included 70 patients who were successively operated on at the Shalimov National Institute of Surgery and Transplantation due to coronary heart disease, in whom coronary artery bypass grafting was performed on a working heart. The study group included 30 patients in whom heparin was neutralized with protamine in a ratio of 1:0.5. The comparison group included patients in whom heparin was neutralized with protamine in a ratio of 1:1. Statistical processing of the material was performed using the software StatPlus professional 2007. Both parametric and non-parametric methods of statistical analysis were used. The parametric method (Student’s t-test) was used to test the hypothesis of the equality of the mean values of two samples from different general sets. Pearson’s criterion was used to compare the two sets by qualitative features. Statistically significant differences in the obtained results were considered at p <0.05, which indicated a 95% probability of discrepancies. Changes in blood pressure, central venous pressure, electrocardiogram, cardiac output, cardiac index, coagulogram, complete blood count, biochemical blood test, electrolyte, acid-base and gas composition of blood during surgery and in the postoperative period were analyzed. The results showed that reduction in the dose of protamine to neutralize heparin is effective and safe in patients undergoing coronary artery bypass grafting. However, changes in hemodynamics and coagulogram in patients treated with 50% protamine dose were insignificant and did not increase perioperative blood loss and blood transfusion needs.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41935251","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 : 2022-06-24DOI: 10.30702/ujcvs/22.30(02)/sg022-8387
S. V. Salo, A. Y. Gavrylyshyn, O. Levchyshyna, Vitalii V. Tokhtarov, A. Y. Hladun
Coronary artery bypass grafting (CABG) has long been considered the gold standard in the treatment of patients with lesions of the left main (LM) coronary artery. Elderly patients are one of the most difficult categories of patients with LM lesions due to severe coronary artery calcification. Thanks to constant progress in the field of engineering and technology, it has become possible to perform percutaneous coronary interventions (PCI) for patients with unprotected stenosis of the LM. Drug-eluting stents and the development of pharmacotherapy have improved the results of PCI in these lesions. Comparative studies of the efficacy and safety of PCI and CABG have shown similar results in terms of the need for revascularization. Patients with severe calcification of the coronary arteries mostly belong to the older age group and hold large part in this cohort. Technological advances enabled to treat patients with complex coronary anatomy and LM lesions not only through CABG, but also through PCI. Comparative studies show that the efficacy and safety of PCI and CABG have similar results in terms of the need in revascularization. The aim. To highlight the importance of discussion of each clinical case by the heart team and comprehensive approach with the use of modern equipment. Stage 1. A 80-year-old woman with type 2 diabetes mellitus was delivered by an ambulance team to the National Amosov Institute of Cardiovascular Surgery with severe pain; the patient was diagnosed with non-ST-elevation myocardial infarction (NSTEMI). Electrocardiography revealed ST-segment depression in leads V1-V5. After performing echocardiographic examination, valvular pathology and segmental contraction defects were not detected, EF 52%. Urgent coronary angiography revealed significant calcification of the ascending aorta (porcelain aorta) and coronary arteries. Coronary artery lesions: 90% unstable LM stenosis, significant calcified stenosis of the circumflex artery (CA), middle left anterior descending artery (mid-LAD), and chronic coronary occlusion of the right coronary artery, besides, 5 episodes of ventricular tachycardia were recorded. Despite the high SYNTAX Score I and SYNTAX Score II, due to the clinical picture and heart rhythm disorders, the heart team decided to perform emergency PCI. Bare-metal stent for LM – mid-LAD was implanted and angioplasty of mid-LAD was performed. Rough calcification of LM caused stent recoil; postdilatation of LM stent by high pressure balloon (p = 25 atm) was performed. The operation ended with a good angiographic result. The woman was discharged in a stable condition to plan further intervention in 1 month. Stage 2. A 81-year-old woman with complaints of severe chest pain was re-hospitalized with NSTEMI to the National Amosov Institute of Cardiovascular Surgery 3 months after the primary PCI. Echocardiography revealed EF 53%; valvular pathology and segmental contraction defects were not detected. Urgent coronary angiography reve
