Оптимизация результатов хирургического лечения больных ишемической болезнью сердца с дегенеративным поражением аортального клапана

The aim of the study: Comparison of results and choice of surgical treatment tactics for elderly patients with ischemic heart disease and degenerative aortic valve stenosis. Material and methods: Between 2015 and 2018, 58 older patients (average age – 75,4 ± 4,32) were operated on in the Department of Cardiac Surgery of RSSPMCC. The patients divided into 2 groups. I – is an investigated group (n – 32) of patients with IHD and severe AS who performed simultaneous myocardial revascularization and SAVR. The II – control group (n – 26) included patients with mild AV changes who performed isolated CABG. The majority of patients in the 31 (97 %) main group had severe AS, and in the control group had mild AS – 25 (96 %) and only 1 patient had moderate AS. The results of study: Duration of AVL in the study group, as well as postoperative blood loss (245,4 ± 117,3 ml vs 213,3 ± 46,5 ml, p < 00,05), was reliably longer (565,4 ± 68,3 min) than in the control group (372,3 ± 98,7 min, (p < 0,05)). There were no cases of perioperative IM in patients. Acute heart failure, respiratory failure, which required prolonged artificial pulmonary ventilation, renal failure, which didn’t require hemodialysis, were more often observed among patients in the study group, but the differences were not reliable (p > 0,05.). Signs of dyscirculatory encephalopathy in the early postoperative period were observed in quite a large number of patients of both groups, but significantly more were found in the investigated group (6 (19 %) vs. 2 (7,6 %), p < 00,05). Heart rhythm disorders were reliably frequently observed in the postoperative period in the study group – 7 (22 %) vs – 2 (7,6 %) in the control group (p < 00,05). The bleeding that required resternotomy was in one 1(3 %) of the patient of the study group, there was no such complication in the control group (p > 0,05). Сonclusion: simultaneous surgical aortic valve replacement and coronary artery bypass grafting can be performed safely and elderly patients must be operated on as early as possible to prevent disease progression. At the current stage of cardiosurgery development in simultaneous surgical treatment of degenerative aortic valve stenosis in elderly patients, due to surgical treatment tactics, it is possible to achieve satisfactory results comparable to the results of surgical treatment of patients of younger age.