emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2022.6.1.1525emcardio-111Research ArticleОригинальные научные публикацииOriginal Scientific ResearchФакторы риска развития посткардиотомного синдрома малого сердечного выброса у пациентов после аортокоронарного шунтирования в условиях искусственного кровообращенияRisk factors for postcardiotomy low cardiac output syndrome after on-pump coronary artery bypass graftingЯрошР. Г.YaroshR.

г. Минск

Minsk

ШестаковаЛ. Г.ShestakovaL.

г. Минск

Minsk

ГУ «Республиканский научно-практический центр «Кардиология»Scientific and Practical Center “Cardiology”2022270620256115251530Copyright © Ярош Р.Г., Шестакова Л.Г., 20252025Ярош Р.Г., Шестакова Л.Г.Yarosh R., Shestakova L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/111

Цель. Определить факторы риска развития посткардиотомного синдрома малого сердечного выброса у пациентов после реваскуляризации миокарда в условиях искусственного кровообращения.Методы. В исследование включено 157 пациентов, которым было выполнено аортокоронарное шунтирование в условиях искусственного кровообращения. Из них у 25 пациентов интраоперационно и в ранний послеоперационный период развился посткардиотомный синдром малого сердечного выброса (ПСМСВ), рефрактерный к медикаментозной терапии, которым подключали механическую поддержку кровообращения (МПК), у 132 – ПСМСВ не развился и МПК не подключали (группа сравнения).Результаты. Проведено ретроспективное, обсервационное исследование по типу “случай-контроль”. На основании унивариантного анализа были выделены факторы риска развития ПСМСВ: дооперационная фракция выброса левого желудочка (в Б-режиме) < 45%, ОШ = 4,7 (95% ДИ 1,9 – 11,5, p = 0,001), выполнение операции на открытом сердце в течение острого периода инфаркта миокарда (30 дней) ОШ = 9,8 (95% ДИ 3,1 – 31,9, р = 0,001), повторное пережатие аорты ОШ = 5,8 (95% ДИ 1,1 – 30,9, p = 0,049), дисфункция коронарных шунтов, выявленная при шунтографии в раннем послеоперационном периоде ОШ = 54,7 (95% ДИ 13,6-219, р = 0,001).Заключение. Посткардиотомный синдром малого сердечного выброса – это тяжелое осложнение после выполнения хирургических операций на открытом сердце, приводящее к полиорганной недостаточности, вследствие системной гипоперфузии органов и тканей и характеризуется высокой госпитальной летальностью до 80%. Механическая поддержка кровообращения в этом случае является единственным методом лечения данной когорты пациентов.

Aim. To determine the risk factors for postcardiotomy syndrome of low cardiac output in patients after on-pump coronary artery bypass grafting.Methods. The study included 157 patients who underwent on-pump coronary artery bypass grafting. Intraoperatively and in the early postoperative period, 25 patients developed postcardiotomy low cardiac output syndrome (PLCOS), which was refractory to drug therapy and followed by mechanical circulatory support (MCS). 132 patients did not develop PLCOS and did not require MCS (comparison group).Results. A retrospective, observational case-control study was carried out. Based on a univariate analysis, risk factors for the development of PLCOS were identified: preoperative left ventrical ejection fraction (LVEF) (B-mode) < 45%, OR = 4.7 (95% CI 1.9–11.5, p = 0.001), open heart surgery during the acute period of myocardial infarction (10 days) OR = 20.5 (95% CI 3.8-109, p = 0.001), aorta reclumping OR = 5.8 (95% CI 1.1 – 30.9, p = 0.049), dysfunction of coronary bypass grafts detected by bypass imaging in the early postoperative period OR = 54.7 (95% CI 13.6-219, p = 0.001).Conclusions. Postcardiotomy syndrome of low cardiac output is a severe complication after open-heart surgery, leading to multiple organ failure due to systemic hypoperfusion of organs and tissues and is characterized by a high hospital mortality rate of up to 80%. Mechanical support of blood circulation (MCS) in this case is the only method of treatment for this cohort of patients.

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The authors declare that there are no conflicts of interest present.