{"title":"Clinical Case of Unprotected Left Main Percutaneous Coronary Intervention in Elderly Patient With Porcelain Aorta","authors":"S. V. Salo, A. Y. Gavrylyshyn, O. Levchyshyna, Vitalii V. Tokhtarov, A. Y. Hladun","doi":"10.30702/ujcvs/22.30(02)/sg022-8387","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(02)/sg022-8387","url":null,"abstract":"Coronary artery bypass grafting (CABG) has long been considered the gold standard in the treatment of patients with lesions of the left main (LM) coronary artery. Elderly patients are one of the most difficult categories of patients with LM lesions due to severe coronary artery calcification. Thanks to constant progress in the field of engineering and technology, it has become possible to perform percutaneous coronary interventions (PCI) for patients with unprotected stenosis of the LM. Drug-eluting stents and the development of pharmacotherapy have improved the results of PCI in these lesions. Comparative studies of the efficacy and safety of PCI and CABG have shown similar results in terms of the need for revascularization. Patients with severe calcification of the coronary arteries mostly belong to the older age group and hold large part in this cohort. Technological advances enabled to treat patients with complex coronary anatomy and LM lesions not only through CABG, but also through PCI. Comparative studies show that the efficacy and safety of PCI and CABG have similar results in terms of the need in revascularization. \u0000The aim. To highlight the importance of discussion of each clinical case by the heart team and comprehensive approach with the use of modern equipment. \u0000Stage 1. A 80-year-old woman with type 2 diabetes mellitus was delivered by an ambulance team to the National Amosov Institute of Cardiovascular Surgery with severe pain; the patient was diagnosed with non-ST-elevation myocardial infarction (NSTEMI). Electrocardiography revealed ST-segment depression in leads V1-V5. After performing echocardiographic examination, valvular pathology and segmental contraction defects were not detected, EF 52%. \u0000Urgent coronary angiography revealed significant calcification of the ascending aorta (porcelain aorta) and coronary arteries. Coronary artery lesions: 90% unstable LM stenosis, significant calcified stenosis of the circumflex artery (CA), middle left anterior descending artery (mid-LAD), and chronic coronary occlusion of the right coronary artery, besides, 5 episodes of ventricular tachycardia were recorded. Despite the high SYNTAX Score I and SYNTAX Score II, due to the clinical picture and heart rhythm disorders, the heart team decided to perform emergency PCI. Bare-metal stent for LM – mid-LAD was implanted and angioplasty of mid-LAD was performed. Rough calcification of LM caused stent recoil; postdilatation of LM stent by high pressure balloon (p = 25 atm) was performed. The operation ended with a good angiographic result. The woman was discharged in a stable condition to plan further intervention in 1 month. \u0000Stage 2. A 81-year-old woman with complaints of severe chest pain was re-hospitalized with NSTEMI to the National Amosov Institute of Cardiovascular Surgery 3 months after the primary PCI. Echocardiography revealed EF 53%; valvular pathology and segmental contraction defects were not detected. Urgent coronary angiography reve","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41328941","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 : 2022-06-24DOI: 10.30702/ujcvs/22.30(02)/km020-5158
M. Kucheriava, Georgy B. Mankovsky, N. Rudenko
The aim. To evaluate clinical and prognostic effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on primary (progression of heart failure, rehospitalization) and secondary endpoints (death from cardiovascular disease and from all causes) in patients with heart failure with reduced ejection fraction (HFrEF) within 8 months after percutaneous coronary intervention (PCI). Materials and methods. In a one-center study on the basis of the Ukrainian Children’s Cardiac Center, Clinic for Adults we analyzed the data for drug and interventional treatment of 166 patients with coronary artery disease and reduced left ventricular ejection fraction (LVEF) (<40%), who underwent PCI in the last 8 months. Among the 166 patients studied, 86 (51.8%) patients received SGLT2 inhibitors as an adjunct to the standard baseline therapy, and 80 (48.2%) patients did not receive SGLT2 inhibitors after PCI. Results and discussion. The primary combined outcome was observed in 10 patients (6.02%) in the group of patients taking SGLT2 inhibitors and 35 patients (21.08%) without addition of SGLT2 inhibitors (hazard ratio 0.72; 95% CI, 0.65-0.85; p <0.001). The incidence of the secondary combined result was lower in the group receiving SGLT2 inhibitors than in the comparison group (risk ratio, 0.85; 95% CI, 0.75-0.95; p <0.001). Conclusions. The use of SGLT2 inhibitors in addition to the standard therapу provided a 72% reduction in the relative risk, estimated by the incidence of primary combined endpoint in particular, hospitalization due to the heart failure decompensation by 34% in the same group, and the secondary endpoint by 50%. The advantage of SGLT2 inhibitors over the standard therapy in the effect on the primary endpoint did not depend on the complete or incomplete myocardial revascularization by PCI in patients over an 8-month follow-up period. SGLT2 inhibitors use in patients after PCI with reduced left ventricular systolic function over the 8-month follow-up period led to regression of angina according to the KCCQ-TSS questionnaire, decreased functional class according to the New York classification, and increased LVEF.
