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Double Minimally Invasive Access - For Combined Damage To The Coronary Arteries And Aortic Valve In Patients With Coronary Artery Disease.
Maksud Muradov, Rustam Yarbekov, Georgiy Li.
American Hospital, Tashkent, Uzbekistan.
Introduction: Combined damage to the coronary arteries and aortic valve is common, especially in elderly patients. In about 40% of patients operated on for aortic valve stenosis, multivessel damage to the coronary arteries is detected. Approximately 60% of patients with coronary artery disease and multivessel coronary artery disease have pathological damage to the aortic valve. Therefore, it is important to consider performing these combined operations from minimally invasive access to reduce injuries.
Material and Methods: From 2020 to the present, 3380 open heart surgeries have been performed in the Department of Cardiac Surgery. For comparison, 400 patients were selected from the total cohort of patients (mean age 53.8 ± 14.3). The patients were divided into 2 groups: Group I (n-223) patients who underwent surgery through a median sternotomy. Group II (n-177) included patients who underwent minimally invasive surgery in the 2th intercostal space on the right and 5th intercostal space on the left. In group II, the length of the skin incision was 7-8 cm, CPB was connected through peripheral arteries. The duration of the operation from the mini-approach was on average (142 ± 23 min), versus sternotomy (156 ± 33 min) min.
Results. In the postoperative period, there were no cases of postoperative pneumonia, severe respiratory failure. There were no significant differences between the groups in the postoperative period. The patient's time in the ICU is 1 day. The duration of hospitalization after surgery was significantly less in group II (4.3±1.2 days), versus (6.4±1.7 days (p<0.05)). At discharge, all patients of group II have less pain, improved condition and quality of life. Indicators of functional and laboratory methods will be better than before operation.
Conclusion. In patients with coronary artery disease with hemodynamically significant aortic valve stenosis, the natural choice is a combined surgery of CABG and aortic valve replacement of two of the minimally invasive approaches. In such cases, performing only isolated CABG determines a high probability of repeated surgery due to the inevitable progression of atherocalcinosis of the artery. Mini-access reduces the traumatic nature of surgery, improves the early postoperative period, reduces the incidence of complications, and is economica
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