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17
III. ХИРУРГИЯ
STRATIFICATION OF THE OPERATIONAL UDC 61 089-844:616 1 RISK IN PATIENTS WITH CORONARY HEART DISEASE, ACQUIRED AND CONGENITAL HEART DISEASES
Sagatov I.Ye., Ongarbayev K.O., Imammyrzaev U.Ye.
National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Kazakhstan Department of cardiosurgery, Kazakh medical university of continuous education
Abstract
There are given results of use of the stratification scales EuroSCORE and Aristotle Basic Complexity ~ " a r ' Key words:
score in cardosurgical pat>ents. operation risk, cardiac surgery.
About the authors:
Inkar Y. Sagatov - dr. med., a surgeon of cardiac surgery department of the NSCS n/a A.N. Syzganov.
Журектщ ишемиялык ауруына, журе пайда 6oëfaH жэне туа б1ткен журек акауларына шалдыккан наукастарда^! операциялык рисктщ стратификациясы
Cafaтoв И.Е., О^арбаев К.О., Имаммырзаев У.Е.
А.Н. Сь^анов атындаш ¥лттык шлыми хирургия орталыш, Алматы к., Кдзакстан
Кардиохирургия 6eëiMrneci,
К,азак медициналык Y3äiKCi3 6rniM беру унивeрcитeтi
Авторлар туралы:
Сагатов Щкэр Ерталиулы - А.Н. Сызтанов атындаты YFXO кардиохирургия 6eëiMrneciHiœ äapirepi, мт.д.
Туйш
EuroSCOREœdHe Aristotle Basic Complexity score стратификациялык шкалаларын кардиохирургиялык Туйш сездер: наукастарда колдану нэтижeлepi керсетшген. 0талау кауп', жУрек
хирургиясы.
Стратификация операционного риска у больных с ишемической болезнью сердца, врожденными и приобретенными пороками сердца
Сагатов И.Е., Онгарбаев К.О., Имаммырзаев У.Е.
Национальный научный центр хирургии им. А.Н. Сызганова, Алматы, Казахстан Отделение кардиохирургии,
Казахский медицинский университет непрерывного образования Аннотация
Представлены результаты применения стратификационных шкал EuroSCORE и Aristotle Basic Complexity score у пациентов кардиохирургического профиля.
Об авторах
Сагатов Инкар Еpгaлиeвич -д.м.н., врач-хирург отдeлeния кардиохирургии ННЦХ им.А.Н. Сызганова, e-mail: inkar_ [email protected].
Ключевые слова:
опepaционный риск, кардиохирургия.
Introduction
Stratification of operation risk allows to distinguish objectively a group of patients, in which the degree of a development of postoperative complications and lethality is relatively high, as well as a group of patients, in which, on the contrary, operational risk is minimum. It is known that surgical interventions on heart and main arteries in a number of cases are interfaced with development of postoperative complications and lethality. In connection with this, stratification of possible lethal and unlethal complications in cardiosurgical departments is an important need [1,4,5,6,7].
Diverse stratification scales are often used for the purpose of minimization of risks and improvement of a quality of the surgical treatment in a clinical practice, such as Aristotle Basic Complexity (ABC) score, Aristotle Comprehensive Complexity (ACC) score, EuroSCORE, EuroSCORE-II, GRACE, Mass-DAC Mortality Risk, PCI Risk score, Risk Adjustment for Congenital Heart Surgery (RACHS-1), STS score, STS-EACTS, CRUSADE, Mortality score, SYNTAX score and others. The predictive value of these scales was proved in patients with a large number of supervisions.
The aim of research is to analyze of operational risk in cardiosurgical patients using stratification scales.
Materials and methods of research
Before surgical intervention there were examined 66 patients with isolated and combined defects of heart valves were examined, 75 patients with coronary heart disease (CHD) and 143 patients with congenital heart malformations (CHM) that were treated in inpatient department of National Scientific Center of Surgery named after A.N. Syzganov in 2011-2014.