{"title":"Clinical Prognosis in Patients with Heart Failure and Reduced Left Ventricular Ejection Fraction after Myocardial Revascularization on the Background of Taking SGLT2 Inhibitors","authors":"M. Kucheriava, Georgy B. Mankovsky, N. Rudenko","doi":"10.30702/ujcvs/22.30(02)/km020-5158","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(02)/km020-5158","url":null,"abstract":"The aim. To evaluate clinical and prognostic effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on primary (progression of heart failure, rehospitalization) and secondary endpoints (death from cardiovascular disease and from all causes) in patients with heart failure with reduced ejection fraction (HFrEF) within 8 months after percutaneous coronary intervention (PCI). \u0000Materials and methods. In a one-center study on the basis of the Ukrainian Children’s Cardiac Center, Clinic for Adults we analyzed the data for drug and interventional treatment of 166 patients with coronary artery disease and reduced left ventricular ejection fraction (LVEF) (<40%), who underwent PCI in the last 8 months. Among the 166 patients studied, 86 (51.8%) patients received SGLT2 inhibitors as an adjunct to the standard baseline therapy, and 80 (48.2%) patients did not receive SGLT2 inhibitors after PCI. \u0000Results and discussion. The primary combined outcome was observed in 10 patients (6.02%) in the group of patients taking SGLT2 inhibitors and 35 patients (21.08%) without addition of SGLT2 inhibitors (hazard ratio 0.72; 95% CI, 0.65-0.85; p <0.001). The incidence of the secondary combined result was lower in the group receiving SGLT2 inhibitors than in the comparison group (risk ratio, 0.85; 95% CI, 0.75-0.95; p <0.001). \u0000Conclusions. The use of SGLT2 inhibitors in addition to the standard therapу provided a 72% reduction in the relative risk, estimated by the incidence of primary combined endpoint in particular, hospitalization due to the heart failure decompensation by 34% in the same group, and the secondary endpoint by 50%. The advantage of SGLT2 inhibitors over the standard therapy in the effect on the primary endpoint did not depend on the complete or incomplete myocardial revascularization by PCI in patients over an 8-month follow-up period. SGLT2 inhibitors use in patients after PCI with reduced left ventricular systolic function over the 8-month follow-up period led to regression of angina according to the KCCQ-TSS questionnaire, decreased functional class according to the New York classification, and increased LVEF.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49234999","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 : 2022-06-24DOI: 10.30702/ujcvs/22.30(02)/dt025-4430
I. Dziuryi, I. Truba, Liliya M. Prokopovych, Vasyl V. Fylypchuk, V. Lazoryshynets
Tricuspid atresia (TA) is a rare cyanotic congenital heart disease (CHD) first described by Kreysig (1817). Bidirectional cavopulmonary anastomosis (BCPA) is part of the hemodynamic correction of such a complex combined CHD. In patients after BCPA, blood flow through the superior vena cava, providing efficient pulmonary blood flow, is the most important factor influencing blood oxygen saturation. The aim. To evaluate perioperative characteristics of the patients, immediate and long-term results after BCPA with TA. Materials and methods. In the period from January 1996 to April 2022, 50 patients with TA and multiple concomitant CHD underwent hemodynamic correction at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. There were 27 male patients (54%) and 23 female patients (46%). The mean age of the patients at the time of surgery was 31.6 ± 17.2 months (from 6 to 144 months). The main method of diagnosis in determining the defect and assessing the immediate and long-term results was echocardiographic examination and probing of the heart cavities. Among the 50 patients surveyed, 17 children were older than 2.5 years, so all the subjects were divided into 2 age groups: group I (n = 33) up to 2.5 years, group II (n = 17) older than 2.5 years to determine the optimal time of hemodynamic correction based on immediate and long-term results. Results. In the early postoperative period, there were 2 (4%) deaths among the patients of group II. The cause of death was acute heart failure in one case and infectious factor which led to the development of sepsis in another. There was a very interesting trend of increase in the duration of the operation (min): 239 ± 73.3 in group I, 251 ± 68.5 in group II; duration of mechanical ventilation (hours): 5.3 ± 1.4 in group I, 11 ± 3.7 in group II; duration of exudation (hours): 67 ± 22.9 in group I, 76 ± 26.8 in group II. There was significantly higher average dose of sympathomimetic (μg/kg/hour): 5 ± 2.1 for 60 ± 21.4 (hours) in group I; 7 ± 4.5 for 84 ± 29 (hours) in group II, hospital stay (days): 18 ± 5.7 in group I, 22 ± 11.3 in group II. Significantly lower mean systemic saturation at discharge 81 ± 4.6 (%) which was reported in children of group II compared to those of group I 88 ± 3.4 (%) clearly shows a decrease in the contribution of superior vena cava flow into the systemic circulation depending on the patient’s age, therefore, the clinical effect of performing BCPA as a stage of single-ventricular correction in patients with TA is much better when performing surgery in early childhood. Early postoperative period was uneventful in 27 (54%) patients. The other 23 (46%) patients of both groups had 16 and 18 complications in 10 (20%) patients of group I and 13 (26%) patients of group II, respectively, due to adverse factors of preoperative condition and specific changes in blood circulation characteristic of the BCPA. During the observation perio
