Title : Pre-and postcondition of coronary artery and myocardium for combined mitral-aortic-tricuspid valve correction
Abstract:
Objective: To present analysis of pharmacological supporting of conditions of coronary artery and myocardium (pre and postcondition) during combined mitral-aortic valve replacement (MVAR) + TV`s plasty .
Materials and Methods: During 2015-2022 y 203 patients (pts) with isolated pathology of mitral valve disease were operated by MVAR + TV`s plasty in institute. There were 91 (44,8%) males, 112 (55,2%) females. Average age was 64,4±8,7 yy. NYHA class in all group were followings: III class – 77 (37,9%), IV class – 126 (62,1%) pts. Concomitant procedures: TV`s plasty (n=9), LA`s plasty (n=41), Maze (n=29). Pharmacological supporting of conditions of coronary artery and myocardium (PSCCAM) was performed by applying during 20 minutes of 100 ml solution with following drugs: papaverine 40mg + verapamil 5mg + ATP 50,0 mg.
All pts were divided at 3 groups: group A - PSCCAM was applied before starting of CPB - 37 pts; group B - PSCCAM was applied before starting of CPB and the same dose was used after declamping of aorta - 39 pts; group C - only MVAR without precondition 127 pts.
Systemic hypothermia 32-34 C, cardiopulmonary bypass, retrograde cardioplegic solution (Custadiol) (in dose 20 ml/kg) were occured in all pts. Average time of improvement of cardioplegia solution was 21,2±3,9 minutes. Average cross-clamping time (min) were: 69,3±8,1 and reperfusion time - 29,1±4,5. Absence of using blood product in 48,5%.
Results: There weren`t any pts of hospital mortality. Average doses of dobutamin (1,8±0,6 mcrg/min/kg) were marked (hours) for: group A - 24,8±7,2; group B - 19,1±5,7; group C - 39,5±5,4 (p <0,05). Average level of MB KFK (U/L) at 2-td postoperative day were occured for: group A - 56,3±7,2; group B - 53,4±6,8; group C - 61,1±9,3 (p<0,05). Duration of stay on artificial lung ventilation (hours) were: group A - 7,1±0,9; group B - 6,9±0,7; group C - 7,4±0,5 (p>0,05). Average time of staying in intensive care unit (hours) were: group A - 47,2±5,6, group B - 43,3±6,5, group C - 48,7±5,7 (p <0,05).
Conclusion: Both variances of pharmacologic supporting of conditions of coronary artery and myocardium (group A,B) had improved myocardial protection compare with group C (p<0,05).
