Search

Cardiorenal interaction in acute heart failure (AHF) is becoming an increasingly recognized factor to consider in the management of cardiac surgical patients. Achieving adequate control of water balance and simultaneously preserving kidney function is the goal of the optimal management strategy for patients with AHF. The majority of preoperative hospitalizations to intensive care units in patients with infective endocarditis (IE) are associated with the development of AHF. The term “cardiorenal syndrome” (CRS) is used to define kidney dysfunction on the background of AHF. Due to the lack of clear clinical manifestations of CRS in IE, the diagnosis and treatment of this pathology may be delayed and contribute to the increase in the number of postoperative complications. Recent data, both in basic science and in clinical research, have changed our understanding of CRS. To date, several types of impaired interaction between the kidneys and the heart have been identified. The aim. To study the peculiarities of CRS in patients with IE complicated by AHF. Materials and methods. The basis of this study was the clinical data of 41 patients with active IE who were treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 1/1/2020 to 8/31/2020. In order to study the features of clinical manifestation and the course of CRS, a comparative analysis was conducted based on the history and results of laboratory and instrumental research for the group of patients with IE complicated by preoperative AHF, and patients without clinical manifestations of AHF at the time of hospitalization. For an in-depth study of myocardial damage in heart failure, troponin, NT-proBNP, lactate levels were analyzed; dysfunction of the urinary system was assessed by the level of urea and serum creatinine, the volume of diuresis. Results. A reliable relationship between the levels of NT-proBNP and serum creatinine at the preoperative stage was revealed (p˂0.001), as an indicator of the presence of CRS in patients with IE. In the early postoperative period, signs of CRS persisted in patients with IE complicated by preoperative AHF (serum creatinine 157.0±8.5 μmol/l [p

The aim. To analyze the features of the perioperative period in cardiac surgery patients with stable and unstable angina. Materials and methods. Retrospective analysis of random 194 cardiac surgery patients with coronary artery disease (CAD) and EuroSCORE II > 5%, who were operated and discharged from the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine from 2009 to 2019. All the patients underwent standard clinical, laboratory and functional tests, coronary angiography and coronary artery bypass grafting (CABG). Results. When assessing the initial clinical picture of randomized patients, 110 (56.7%) were diagnosed with stable angina, and 84 (43.2%) with unstable. On admission, acute myocardial infarction (AMI) was diagnosed in 12 (14.3%) patients (p < 0.0001), and among patients with stable angina 91 (82.7%) had a history of AMI (p = 0.0158). All the patients had polymorbidity: the Charlson comorbidity index was 5.7 ± 1.8 in patients with unstable angina and 5.9 ± 1.9 in stable CAD (p = 0.4583). Patients with unstable angina were more likely to have subocclusive-occlusive lesions of the left main coronary artery (p = 0.0083), left anterior descending artery (p = 0.0392) and left circumflex artery (p = 0.0387). All the patients were discussed by the cardiac team prior to surgery which was performed by experienced cardiac surgeons with 24 ± 12.5 years of experience. Emergency surgery was performed in 43 (51.1%) patients with unstable angina and 12 (10.9%) with stable angina (p