{"title":"Experience in Performing Bidirectional Cavopulmonary Anastomosis in the Surgical Treatment of Tricuspid Atresia","authors":"I. Dziuryi, I. Truba, Liliya M. Prokopovych, Vasyl V. Fylypchuk, V. Lazoryshynets","doi":"10.30702/ujcvs/22.30(02)/dt025-4430","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(02)/dt025-4430","url":null,"abstract":"Tricuspid atresia (TA) is a rare cyanotic congenital heart disease (CHD) first described by Kreysig (1817). Bidirectional cavopulmonary anastomosis (BCPA) is part of the hemodynamic correction of such a complex combined CHD. In patients after BCPA, blood flow through the superior vena cava, providing efficient pulmonary blood flow, is the most important factor influencing blood oxygen saturation. \u0000The aim. To evaluate perioperative characteristics of the patients, immediate and long-term results after BCPA with TA. \u0000Materials and methods. In the period from January 1996 to April 2022, 50 patients with TA and multiple concomitant CHD underwent hemodynamic correction at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. There were 27 male patients (54%) and 23 female patients (46%). The mean age of the patients at the time of surgery was 31.6 ± 17.2 months (from 6 to 144 months). The main method of diagnosis in determining the defect and assessing the immediate and long-term results was echocardiographic examination and probing of the heart cavities. Among the 50 patients surveyed, 17 children were older than 2.5 years, so all the subjects were divided into 2 age groups: group I (n = 33) up to 2.5 years, group II (n = 17) older than 2.5 years to determine the optimal time of hemodynamic correction based on immediate and long-term results. \u0000Results. In the early postoperative period, there were 2 (4%) deaths among the patients of group II. The cause of death was acute heart failure in one case and infectious factor which led to the development of sepsis in another. There was a very interesting trend of increase in the duration of the operation (min): 239 ± 73.3 in group I, 251 ± 68.5 in group II; duration of mechanical ventilation (hours): 5.3 ± 1.4 in group I, 11 ± 3.7 in group II; duration of exudation (hours): 67 ± 22.9 in group I, 76 ± 26.8 in group II. There was significantly higher average dose of sympathomimetic (μg/kg/hour): 5 ± 2.1 for 60 ± 21.4 (hours) in group I; 7 ± 4.5 for 84 ± 29 (hours) in group II, hospital stay (days): 18 ± 5.7 in group I, 22 ± 11.3 in group II. Significantly lower mean systemic saturation at discharge 81 ± 4.6 (%) which was reported in children of group II compared to those of group I 88 ± 3.4 (%) clearly shows a decrease in the contribution of superior vena cava flow into the systemic circulation depending on the patient’s age, therefore, the clinical effect of performing BCPA as a stage of single-ventricular correction in patients with TA is much better when performing surgery in early childhood. Early postoperative period was uneventful in 27 (54%) patients. The other 23 (46%) patients of both groups had 16 and 18 complications in 10 (20%) patients of group I and 13 (26%) patients of group II, respectively, due to adverse factors of preoperative condition and specific changes in blood circulation characteristic of the BCPA. During the observation perio","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46131904","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 : 2022-03-23DOI: 10.30702/jcvs/22.30(01)/yab006-2126
Olena O. Yakimishen, Serhii M. Boyko, T. Malysheva, Anna P. Goidra, I. Truba
Background. Klebsiella pneumoniae (K. pneumoniae) is one of the main causes of hospital infections (pneumonia, urinary tract infections, blood infections) in children with congenital heart disease in the intensive care unit. Multidrugresistant strains significantly complicate and treatment, but with rational antibiotic therapy it is possible to achieve effective treatment results. The aim. To analyze the detection of different strains of K. pneumoniae in children with congenital heart disease in the intensive care unit and the principles of antibiotic therapy in the treatment of infections caused by them. Materials and methods. At the Department Of Congenital Heart Disease Surgery for Newborns and Young Children, of the National Amosov Institute of Cardiovascular Surgery we examined 2548 patients in 2018-2020. Microbiological examination was performed in 370 children. Bacteriological culturing (sputum, blood) of the studied material on special medium for bacterial growth was analyzed on VITEK-2 analyzer for 72 hours. If a progenitor was seen, the sample was considered as positive, and the resulting columns were tested for sensitivity to antibiotics. Results. The bacterial growth was positive in 277 (75%) children, of whom K. pneumoniae was found in 98 (25%) patients in 138 tests. We obtained the following data: K. pneumoniae in 79 (57%) patients, extended spectrum betalactamase (ESBL)-producing K. pneumoniae in 47 (34%), carbapenem-resistant K. pneumoniae in 11 (8%), multiresistant K. pneumoniae in 1 (1%) patient. We prescribed standard or specific therapy in accordance with the recommendations for the treatment of infections caused by K. pneumoniae and its susceptibility to the antibiotics. Conclusions. It is important to follow the rules of rational antibiotic therapy (taking into account the sensitivity of the stimuli, pharmacodynamic and pharmacokinetic properties of the drugs) when treating infections. The spread of carbapenem-resistant strains of microorganisms leads to the loss of the possibility of using carbapenems as a reserve antibiotic, which significantly complicates the treatment of infections, and ceftazidime/avibactam should be the drug of choice in wards where the number of carbapenem-resistant strains equals to/exceeds 20%.
