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Госпитальные результаты коронарного шунтирования и течение раннего послеоперационного периода у больных с низкой фракцией выброса левого желудочка: аргументы в пользу предоперационной подготовки левосименданом In-hospital results of Coronary artery surgery and current of the early post-operative period in patients with low left ventricular ejection fraction: arguments in preoperative Levosimendan В.П. ГазизоВа, Э.Е. ВласоВа, Е.В. Дзыбинская, В.В. ГрамоВич, В.П. ВасильЕВ, Д.м. ГаляутДиноВ, а.а ШиряЕВ, р.с. акчурин V.P. GazizoVa, E.E. VlasoVa, E.V. Dzybinskaya, V.V. GramoVich, a.a. shiryaEV, V.P. VasiliEV, D.m. GalyautDinoV, r.s. akchurin institute of cardiology named after a.l. myasnikov of national medical research center of cardiology SummaryObjective. low cardiac output syndrome is the main complication of coronary artery bypass surgery (cabG) in patients with low left ventricular ejection fraction (lVEF), wich increases in-hospital mortality. to reduce the risk of this syndrome is the main goal of preoperative medical preparation. levosimendan (l) in addition to standard therapy for chronic heart failure (chF) is expected to be useful for this purpose due to its ability to maintain oxygen balance in ischemic myocardium and at the same time showing a positive inotropic action. Promising results have already received; there is still a need to accumulate more data.Methods. 59 patients with multivessel coronary disease and lVEF ≤35% who underwent cabG were included. 19 patients received l, administered by a cardiologist, as infusion of 12.5mg for 24± 10,5h, without a bolus, 2 days before surgery (group l). 40 patients, operated earlier, made up the retrospective control group (group c). We compared in-hospital results of cabG in patients with lVEF≤35% who was preoperatively treated only with standard therapy for chF (group c) and who additionally received levosimendan (group l). институт клинической кардиологии имени а.л. мясникова ФГбу «нмиЦ кардиологии» минздрава россии, москва, россия Резюме Введение. синдром низкого сердечного выброса -основное и наиболее опасное осложнение коронарного шунтирования (кШ) у больных с низкой фракцией выброса левого желудочка (ФВлЖ), повышающее госпитальную летальность. снизить риск его развития -главная задача предоперационной медикаментозной подготовки. Помимо стандартных препаратов для лечения сердечной недостаточности (сн) с этой целью используется левосимендан, способный сохранять кислородный баланс ишемизированного миокарда на фоне положительного инотропного действия. Получены обнадеживающие результаты, сохраняется потребность в накоплении данных. Материал и методы. обследованы 59 пациентов с многососудистой коронарной болезнью и ФВлЖ≤35%, которым выполнено кШ. из них 19 пациентов, оперированных в 2016-2017 годах, за 2-3 суток до операции в дополнение к стандартной терапии хронической сн получили предоперационную подготовку левосименданом (12,5 мг в течение 24±10,5 часа, без болюса) и составили группу л. Группу ретроспективного контроля к сформировали 40 пациентов, оперирова...

Aim: to work out an approach of preoperative drug preparation for CAD patients with low LVEF and varying degrees of compensation for CHF, to study the possibility of using levosimendan (L) in this preparation. Materials and methods. We studied 82 patients with severe angina pectoris, multivascular coronary disease, extensive postinfarction zone, LVEF ≤35%, chronic heart failure and proven viable myocardium, which performed CABG. All patients received long - term standard CHF therapy before surgery: loop diuretic, ACE/ARA, beta - blocker, aldosterone antagonist. In the first, retrospective part of the study (39 pts), it was determined which factors could be associated with perioperative AHF. In the second, prospective part (43 pts), the course of the operation and the early postoperative period in patients with compensated and uncompensated heart failure were compared; uncompensated pts received L 2 days before surgery in addition to standard therapy. The third, retro - prospective part of the study (37 pts) was the assessment of operation outcome in patients only with uncompensated pre - operative CHF, but with different preoperative drug preparation. Results. Statistically significant direct influence on the perioperative AHF development was provided by the combined clinical sign - venous pulmonary congestion+orthopnea (p