Taking into account the aging of the population, the number of operations for surgical correction of valvular heart defects under cardiopulmonary bypass (CPB) in this category of patients over the past 10 years has been performed in many cardiac surgical clinics of the Russian Federation and the number of such operations is constantly increasing. By improving surgical, anesthetic and perfusion benefits, improving the quality of the introduction of the postoperative period and rehabilitation measures, new opportunities are opening up for the successful treatment of elderly and old patients.
The question of the portability of the operation in each case requires an individual approach. Well-known interventional cardiologist Peter Block, in his traditional American College of Cardiology news release, asked a PARTNER A Michael J. Reardon study participant what valve he would prefer for a 40-year-old patient. Michael J. Reardon replied that he would advise a young patient to implant mechanical valve prosthesis, but for a patient ≥60 years old he would consider transcatheter aortic valve implantation as an alternative, due to the fact that in this age group, comorbidity also increases, which requires an individual approach to the choice of method treatment.
In addition to the application of clinical, instrumental and laboratory research methods, it is necessary to adequately assess the physiological status of the patient and, in essence, determine: the correspondence of the biological age of the patient to his physiological capabilities; to analyze the impact of existing concomitant diseases on the perioperative and early postoperative period; determine the degree of cognitive impairment (transferred stroke, dementia).
The analysis of the obtained data must be compared with the EuroSCORE II and SYNTAX Score (STS), and the decision on the possibility and safety of the heart valve correction operation under CPB conditions should be made by an extended interdisciplinary consultation with the participation of a cardiologist, cardiac surgeon, anesthetist, endocrinologist, neurologist, hematologist, detoxologist and etc.
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About the authors
- Dmitriy M. Pelekh, Cand. Med. Sc., Researcher, Cardiologist, ORCID
- Tat’yana G. Nikitina, Dr. Med. Sc., Professor, Head of Department, ORCID