{"title":"Analysis of Cases of Multidrug-Resistant Klebsiella Pneumoniae Infection in Children with Congenital Heart Defects","authors":"Olena O. Yakimishen, Serhii M. Boyko, T. Malysheva, Anna P. Goidra, I. Truba","doi":"10.30702/jcvs/22.30(01)/yab006-2126","DOIUrl":"https://doi.org/10.30702/jcvs/22.30(01)/yab006-2126","url":null,"abstract":"Background. Klebsiella pneumoniae (K. pneumoniae) is one of the main causes of hospital infections (pneumonia, urinary tract infections, blood infections) in children with congenital heart disease in the intensive care unit. Multidrugresistant strains significantly complicate and treatment, but with rational antibiotic therapy it is possible to achieve effective treatment results. \u0000The aim. To analyze the detection of different strains of K. pneumoniae in children with congenital heart disease in the intensive care unit and the principles of antibiotic therapy in the treatment of infections caused by them. \u0000Materials and methods. At the Department Of Congenital Heart Disease Surgery for Newborns and Young Children, of the National Amosov Institute of Cardiovascular Surgery we examined 2548 patients in 2018-2020. Microbiological examination was performed in 370 children. Bacteriological culturing (sputum, blood) of the studied material on special medium for bacterial growth was analyzed on VITEK-2 analyzer for 72 hours. If a progenitor was seen, the sample was considered as positive, and the resulting columns were tested for sensitivity to antibiotics. \u0000Results. The bacterial growth was positive in 277 (75%) children, of whom K. pneumoniae was found in 98 (25%) patients in 138 tests. We obtained the following data: K. pneumoniae in 79 (57%) patients, extended spectrum betalactamase (ESBL)-producing K. pneumoniae in 47 (34%), carbapenem-resistant K. pneumoniae in 11 (8%), multiresistant K. pneumoniae in 1 (1%) patient. We prescribed standard or specific therapy in accordance with the recommendations for the treatment of infections caused by K. pneumoniae and its susceptibility to the antibiotics. \u0000Conclusions. It is important to follow the rules of rational antibiotic therapy (taking into account the sensitivity of the stimuli, pharmacodynamic and pharmacokinetic properties of the drugs) when treating infections. The spread of carbapenem-resistant strains of microorganisms leads to the loss of the possibility of using carbapenems as a reserve antibiotic, which significantly complicates the treatment of infections, and ceftazidime/avibactam should be the drug of choice in wards where the number of carbapenem-resistant strains equals to/exceeds 20%.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49359224","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 : 2022-03-23DOI: 10.30702/ujcvs/22.30(01)/dl012-4348
K. Denysiuk, O. Loskutov, O. Druzhyna
Background. Heart failure is the leading cause of death among all cardiovascular diseases. The five-year survival rate in such patients is 50%. In most cases, heart transplantation is the treatment of choice in these patients. However, its use is limited by severe and progressive donor organ deficiency. The aim. To study the effectiveness of immunosorbent-based hemosorption in comprehensive conservative treatment of patients with end-stage heart failure. Materials and methods. A retrospective analysis of the results of treatment in 59 patients 90% men, 10% women; mean age 41.3 ± 12.4 years; NYHA IIB-III, baseline left ventricular ejection fraction 21.1 ± 4.66%, left ventricular endsystolic volume 206.87 ± 84.1 ml, left ventricular end-diastolic volume 264.4 ± 86.02 ml) hospitalized for end-stage heart failure was performed. Conservative therapy was carried out following international guidelines and was supplemented by a course of 2-4 hemosorption procedures for which hemosorbent granulated deliganding was used. The Student’s t-test was used to analyze the data. Results. The clinical condition of all patients improved after the performed hemosorption procedures by at least one NYHA class. The brain natriuretic peptide level decreased from 1281.17±165.33 pg/ml to 859.48±113.38 pg/ml (p<0.05). Left ventricular ejection fraction increased by 10.77±4.3% (to 29.36 ± 6.27%) (p<0.01), and after 12 months it was 34 ± 2.59% (p<0.05). Left ventricular end-systolic volume decreased by 68.75±43.56 ml (to 137.77 ± 33.21 ml), left ventricular end-diastolic volume decreased by 41.38±31.48 ml (to 238.04 ± 82.1 ml) (p<0.05). Conclusions. The use of hemosorption with hemosorbent granulated deliganding, against the background of conservative treatment of end-stage heart failure, improves the contractile function of the heart and general clinical condition of patients.
