Медицина неотложных состояний (Oct 2024)
Analysis of risk factors for the development of major adverse cardiovascular and cerebrovascular events in patients after aortic valve replacement with myocardial revascularization
Abstract
Background. Acquired aortic valve disease and coronary heart disease often occur together, and almost two thirds of patients with aortic valve stenosis have severe coronary heart disease. Given the presence of both pathologies, this cohort of patients requires an individual diagnostic and therapeutic approach. The aim of the study was to analyze risk factors for the development of major adverse cardiovascular and cerebrovascular events (MACCE) in patients after aortic valve replacement with myocardial revascularization. Materials and methods. For this study, a selection of disease histories of adult patients (over 18 years old) who underwent surgical aortic valve replacement (SAVR) together with myocardial revascularization at the State Institution “Heart Institute of the Ministry of Health of Ukraine” from 2018 to 2022 was carried out. Results. We selected 130 case histories of patients who underwent SAVR together with myocardial revascularization: the first group (n = 51) — a combination of SAVR and percutaneous coronary interventions; the second group (n = 79) — a combination of SAVR and coronary artery bypass grafting. The analysis of intraoperative data showed that the duration of cardiopulmonary bypass and aortic cross-clamping in patients of the first group was significantly lower, by 1.5 times (p = 0.0001) and 1.4 times (p = 0.0001), compared to the second group. There was no significant difference between the study groups regarding the frequency of MACCE (p = 0.589). Reliable risk factors for the development of MAССE in the early postoperative period were the evaluation of the operative risk according to the EuroSCORE II scale (odds ratio (OR) 2.13, confidence interval (CI) 1.54–4.48, p = 0.012), the history of myocardial infarction (OR 1.43, CI 1.13–2.45, p = 0.002) and right coronary artery damage (OR 1.79, CI 1.44–3.78, p = 0.021). Conclusions. Patients who underwent percutaneous coronary interventions before SAVR were characterized by a shorter duration of cardiopulmonary bypass and aortic cross-clamping, however, no significant difference in major early postoperative complications was observed between the study groups. In particular, there were no significant differences regarding the frequency of MACCE in the early postoperative period.
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