PROPHYLAXIS OF CEREBRAL AND CARDIACCOMPLICATIONS AT OPEN SURGICAL REPAIROF INFRARENAL ABDOMINAL AORTIC ANEURISM

Abstract

Introduction. A problem of tactic determination of abdominal aortic aneurysm surgical treatment at
combined pathology of carotid and coronary arteries remains actual and polyhedral, but it has no final
solution yet.
Aim of research. To study effectiveness of therapeutical and stage-by-stage surgical correction of
combined pathology of coronary and carotid arteries during open surgical repair of abdominal aortic
aneurysm.
Methods: Calculation of selection rate carried out for regression analyses using PASS 200
programm, version 12.0.4. Retrospective and prospective nonrandomized clinical research of 262
patients after surgical treatment on abdominal aortic aneurysm in 1998-2015 study period were carried
out, which were divided into 2 groups depending on tactics and method of surgical treatment. In 1 –
control group 92 (35,1%) patients after open surgical repair of abdominal aortic aneurism with no
surgical correction of cardiac and cerebral ischemia complication predictors, had been undergoing
therapeutical treatment of combined pathology in arterial basin of heart and brain; this group has been
created to establish predictors of complications. 2nd group of patients or group of study – 170 (64,9%)
patients after open surgical repair of abdominal aortic aneurysm with surgical correction of complication
predictors, in which preliminary surgical correction of arterial pathology of heart and brain were
preformed according to indications. Analysis of predictors of complication and mortality rate in 30 day
period carried out by logistic regression; in 5 years of postoperative period analyzed by Cox regression
with correction of Firth.
Results: In 30 days of postoperative period myocardial infarction developed in 7 (7,6%) cases, in 2nd
group of patients 1 (0,6%) (р=0,020); case of myocardial infarction; in 5 years of postoperative period in
4 (4,5%) cases in 1st group and in 2 (1,2%) cases in 2nd group. Stroke developed in 3 (3,3%) cases in
30 days of postoperative period in 1st group of patients and in (1,2%) (р=0,317) cases in 2nd group; in 5
years of postoperative period 4 (4,5%) cases in 1st group and 3 (1,8%) cases of stroke in 2nd group.
Conclusions: Preliminary surgical correction of coronary artery pathology (OR 0,068; 95% CI 0,005-
0,443) and normal ejection fraction of left ventricle (OR 0,911; 95% CI 0,859-0,965) decreases risk of
myocardial infarction development; internal carotid artery (ICA) stenosis (OR 1,145; 95% CI 1,052-1,246) increases risk of ischemic stroke in 30 days of postoperative period. Development of myocardial
infarction influences on survival as in 30 days of postoperative period (RR 6,159; 95% CI 4,027-8,938),
so in 5 years of postoperative period (RR 3,509; 95% CI 1,153-5,945); stroke development influences
on 5 year survival rate of patients (RR 3,273; 95% CI 1,177-5,509).