Predictors of intraoperative complications and on-pump conversions of isolated coronary artery bypass grafting in patients with coronary artery disease
Background. Direct myocardial revascularization is the most effective, and sometimes the only method of treating patients with coronary artery disease. At present, there are basic technologies of coronary artery bypass grafting (CABG) — with artificial circulation, on-pump, and beating heart operations — off-pump. Off-pump CABG has certain advantages, but there are often situations requiring an urgent conversion to artificial circulation. An emergency conversion to artificial circulation affects the immediate results of surgical treatment, so it is optimal preoperative identification of patients at high risk of conversion. The purpose of the study was the optimization of indications for artificial circulation by determining the predictors of intraoperative complications and the conversion of off-pump CABG to cardiopulmonary bypass. Materials and methods. The retrospective analysis of the disease history was performed in 4068 patients who were operated in the department of surgical treatment of coronary artery disease in Amosov National Institute of Cardiovascular Surgery. All patients had isolated CABG, including 82 (2.0 %) patients with emergency conversion to cardiopulmonary bypass and 110 (2.7 %) patients with planned artificial circulation. Results. It was found that in patients with emergent conversion to cardiopulmonary bypass during CABG, levels of 30-day mortality rate and postoperative complications were significantly higher (heart failure, lung failure, renal dysfunction, infections). According to the results of the initial clinical and anamnestic data (concomitant pathology, features of the main and concomitant cardiac pathology, emergency of the operation and features of coronary artery defeat), predictors of intraoperative complications were identified, including those requiring emergent conversion to the artificial circulation, and a comprehensive system was proposed for evaluating the risk of intraoperative complications. Conclusions. The proposed prognostic method allows us to identify patients requiring CABG with planed artificial circulation.
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