Authors
ZHbanov I.V., Uryuzhnikov V.V., Kiladze I.Z., Galimov N.M., Revishvili G.A., Martirosyan A.K., Perevertov V.A., Aleksandrova E.N., SHabalkin B.V.
Russian Scientific center of Surgery named after academician B.V. Petrovsky, Moscow
Abstract
Degenerative aortic valve stenosis is in the 3rd place after hypertension and coronary heart disease among cardiovascular diseases in the elderly population. Without surgical treatment, these patients have an unfavorable prognosis of life with a high mortality rate. Single-stage surgical correction — myocardial revascularization and, as a rule, aortic valve replacement-is currently a radical method of treatment that can improve the prognosis and prolong the life of a patient with coronary heart disease and degenerative aortic valve stenosis. At the same time, combined interventions remain higher-risk operations compared to isolated AV prosthetics or aortocoronary bypass surgery.
The purpose of this work is to determine the optimal tactics of surgical treatment of elderly patients with coronary heart disease and degenerative aortic valve stenosis.
Materials and methods. Between 2010 and 2018, we operated 390 elderly patients. All patients were divided into 2 groups: the study group consisted of successively operated patients who underwent coronary bypass surgery and aortic valve replacement (n = 54). The control group included 78 patients, randomized from 336 patients with no or minor changes in AV, who underwent isolated CABG.
Results. We did not find any significant differences in the frequency of most postoperative complications and in the rate of hospital mortality in comparison with isolated coronary bypass surgery. Therefore, the decision in favor of intervention on the aortic valve in its moderate stenosis may be justified due to the high risk of its further progression, but should be based on a thorough analysis of the risk factors of combined surgery in each individual elderly patient.
Conclusion. The presented research gives grounds to assert that old age is not a contraindication to surgical treatment of patients with coronary heart disease with degenerative aortic valve stenosis.
Keywords: ischemic heart disease, degenerative aortic valve stenosis, old age.
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