Вестник хирургии имени И.И. Грекова (May 2020)

Preoperative risk factors of emergency conversion to artificial circulation during off-pump coronary artery bypass grafting in patients with ischemic congestive heart disease

  • G. G. Khubulava,
  • A. E. Sukharev,
  • V. N. Kravchuk,
  • A. M. Volkov,
  • A. I. Lyubimov,
  • E. A. Knyazev,
  • A. S. Kusay,
  • D. U. Romanovskiy,
  • A. V. Birukov,
  • V. I. Zvoznikov

DOI
https://doi.org/10.24884/0042-4625-2020-179-1-12-19
Journal volume & issue
Vol. 179, no. 1
pp. 12 – 19

Abstract

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INTRODUCTION. Coronary artery bypass surgery is the most popular method of surgical treatment of patients with chronic heart failure of ischemic origin. Modern direction of developing the cardiac surgery in treating patients with chronic heart failure of ischemic origin is «off-pump» techniques. However, the high risk of emergency conversion to«on pump» reduce the availability for using «off pump» techniques with this kind of patients. Preoperative risk factors for unplanned conversion to cardiopulmonary bypass have not been studied.The OBJECTIVE was to determine preoperative risk factors of urgent conversion to bypass in patients with congestive ischemic heart failure during off-pump coronary artery bypass grafting.METHODS AND MATERIALS. The results of 44 coronary artery bypass grafting (CABG) off-pump procedures in patients with ischemic cardiomyopathy were retrospectively analyzed. Emergent conversion to artificial circulation was needed due to acute heart failure in 8 (18 %) patients. All patients were divided into 2 groups depending on the necessity for emergency using the cardiopulmonary bypass. Then the patients’ preoperative status was analyzed.RESULTS. We determined that the risk factors of emergent conversion to cardiopulmonary bypass were observed in the following cases: patients after 70 years old with a combined left main coronary artery lesion and right coronary artery occlusion; left ventricle end-diastolic size more than 70 mm; mild mitral insufficiency; the presence of atrial or ventricle rhythm disturbances; EuroSCORE logistic score more than 4.9 %.CONCLUSION. The identified risk factors allow to minimize the risk of urgent conversion to bypass circulation during off-pump myocardial revascularization in patients with congestive ischemic heart failure. When these risk factors are present, it is recommended to use on-pump or on-pump beating heart techniques of coronary artery bypass grafting in these patients.

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