Radikālas ķirurģiskas miokarda revaskularizācijas nepieciešamības izvērtējums gados veciem pacientiem ar kombinētu aortālu sirdskaiti un koronāro sirds slimību

The aging of population has led to an increased number of elderly patients undergoing heart surgery. These patients generally have lesser biological reserves and more comorbid conditions that results in higher postoperative mortality and morbidity.
Hypothesis: perhaps the potential benefit of the shorter operative, cardiopulmonary bypass and aortic cross-clumping time in elderly patients with incomplete revascularization overweigh the advantages of complete revascularization.
The purpose of this study is to assess the necessity of complete revascularization in elderly patients with concomitant aortic valve stenosis and coronary heart disease.
The study included 66 patients older than 70 years who had undergone concomitant aortic valve replacement and coronary artery bypass grafting. They were divided into four groups, based on coronary artery angiography and completeness of revascularization.
The surgeons have a tendency to perform isolated aortic valve replacement without coronary artery bypass grafting in patients with more severe aortic heart disease. Operative, cardiopulmonary bypass and aortic cross-clumping time were not significantly different between patients with complete and incomplete revascularization. The worst outcome as the highest mortality, the most frequent inotrope and   intra-aortic balloon pump use or prolonged mechanical ventilation was found in patients with incomplete revascularization.
Conclusion. In elderly patients with combined aortic and coronary heart disease complete revascularization is highly recommended. In elderly patients with severe aortic stenosis aortic valve replacement without miocardial revascularization is permissible.