The Results of Surgical Treatment of Patients with Many Valve Defects in Combination with Coronary Pathology

The objective: to analyze the impact of various surgical management on the duration of the ischemic period and the quality of myocardial protection during simultaneous combined correction of two-three heart valves and myocardial revascularization. Materials and methods. The results of the treatment of single-stage multivalve correction in combination with coronary artery bypass grafting in 93 patients, which was performed at the M.M. Amosov National Institute of Cardiovascular Surgery for the period from 2014 to 2021, were studied. Depending on the methods and the sequence of surgical manipulations, the patients were divided into three groups. I group – 42 patients who had the correction of heart valves firstly and then aortocoronary shunting in conditions of pharmaco-cold cardiac arrest, II group – 36 patients who first had aortocoronary bypass surgery, then valve correction in conditions of pharmaco-cold cardiac arrest, III group – 15 patients, who at the first stage had coronary artery bypass grafting on a working heart, then – correction of valve damage in conditions of pharmaco-cold cardiac arrest. Results. The use of the technique of primary restoration of coronary blood flow by shunting coronary arteries in a working heart before clamping the aorta (before pharmaco-cold cardiac arrest and the start of artificial blood circulation) allows to reduce the duration of artificial blood flow and ischemic time, which positively affects the heart rhythm in the postoperative period. Conclusions. The technique of performing aortocoronary shunting on a working heart is more effective than when performing aortocoronary shunting in conditions of pharmaco-cold cardiac arrest. This technique requires more time to perform and is technically more difficult, but it can statistically significantly reduce the time of myocardial ischemia, which reduces the frequency of severe heart failure and the frequency of postoperative complications.