{"title":"Evaluation of the Effectiveness of Immunosorbent-Based Hemosorption in Comprehensive Conservative Therapy of End-Stage Heart Failure Patients","authors":"K. Denysiuk, O. Loskutov, O. Druzhyna","doi":"10.30702/ujcvs/22.30(01)/dl012-4348","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(01)/dl012-4348","url":null,"abstract":"Background. Heart failure is the leading cause of death among all cardiovascular diseases. The five-year survival rate in such patients is 50%. In most cases, heart transplantation is the treatment of choice in these patients. However, its use is limited by severe and progressive donor organ deficiency. \u0000The aim. To study the effectiveness of immunosorbent-based hemosorption in comprehensive conservative treatment of patients with end-stage heart failure. \u0000Materials and methods. A retrospective analysis of the results of treatment in 59 patients 90% men, 10% women; mean age 41.3 ± 12.4 years; NYHA IIB-III, baseline left ventricular ejection fraction 21.1 ± 4.66%, left ventricular endsystolic volume 206.87 ± 84.1 ml, left ventricular end-diastolic volume 264.4 ± 86.02 ml) hospitalized for end-stage heart failure was performed. Conservative therapy was carried out following international guidelines and was supplemented by a course of 2-4 hemosorption procedures for which hemosorbent granulated deliganding was used. The Student’s t-test was used to analyze the data. \u0000Results. The clinical condition of all patients improved after the performed hemosorption procedures by at least one NYHA class. The brain natriuretic peptide level decreased from 1281.17±165.33 pg/ml to 859.48±113.38 pg/ml (p<0.05). Left ventricular ejection fraction increased by 10.77±4.3% (to 29.36 ± 6.27%) (p<0.01), and after 12 months it was 34 ± 2.59% (p<0.05). Left ventricular end-systolic volume decreased by 68.75±43.56 ml (to 137.77 ± 33.21 ml), left ventricular end-diastolic volume decreased by 41.38±31.48 ml (to 238.04 ± 82.1 ml) (p<0.05). \u0000Conclusions. The use of hemosorption with hemosorbent granulated deliganding, against the background of conservative treatment of end-stage heart failure, improves the contractile function of the heart and general clinical condition of patients.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45882119","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 : 2022-03-23DOI: 10.30702/ujcvs/22.30(01)/t003-3742
Yurii M. Tarasenko
Postcoarctation aneurysm is one of the most dangerous complications in the long-term period after surgery for coarctation of the aorta (CoA). Postcoarctation aneurysm formation is associated with high risk of aneurysm rupture, and, therefore, of patient death. Considering high risk of this pathology, it is necessary to study thoroughly the results of surgical treatment and quality of life after the correction and to develop measures to prevent the aneurysms formation. The aim. To present and analyze immediate and long-term effects of treatment of postcoarctation aneurysms of aorta. Materials and methods. We analyzed the long-term results of surgical treatment of postcoarctation aneurysms for 25 years of follow-up (1995–2020). We performed comparative analysis of the results of postcoarctation aneurysms surgical correction. Ninety-one patients were included in the study. All the patients were divided into two groups. Group I included 69 (75.8%) patients who underwent open surgical intervention. Group II included 16 (17.6%) patients who, in turn, were divided into two subgroups: group ІІ-A (5 patients) who underwent endovascular intervention, and group ІІ-B (11 patients) who received hybrid treatment of the discussed pathology. We studied and summarized the results of assessment of the quality of life in the operated patients in a long-term period using SF-36 questionnaire. Results. The study showed that postcoarctation aneurysms most often developed in patients operated for CoA by indirect isthmoplasty procedure (53.5%, n=31). Aneurysms most frequently developed due to the tear of the lower edge of the patch. Better results of surgical treatment were reported in patients of group ІІ. Average period from correction of CoA till correction of postcoarctation aneurysm was 22 years. The postoperative 30-day mortality in all the operated patients (n=85) was 8.2%. The causes of death were as follows: infectious complications in 4 patients (57.1%), hemorrhage in 3 patients (42.9%). Long-term results were observed in 93.5% patients (n= 79). Treatment results were good in 54 patients (68.3%), satisfactory in 16 patients (20.2%), and unsatisfactory in 7 patients (8.9%). Two (2.5%) patients died in the long-term follow-up period. Conclusions. It was established that after indirect isthmoplasty, the cause of the formation of postcoarctation aneurysm was mostly a tear in the lower edge of the patch. It is interesting to note that the younger were the patients by the time of coarctation correction, the longer was the period till the correction of postcoarctation aneurysm. The performed surgical interventions in postcoarctation aneurysms proved to be highly effective in the long term, and the assessment of long-term results in non-operated patients showed their necessity. Long-term quality of life assessment showed significant improvement. There was improvement in the parameter for physical functioning by 26.2%, for general health by 40.7%, and for everyday a