The mean age of patients with acquired heart defects at the moment of surgery made 45,0±16,0 years. The youngest patient was 13 years old, but oldest one was 62 years old. The males prevailed among patients (55,9%). All patients had a prosthetic mitral and/or aortic valve replacement in combination with suture annuloplasty of the tricuspid valve or without it. In several cases Kawazoe plication procedure was performed too, but also thrombectomy from left atrium with ligation of the left atrium auricle.
The mean age of patients with coronary heart disease at the moment of surgery made 60,2±8,2 years. The youngest patient was 48 years old, but oldest one was 80 years old. The males prevailed among patients (94,4%). In several cases the coronary artery bypass grafting was combined with left ventricle remodeling procedure and thrombectomy, but also with radical correction of congenital heart malformation.
The mean age of patients with congenital heart malformations at the moment of surgery made 15,9±11,9 years. The youngest patient was 5 months old, but oldest one was 54 years old. The males slightly prevailed among patients (51,6%). There were generally patients with different types of septal defects, rarely patients with tetralogy of Fallot, supracardial and cardial forms of the partial anomalous pulmonary venous drainage, balanced incomplete and complete forms of atrioventricular septal defects and other obstructive defects on the level of valves and ventricular outlet tracts.
We have used such scales as EuroSCORE (EuroSCORE-II) m Aristotle Basic Complexity score for stratification of the operational risk. The data processing, including the statistic ones, was realized by such application programs as Windows (Excel, Access), but also Statistica 5,5 and programs for calculation of indicators of the stratification scales. The mean size are presented with standard deviations (Mym). The distinctions between mean sizes were considered reliable at values p<0,05.
Results of researches and their discussion
The statistical analysis of logistic indicators of the scale EuroSCORE showed that they were much lower in patients with defects of heart valves and a mild postoperative current: (11,9±8,8)% versus (3,8±2,8)% (p=0,022). The similar situation was also detected in analysis of logistic indicators in patients with coronary heart disease: (6,4±1,8)% versus (3,5±3,1)% (p=0,087).
According to the received results, we can notice the rather considerable difference of logistic indicators of the scale EuroSCORE in patients with acquired heart defects with complications and mild postoperative current. On the contrary, we have not noticed the considerable differences in indicators in patients with coronary heart diseases with complications and mild postoperative current.
According to received results of researches, the degree of an operational risk is relatively high in patients elder than 60 years due to presence of risk factors, being often increased with aging.
As a result of carrying out the statistical analysis of logistic indicators of EuroSCORE in patients with acquired heart diseases the following data were received: in patients aged till 40 years with mild postoperative current the indicators made 3,4±2,3 versus 4,7±4,5 in patients with complicated current. But in patients aged elder than 40 years they were 3,6±2,2 m 15,2±14,5 respectively.
According to scale ABC Score the operational risk in patients with congenital heart malformations made 6,7±3,8 grades on average that corresponded to 2 degree of complexity. The operational risk according to scale ABC Score in patients with
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ВЕСТНИК ХИРУРГИИ КАЗАХСТАНА № 2(43)-2015
congenital heart malformations with complicated postoperative current made 7,9±4,2, but in patients with mild postoperative period it made 5,7±2,2 grades.
The scale EuroSCORE-II, firstly offered in Annual Conference of the European Association of Cardiothoracic Surgeons (EACTS) in Lisbon in 2011, unlike EuroSCORE, allows to perform the stratification of an operational risk according to following factors too: insulin-dependent diabetes mellitus; 1, 2, 3, 4 functional classes according to NYHA; angina pectoris 4 functional class according to CCS; left ventricle function, including: ejection fraction of the left ventricle <20%; pulmonary arterial hypertension, including: the mean pressure in pulmonary artery is 31-55 mm per mercury; the volume of a surgical intervention: isolated CABG, one procedure without CABG, two or three procedures.
Conclusions
Stratification scales of risk estimation EuroSCORE (EuroSCORE-II) present definite possibilities to prediction of the complicated current of an early postoperative period in patients with acquired heart valve defects (p=0,022), especially aged older than 40 years (p=0,024).
The account is necessary with possible correction of type, combination, sequence and the volume of surgical intervention in high and significantly high operational risk according to scales EuroSCORE (p=0,022, p=0,024) and ABC Score (p=0,011).
References
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