Perioperative acute myocardial dysfunction is an actual problem of cardiac surgery. Rational use of inotropes and mechanical circulatory support in the postoperative period remains a subject of debate. The outcomes of the combined coronary artery bypass grafting and heart valve prosthesis were analyzed in Irkutsk Cardiac Surgery Center after 80 patients were operated on. As a result of the conducted research, authors proposed a method of differentiated approach to the treatment of acute heart failure in the early postoperative period. Failure to escalate therapy beta agonists in the absence of adequate response hemodynamics and the transition to a mechanical circulatory support improves performance of the cardiovascular system and clinical outcomes, reduces hospitalization duration in the department of intensive therapy. The study showed the superiority of an early beginning of an intra-aortic balloon counterpulsation before traditional inotropic therapy in the treatment of postcardiotomy heart failure at combined cardiac surgery.
acute heart failure, combined heart surgery , differentiated approach, intra-aortic balloon counter pulsation
1. Bokeriya LA, Gudkova RG (2014). Cardiovascular surgery – 2013. Diseases and congenital anomalies of the circulatory system [Serdechno-sosudistaja hirurgija – 2013. Bolezni i vrozhdennye anomalii sistemy krovoobrashhenija], 220.
2. Gardner RS, McDonagh TA, Walker NL (2014). Heart failure [Serdechnaja nedostatochnost’], 360.
3. Krymov KV (2014). Modern view on the preventive intra-aortic balloon counterpulsation and its role in the treatment of patients with severe and complicated forms of ischemic heart disease [Sovremennyj vzgljad na profilakticheskuju kontrpul’saciju vnutriaortal’nym ballonom i ejo rol’ v lechenii bol’nyh s tjazhjolymi i oslozhnjonnymi formami ishemicheskoj bolezni serdca]. Bjul. NCSSH im. Bakuleva RAMN, 4 (15), 4-10.
4. Nadiradze ZZ, Bakhareva YA, Nadiradze TZ, Podkamenny VA. (2005). Analysis of risk factors as an indication for the use of intra-aortic balloon counterpulsation [Analiz faktorov riska kak pokazanie k primeneniju vnutriaortal’noj ballonnoj kontrpul’sacii]. Materialy dokladov XII Rossijsko-Japonskogo medicinskogo simpoziuma, 217-218.
5. Shumakov VI, Tolpekin VE, Shumakov DV (2003). Artificial heart and circulatory support [Iskusstvennoe serdce i vspomogatel’noe krovoobrashhenie], 376.
6. Yavorovskiy AG, Yeremenko AA, Zyulyayeva TP, Konstantinov BA, Molochnikov IO (2006). Preventive intra-aortic balloon counterpulsation in surgical myocardial revascularization [Preventivnaya vnutriaortal’naya ballonnaya kontrpul’satsiya pri khirurgicheskoy revaskulyarizatsii miokarda]. Hirurgija. Zhurnal im. N.I. Pirogova, 1, 4-10.
7. Baskett RJ, Ghali WA, Maitland A et al. (2002). The intra-aortic balloon pump in cardiac surgery. Ann. Thorac. Surg, 74 (4), 1276-1287.
8. Kantrowitz A, Tjonneland S, Freed P (1968). Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA, 203 (1), 113-118.
9. Litton E, Delaney A (2013). Prophylactic intra-aortic balloon counterpulsation in high-risk cardiac surgery: a survey of opinion and current practice. HSR Proc. Intensive Care Cardiovasc. Anesth., 5 (1), 33-39.
10. Moulopoulos S, Topaz S, Kolff W (1962). Diastolic balloon pumping (with carbon dioxide) in the aorta mechanical assistance to the failing circulation. Am. Heart J., 63 (5), 669-675.
11. Vales L, Kanei Y, Ephrem G, Misra D. (2011). Intraaortic balloon pump use and outcomes with current therapies. J. Invasive Cardiol, 23 (3), 116-119.