{"title":"Immediate and Long-Term Results of Surgical Treatment of Postcoarctation Aneurysms of Aorta","authors":"Yurii M. Tarasenko","doi":"10.30702/ujcvs/22.30(01)/t003-3742","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(01)/t003-3742","url":null,"abstract":"Postcoarctation aneurysm is one of the most dangerous complications in the long-term period after surgery for coarctation of the aorta (CoA). Postcoarctation aneurysm formation is associated with high risk of aneurysm rupture, and, therefore, of patient death. Considering high risk of this pathology, it is necessary to study thoroughly the results of surgical treatment and quality of life after the correction and to develop measures to prevent the aneurysms formation. \u0000The aim. To present and analyze immediate and long-term effects of treatment of postcoarctation aneurysms of aorta. \u0000Materials and methods. We analyzed the long-term results of surgical treatment of postcoarctation aneurysms for 25 years of follow-up (1995–2020). We performed comparative analysis of the results of postcoarctation aneurysms surgical correction. Ninety-one patients were included in the study. All the patients were divided into two groups. Group I included 69 (75.8%) patients who underwent open surgical intervention. Group II included 16 (17.6%) patients who, in turn, were divided into two subgroups: group ІІ-A (5 patients) who underwent endovascular intervention, and group ІІ-B (11 patients) who received hybrid treatment of the discussed pathology. We studied and summarized the results of assessment of the quality of life in the operated patients in a long-term period using SF-36 questionnaire. \u0000Results. The study showed that postcoarctation aneurysms most often developed in patients operated for CoA by indirect isthmoplasty procedure (53.5%, n=31). Aneurysms most frequently developed due to the tear of the lower edge of the patch. Better results of surgical treatment were reported in patients of group ІІ. Average period from correction of CoA till correction of postcoarctation aneurysm was 22 years. The postoperative 30-day mortality in all the operated patients (n=85) was 8.2%. The causes of death were as follows: infectious complications in 4 patients (57.1%), hemorrhage in 3 patients (42.9%). Long-term results were observed in 93.5% patients (n= 79). Treatment results were good in 54 patients (68.3%), satisfactory in 16 patients (20.2%), and unsatisfactory in 7 patients (8.9%). Two (2.5%) patients died in the long-term follow-up period. \u0000Conclusions. It was established that after indirect isthmoplasty, the cause of the formation of postcoarctation aneurysm was mostly a tear in the lower edge of the patch. It is interesting to note that the younger were the patients by the time of coarctation correction, the longer was the period till the correction of postcoarctation aneurysm. The performed surgical interventions in postcoarctation aneurysms proved to be highly effective in the long term, and the assessment of long-term results in non-operated patients showed their necessity. Long-term quality of life assessment showed significant improvement. There was improvement in the parameter for physical functioning by 26.2%, for general health by 40.7%, and for everyday a","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42760298","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 : 2022-03-23DOI: 10.30702/ujcvs/22.30(01)/pk002-3236
V. Kravchenko, Andrii I. Perepeliuk, I. Zhekov, B. Cherpak, Oleh I. Sarhosh
