emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2023.7.1.1852emcardio-60Research ArticleОригинальные научные публикацииOriginal Scientific ResearchЧастота, факторы риска и предикторы развития синдрома малого сердечного выброса после операций на открытом сердцеIncidence and risk factors for low cardiac output syndrome after open heart surgeryЯрошР. Г.YaroshR.

г. Минск

Minsk

doc_pomka@mail.ruШестаковаЛ. Г.ShestakovaL.

г. Минск

Minsk

БушкевичМ. И.BushkevichM.

г. Минск

Minsk

ПетровичН. С.PetrovichN.

г. Минск

Minsk

ГУ «Республиканский научно-практический центр «Кардиология»Republican Scientific and Practical Center of Cardiology2023200620257118521858Copyright © Ярош Р.Г., Шестакова Л.Г., Бушкевич М.И., Петрович Н.С., 20252025Ярош Р.Г., Шестакова Л.Г., Бушкевич М.И., Петрович Н.С.Yarosh R., Shestakova L., Bushkevich M., Petrovich N.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/60

Цель. Изучить частоту и определить предикторы развития посткардиотомного синдрома малого сердечного выброса после операций в условиях искусственного кровообращения.Методы. Проведено ретроспективное, обсервационное исследование по типу «случай-контроль» в РНПЦ «Кардиология» за период 2015–2017 гг. В исследование включено 1540 пациентов, которым были выполнены операции на сердце в условиях искусственного кровообращения. Из них у 46 пациентов интраоперационно и в ранний послеоперационный период развился посткардиотомный синдром малого сердечного выброса (ПСМСВ), рефрактерный к медикаментозной терапии, в связи с чем была подключена механическая поддержка кровообращения (исследуемая группа), группу сравнения составили 1494 пациента.Результаты. Частота развития ПСМСВ после операций на сердце в условиях искусственного кровообращения составила 2,98%. Предикторами развития ПСМСВ являются: повторная операция на сердце ОШ = 3,65 (95% ДИ 1,40–9,51), выполнение операции в острый период (30 дней) инфаркта миокарда ОШ = 7,20 (95% ДИ 2,25–23,01), класс сердечной недостаточности по NYHA III/IV, ОШ = 2,38 (95% ДИ 1,30–4,37) и дооперационный индекс локальной сократимости более 1,81, ОШ = 2,92 (95% ДИ 1,50–5,68).Заключение. Посткардиотомный синдром малого сердечного выброса по-прежнему остается большой проблемой в кардиохирургии. Несмотря на современные методы защиты миокарда и механической поддержки кровообращения (МПК), госпитальная летальность остается крайне высокой и достигает 60–80%. Прогнозирование на основании предиктивных моделей позволит своевременно выбрать необходимый вид МПК, снизить частоту развития полиорганной недостаточности и неблагоприятных исходов хирургического лечения.

Purpose. To study the incidence and to determine predictors of postcar- diotomy low cardiac output syndrome after open-heart surgery.Methods. A retrospective, observational case-control study was conducted at the Republican Scientific and Practical Center of Cardiology for the period 2015–2017.The study included 1, 540 patients who underwent open-heart surgery. Intraoperatively and in early postoperative period, 46 patients developed postcardiotomy low cardiac output syndrome (PCLCOS) refractory to drug therapy, followed by mechanical circulatory support (the study group), the comparison group consisted of 1, 494 patients.Results. The incidence of PCLCOS was 2.98%. The predictors of PCLCOS included the following: reoperation OR = 3.65 (95% CI 1.40–9.51), myocardial infarction (30 days) before operation OR = 7.20 (95% CI 2.25–23.01), heart failure NYHA class III/IV OR = 2.38 (95% CI 1.30–4.37), and preoperative local contractility index more than 1.81, OR = 2.92 (95% CI 1.50–5.68).Conclusion. Postcardiotomy low cardiac output syndrome is still a big issue in cardiac surgery. Despite modern methods of myocardial protection and mechanical circulatory support (MCS), hospital mortali-ty remains extremely high, up to 80%. Prognosis based on predictive mo-dels will allow timely selection of the required type of MCS, reducing the incidence of multiple organ failure, and, as a result, adverse outcomes of surgical treatment.

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