THE RESULTS OF OPEN HEART SURGERY IN VERY ELDERLY PATIENTS AGED 80 YEARS AND OLDER WITH SEVERE AORTIC STENOSIS
Introduction. The purpose of research is to study the results of surgical treatment of critical aortic stenosis under extracorporeal circulation in patients over 80 years. Material and methods. The study included 12 patients including 4 (33.3%) men and 8 (66.7%) women after aortic valve replacement under extracorporeal circulation. The mean age of patients was 82.3±2.4. Isolated aortic valve replacement performed 8 (66.7%) patients, two patients carried out simultaneous operations aortic valve replacement combined with coronary bypass surgery, in two cases before aortic valve replacement patients performed transluminal balloon angioplasty with stenting of coronary arteries. The average EuroScore 2 rate for the group was 9.1±2.5. Period of observation ranged from 6 to 24 months, the mean follow-up was 18.2±6.2 months. Results. During hospital stay fatal cases were no observed. In the early postoperative period in 5 (41.7%) patients were diagnosed with nonfatal complications, including respiratory failure in 2 cases (16.7%), pneumonia - in one case, a violation of cardiac rhythm - in 2 patients (16.7%), neurological disorders - in 2 (16.7%) patients, in 1 (8.3%) patients - acute cerebrovascular accident, one (8.3%) cases of pericardial effusion, one (8.3%) patients developed renal failure. During the observation period one patient died on fourth month after surgery because of progression of renal failure. Positive changes in the basic hemodynamic parameters were observed in the early postoperative period and persisted in the majority of patients during the observation period. The study revealed positive dynamics of functional class (FC) of the group. In most patients (83.3%) after surgery was determined FC I-II (1.85±0.75 for NYHA), whereas prior to operation it was 3.25±0.5 an average for the group. Conclusion. Results of the study demonstrated a significant improvement in clinical and functional status of patients with stable positive changes of hemodynamic parameters during the observation period. The tactics of treatment of this complex group of patients saved numerous unresolved questions. Necessary continue in this direction in order to optimize the treatment of these patients.