DETERMINATION OF A DIFFERENTIATED APPROACH TO SELECTING THE METHOD OF EFFECTIVE SURGICAL CORRECTION OF THE MITRAL VALVE IN PATIENTS WITH ISCHEMIC REGURGITATION AND ISCHEMIC HEART DISEASE

Abstract

The aim of the work: to create an algorithm for a differentiated approach to choosing a technique for effective surgical mitral valve correction in patients with ischemic mitral regurgitation and coronary heart disease.

Materials and Methods. The study included patients with ischemic mitral regurgitation and coronary heart disease (n=140), both males (n=99) and females (n=41), the average age of the study participants was 65.9 ± 4.0 years. All patients in the sample underwent operations for myocardial revascularization and mitral valve plastic/prosthesis. The material for the analysis was data from the primary accounting medical documentation: medical history, physical, clinical, laboratory and instrumental examination data.

Results and Discussion. In the course of the study, the peculiarities of the clinical course and the data of the clinical and instrumental examination of patients with ischemic mitral regurgitation and coronary heart disease were established, which allowed us to implement in the future our attempt to create an algorithm based on a differentiated approach to the selection of the technique of effective surgical correction of the mitral valve. Specifically, the following indicators were found to be statistically significant: duration of arterial hypertension over 25 years (р=0.05, χ2=3.84); the debut of arterial hypertension before the age of 40; features in echocardiography indicators; the average degree of left ventricular hypertrophy (p=0.04, χ2=3.92); the severe degree of left ventricular hypertrophy (p=0.06, χ2=3.52); severe mitral insufficiency (p=0.03, χ2=4.69); the presence of myocardial akinesis, (p=0.04, χ2=4.21); the presence of hypokinesis of the myocardium: according to the localization of akinesis of the posterior-lower-lateral parts of the myocardium, (р=0.001, χ2=19.76); according to the degree of severity: moderate hypokinesis, (p=0.008, χ2=46,417,03); significant hypokinesis, (p=0.03, χ2=4.32), etc. As a result, it made it possible to form an algorithm based on a differentiated approach to the selection of effective surgical mitral valve correction techniques, the essence of which is that a certain phenotype of a patient with ischemic mitral regurgitation and coronary heart disease is formed under the complex influence of primary etiological and secondary modifying factors.

Conclusions. An algorithm of a differentiated approach to the selection of an effective surgical mitral valve correction technique in patients with ischemic mitral regurgitation and coronary heart disease was created, thanks to which it is possible to form dispensary observation groups during periodic medical examinations or during hospitalization in a cardiac surgical hospital.