ABSTRACT
INTRODUCTION: Cardiac surgery patients often need inotropic support to establish hemodynamic stability and adequate oxygen supply. The management of patients with coronary vascular disease can be challenging especially in patients with severe left ventricular dysfunction and critical left main or severe triple vessel disease. METHODS: Article has descriptive character and presents a case report of 58 years old male patient who was admitted to our hospital due to planned coronary bypass surgery. RESULTS: Applying inotropic support, IABP and adequate volume management during surgery and post surgery period in ICU has led to hemodynamic stability. Leading to the recovery of the patient and hospital discharge. DISCUSSION: Given the availability of the treatment options, inotropic and mechanical support played a major role to produce the positive outcome in the presented case. Many factors were unfavourable, extreme hypotension, high lactate and creatining levels, mechanical ventilation and related complications.
Subject(s)
Cardiotonic Agents/therapeutic use , Coronary Artery Bypass/adverse effects , Coronary Disease/surgery , Intra-Aortic Balloon Pumping , Blood Pressure , Coronary Disease/complications , Critical Care , Critical Illness , Humans , Hypotension/etiology , Hypotension/therapy , Intraoperative Complications/etiology , Intraoperative Complications/therapy , Male , Middle Aged , Postoperative Care , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/therapy , Ventricular Dysfunction, Left/complicationsABSTRACT
INTRODUCTION: The aortic valve replacement is a standard operating procedure in patients with severe aortic stenosis. Structure of patients undergoing surgery ranges from young population with isolated mitral valvular disease to the elderly population, which is in addition to the underlying disease additionally burdened with comorbidity. One of the most commonly present factors that further complicate the surgery is coronary heart disease that occurs in, almost, one third of patients with aortic stenosis. The aim is to compare the results of surgery for aortic valve replacement with or without coronary artery bypass graft (CABG). PATIENTS AND METHODS: From August 2008 to January 2013 in our center operated on 120 patients for aortic stenosis. Of this number, 75 were men and 45 women. The average age was 63.37 years (16-78). Isolated aortic valve replacement was performed in 89 patients and in 31 patients underwent aortic valve replacement and coronary bypass surgery. Implanted 89 biological and 31 mechanical valves. RESULTS: Patients with associated aortic stenosis and coronary artery disease were more expressed symptomatic symptoms preoperatively to patients with isolated aortic stenosis who were on average younger age. Intra-hospital morbidity and mortality was more pronounced in the group of patients with concomitant aortic valve replacement and coronary bypass surgery. Morbidity was recorded in 17 patients (14.3%) in both groups, while the mortality rate in both groups was 12 patients (10.1%). CONCLUSION: Evaluation of preoperative risk factors and comorbidity in patients with aortic stenosis and coronary artery disease contributes to a significant reduction in intraoperative and postoperative complications. Also, early diagnosis of associated coronary artery disease and aortic stenosis contributes to timely decision for surgery thus avoiding subsequent ischaemic changes and myocardial damage.
