| Abstract [eng] |
ANNOTATION OF DISERTATION Subject of disertation: Surgical treatment of patients suffering from ischemic heart disease with significantly decreased left ventricle systolic function: clinical evaluation. Objective - evaluation of clinical status and long-term postoperative survival of patients suffering from ischemic heart disease and decreased left ventricle systolic function (LV EF ≤ 35%) after isolated coronary by-pass grafting and left ventricle volume and shape surgical restoration operations. Retrospective study. The study group included 216 patients for whom coronary artery bypass grafting (CABG) and 139 patients who underwent surgical ventricular restoration (SVR). It was postulated that the long-term survival (up to 7 years) in patients after CABG and long-term survival (6 years) in patients after SVR is good. It was found out that the risk of fatal outcome during the first 30 days after CABG in patients 0suffering from ischemic LV dysfunction and symptoms of angina pectoris with viable myocardium, statistically reliably did not differ from patients with nonviable myocardium. It was stated that patients with greater functional class during one year after CABG, preoperatively had longer duration of ECG QRS complex, higher end-diastolic findings and had lower number of by-passes during the operation. We also demonstrated that LV shape and volume restoration operations were being performed for patients with highly advanced LV remodeling safely and postoperative risk of death was not greater than the risk of isolated CABG operations. It was demonstrated that in patients who had not experienced improvement of functional status during one year period after SVR, the reliable decrease of LV EDD and improvement of LV EF were not present. It was demonstrated that important factors for prediction of perioperative mortality included patient’s NYHA functional class IV, LV EF ≤20%, history of rhythm disturbances, surgical correction of MV insufficiency, aneurysm located in the inferior-posterobasal wall, QRS ≥130 ms. Key words: coronary artery disease, heart failure, myocardial revascularization, surgical ventricular restoration. |
