Abstract:

Aim: was to study in-hospital results of high-risk percutaneous coronary intervention (PCI) with extracorporeal circulatory support.

Material and methods: a single center, retrospective study was performed in 49 adult patients undergoing high-risk PCI with mechanical circulatory support (cardiopulmonary bypass - CPB and еxtracorporeal membrane oxygenation – ECMO) performed in high-risk patients with acute coronary syndrome, multiple coronary lesions and impaired ejection fraction between 2011 to 2019. Mean age was 64,4±6,7 years. Previous myocardial infarction had 38(77%) patients, 18(37%) patients had a history of previous cardiac surgery. In 18(37%) patients, ejection fraction (Simpson) was less than 30%. Mean value of the left main (LM) artery stenosis was 74,6±8,9%, while combined with occlusion or subocclusion right coronary artery (RCA) in 38(77%) patients. Multivessel coronary lesion had 42(86%) patients (average SYNTAX Score was 42,1±11,5 points)

Results: 17 patients (35%) underwent high-risk PCI under preventional mechanical circulatory support with CPB. Myocardial infarction, strokes, stent thrombosis, limb ischemia, lethal outcomes were not observed in these patients. 7(14%) patients were admitted to the Cath Lab with myocardial infarction complicated by cardiogenic shock, in 3 patients – with pulmonary edema. 12(24%) patients after previous heart surgery were admitted to the Cath Lab after cardiopulmonary resuscitation on extracorporeal circulatory support, four of them (8%) with ongoing chest compressions. In 6(12%) patients, during CAG/PCI, critical hemodynamic instability was observed, induced by incurable cardiac arrhythmias required an emergency extracorporeal support. Average time of extracorporeal circulatory support was 128,62±92,4 min. Complications associated with CPB and ECMO were not observed. Two patients (4%) had stroke in the postoperative period. Hospital mortality was 17(34,7%) patients.

Conclusion: extracorporeal circulatory supports provide good life maintenance for high-risk PCI and an possibility for emergency PCI in extreme clinical situations.

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Abstract:

Aim: was to reveal factors that cause dyspnea in the early postoperative period after cardiac surgery.

Materials and methods: the study included 818 patients after cardiosurgical interventions in «F^S» Penza from June 2014 to February 2015, with complaints of shortness of breath at rest. The degree of influence of variables was determined using ROC analysis and logistic regression analysis.

Results: dyspnea was noted in 169 patients (19.4 %). ROC-analysis revealed a very large influence on the occurrence of dyspnoea disturbances of the mobility of the diaphragm, the great influence of the frequency of respiratory movements, the average impact of the height of diaphragm domes and low impact of body mass index. Results of logistic regression analysis showed that odds increase in 327 times at a decreased mobility of the left dome of the diaphragm 49 times in dysfunction of the right dome, 4,4-times elevation in the left dome, 3,5 times at the elevation of the right dome, 3.9 times with tachypnea and 2,6 times for severe obesity, in 1,5 times in chronic heart failure II B degree. Other factors, included in research, didn't influence on dispnea appearance.

Conclusions: a leading factor in the occurrence of dyspnea is dysfunction of the diaphragm, especially when decreased mobility of the left dome. To a lesser extent, reasons can be the elevation of diaphragm domes and tachypnea. Obesity 2 and 3 degree and chronic heart failure II B degree, had a small effect on dyspnea.

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