Structure of combined operations on the heart among patients with ischemic heart disease
Relevance. Cardiovascular diseases (CVD) remain the leading cause of death in the world. Combined lesions of the coronary arteries and heart valves are not uncommon pathologies, and therefore there is a regular increase in the number of combined surgical interventions. Purpose of the study. To study the gender-age features of combined heart operations among patients with coronary heart disease. Materials and methods. A retrospective analysis of case histories was carried out, which included 1017 patients with coronary artery disease who had coronary artery bypass surgery in 2015 in the cardiology department of the Federal Center for Cardiovascular Surgery of the Ministry of Health of Russia (Chelyabinsk). Among them were 771 (75.8%) men and 246 (24.2%) women. The average age of all patients was (62.7 ± 7.8) years, men - (61.9 ± 7.7) years, women - (65.5 ± 7.9) years. For comparative analysis, patients were divided into types of surgery: the first group (n = 822) - patients who underwent coronary bypass surgery; the second group (n = 120) - patients who underwent coronary bypass surgery and valve replacement; the third group (n = 48) - patients who underwent coronary bypass surgery and resection of the aneurysm; the fourth group (n = 27) - patients who underwent coronary bypass surgery, valve replacement and resection of the aneurysm. Coronary bypass surgery was performed on the basis of the results of coronary angiography. All patients underwent echocardiography with an assessment of the left ventricular ejection fraction. Diagnosis and treatment of patients were carried out according to the standards of health assistance. Statistical analysis was performed using Microsoft Office applications and SPSS Statistics (version 20.0). Results. The results of our study showed a high prevalence of surgery at the age of 55-64 years in the general group, the lack of operations among women at a young age, a high frequency of combined operations among women aged 65-74 years. Currently, patients are referred to earlier stages of heart failure. In most cases, patients are referred with high-grade exertional angina and with stage 1 chronic heart failure. However, among women, CHF of the 2nd stage with low LV EF and with combined operations prevails. There remains a high percentage of patients admitted after myocardial infarction and who have undergone earlier coronary artery stenting. Despite the availability of modern clinical guidelines and a powerful arsenal of drugs, the frequency of arterial hypertension and hypercholesterolemia remains high. There is an increase in the number of patients with diabetes mellitus and acute cerebrovascular accident.