Thoracic and aortic aneurysms, including Stanford type B and neither A nor B aneurysms, are a complex problem for cardiac surgery. For a long time, the treatment of this pathology was carried out through the open method, which was associated with high hospital mortality. Hybrid and endovascular treatment have significantly reduced the number of complications and improved in-hospital mortality, although such methods are associated with specific difficulties, the study and elimination of which is an urgent issue at the present stage of cardiac surgery. The aim. To analyze the immediate and first long-term results of treatment of type B and non-A non-B aortic dissection through the hybrid method with the formation of avascular zone of proximal fixation of the stent-graft in the aortic arch, i.e. “landing zone”. Materials and methods. For the period from January 1, 2016 to December 31, 2019 at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine 122 patients underwent surgical treatment for type B and non-A nonB aortic dissection, of whom 57 (46.7%) patients underwent hybrid intervention involving the formation of a “landing zone”, i.e. an avascular section of the aortic arch to fix the stent-graft. Stent-graft was implanted in Z0 in 5 (8.8%) cases, in Z1 in 24 (42.1%) cases, and in Z2 in 28 (49.1%) cases. The stent-grafts used were Lifetech Ankura (41 cases), Relay (12 cases), and Medtronic Valiant (4 cases). The main causes of pathology were type B acute aortic aneurysm (11 [19%]), type B subacute aortic aneurysm (4 [7%]), type B chronic aortic aneurysm (30 [53%]), penetrating aortic ulcer (1 [2%]), primary parietal thrombosis of the aortic lumen (1 [2%]), postcoarctation aortic aneurysm (8 [14%]), thoracic aortic aneurysm (3 [5%]). Results. The total number of complications was 11 (19% of cases). Among the types of operations, the number of complications was evenly distributed, 5/28 (18%) were observed in partial debranching, 5/27 (19%) in subtotal debranching and 1/2 (50%) in total debranching. Hospital mortality was 3/122 (5.3%). Conclusions. The described methods of treatment of aneurysms of the arch and descending aorta have real prospects for development due to minimal invasiveness, reduction of the duration of surgery and time spent in the clinic, and significantly lower in-hospital mortality compared to traditional “open” surgery.
{"title":"The Results of the Use of the Technique of Switching the Vessels of the Aortic Arch in the Formation of the Avascular Zone of Stent-Graft Fixation in the Hybrid Treatment of Thoracic Aortic Aneurysms","authors":"V. Kravchenko, Andrii I. Perepeliuk, I. Zhekov, B. Cherpak, Oleh I. Sarhosh","doi":"10.30702/ujcvs/22.30(01)/pk002-3236","DOIUrl":"https://doi.org/10.30702/ujcvs/22.30(01)/pk002-3236","url":null,"abstract":"Thoracic and aortic aneurysms, including Stanford type B and neither A nor B aneurysms, are a complex problem for cardiac surgery. For a long time, the treatment of this pathology was carried out through the open method, which was associated with high hospital mortality. Hybrid and endovascular treatment have significantly reduced the number of complications and improved in-hospital mortality, although such methods are associated with specific difficulties, the study and elimination of which is an urgent issue at the present stage of cardiac surgery. \u0000The aim. To analyze the immediate and first long-term results of treatment of type B and non-A non-B aortic dissection through the hybrid method with the formation of avascular zone of proximal fixation of the stent-graft in the aortic arch, i.e. “landing zone”. \u0000Materials and methods. For the period from January 1, 2016 to December 31, 2019 at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine 122 patients underwent surgical treatment for type B and non-A nonB aortic dissection, of whom 57 (46.7%) patients underwent hybrid intervention involving the formation of a “landing zone”, i.e. an avascular section of the aortic arch to fix the stent-graft. Stent-graft was implanted in Z0 in 5 (8.8%) cases, in Z1 in 24 (42.1%) cases, and in Z2 in 28 (49.1%) cases. The stent-grafts used were Lifetech Ankura (41 cases), Relay (12 cases), and Medtronic Valiant (4 cases). The main causes of pathology were type B acute aortic aneurysm (11 [19%]), type B subacute aortic aneurysm (4 [7%]), type B chronic aortic aneurysm (30 [53%]), penetrating aortic ulcer (1 [2%]), primary parietal thrombosis of the aortic lumen (1 [2%]), postcoarctation aortic aneurysm (8 [14%]), thoracic aortic aneurysm (3 [5%]). \u0000Results. The total number of complications was 11 (19% of cases). Among the types of operations, the number of complications was evenly distributed, 5/28 (18%) were observed in partial debranching, 5/27 (19%) in subtotal debranching and 1/2 (50%) in total debranching. Hospital mortality was 3/122 (5.3%). \u0000Conclusions. The described methods of treatment of aneurysms of the arch and descending aorta have real prospects for development due to minimal invasiveness, reduction of the duration of surgery and time spent in the clinic, and significantly lower in-hospital mortality compared to traditional “open” surgery.","PeriodicalId":33680,"journal":{"name":"Ukrayins''kii zhurnal sertsevosudinnoyi khirurgiyi","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45360147","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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