The influence of rhythm disturbances on the results of combined operations of pulmonary endarterectomy and coronary artery bypass grafting in patients with chronic thromboembolic pulmonary hypertension and coronary heart disease

Aim. To study the features of the early postoperative period in patients with chronic thromboembolic pulmonary hypertension (CTEPH) with surgically significant stenosis of the coronary arteries and to evaluate the impact of cardiac arrhythmias on the hospital period after pulmonary endarterectomy (PEA) in combination with coronary artery bypass grafting (CABG).

Material and methods. The study cohort included 45 patients with CTEPH with surgically significant coronary artery stenosis at the age of 61.4 (55.3-69.5) years. All patients underwent PEA (1st stage) and CABG (2nd stage). The relationship between concomitant rhythm disturbances and various complications in the early postoperative period was assessed using logistic regression analysis.

Results. Initially, in the study cohort, rhythm disturbances were recorded in 33.3% of cases, where atrial fibrillation accounted for a large proportion. Among the early postoperative complications, the leading ones were neurological disorders (28.9%). Hospital mortality was 6.7%. Concomitant rhythm disturbances in the studied patients were associated with the postoperative development of neurological disorders (OR 4.7 (2.5-7.3; p=0.02)), heart failure (OR 2.2 (1.5-6.8); p=0.03)) and acute renal failure (OR 2.4 (1.4-7.9; p=0.01)).

Conclusion. In high-risk cardiac surgical patients with CTEPH and surgically significant coronary artery stenosis, various rhythm disturbances are recorded in 33.3% of cases. In the hospital period after PEA and CABG in the studied patients, neurological disorders accounted for a large proportion of complications among the complications. Hospital mortality was 6.7%. Concomitant rhythm disturbances in patients with CTEPH with surgically significant coronary artery stenosis are associated with a more severe course of the early postoperative period and increase the chances of developing neurological disorders, acute renal failure and acute heart failure.

1. Ardashev A.V., Belenkov Yu.N., Matsiukevich M.Ch., Snezhitskiy V.A. Atrial Fibrillation and Mortality: Prognostic Factors and Direction of Prevention. Kardiologiia. 2021;61(2):91-98. (In Russ.) https://doi.org/10.18087/cardio.2021.2.n1348

2. Sammut M.A., Condliffe R., Elliot C. et al. Atrial flutter and fibrillation in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension in the ASPIRE registry: Comparison of rate versus rhythm control approaches. International Journal of Cardiology. 2023;371:363–70. http://doi.org/10.1016/j.ijcard.2022.09.031

3. Cirulis M.M., Ryan J.J., Archer S.L. Pathophysiology, incidence, management, and consequences of cardiac arrhythmia in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Pulmonary Circulation. 2019;9(1):1-15. https://doi.org/10.1177/2045894019834890

4. Chernyavsky A.M., Edemsky A.G., Chernyavsky M.A. et al. Surgical techniques in treatment of patients with chronic postembolic pulmonary hypertension. Russian Journal of Cardiology and Cardiovascular Surgery. 2016;6:38-43 (in Russ.) https://doi.org/10.17116/kardio20169638-43

5. Chen Z., Tan H., Liu X., Tang M. Application of 24 h Dynamic Electrocardiography in the Diagnosis of Asymptomatic Myocardial Ischemia with Arrhythmia in Elderly Patients with Coronary Heart Disease. Li W, editor. Emergency Medicine International. 2022;2022:1–5. http://doi.org/10.1155/2022/3228023

6. Golitsyn S.P., Kropacheva E.S., Maikov E.B. et al. Clinical guidelines «Diagnosis and treatment of heart rhythm and conduction disorders. Part I». Kardiologicheskii Vestnik. 2014;9(2):3-43. EDN SHKUXB (In Russ.)

7. Gorev M.V., Urazovskaya I.L. Atrial Fibrillation Recurrence Rate in Different Clinical Groups: Coronary Artery Disease and Age Matter. Cardiac Arrhythmias. 2023;3(1):31–40. (In Russ.) http://doi.org/10.17816/cardar305725

8. Liu Z., Liu X., Lin F. et al. Duration of regional cerebral oxygen saturation under 40% is a risk factor for neurological injury following pulmonary thromboendarterectomy: A prospective observational study. J Card Surg. 2022;37(9):2610-2617. http://doi.org/10.1111/jocs.16615

9. Asya S. Klinkova., Oksana V. Kamenskaya., Irina Y. Loginova. et al. Dynamics of social and labor status in patients undergoing pulmonary thromboendarterectomy. Eurasian heart journal. 2023;(4):16-22 (In Russ.) https://doi.org/10.38109/2225-1685-2023-4-16-22

10. Havranek S., Fingrova Z., Ambroz D. et al. Atrial fibrillation and atrial tachycardia in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy. Eur Heart J Suppl. 2020;22(Suppl F):F30-F37. http://doi.org/10.1093/eurheartj/suaa096

11. Anghel D., Anghel R., Corciova F. et al. Preoperative Arrhythmias Such as Atrial Fibrillation: Cardiovascular Surgery Risk Factor. BioMed Research International. 2014;2014:1-7. http://doi.org/10.1155/2014/584918

12. Druzhilov M.A., Kuznetsova T.Yu., Druzhilova O.Yu. et al. Atrial fibrillation and chronic kidney disease: main clinical characteristics of patients in selected subjects of the Russian Federation. Cardiovascular Therapy and Prevention. 2023;22(4):3544. (In Russ.) https://doi.org/10.15829/1728-8800-2023-3544

13. Shavkuta G.V., Yakovleva N.V., Shnyukova T.V. Atherosclerotic and non-atherosclerotic changes in brachiocephalic arteries as predictors of cerebral and coronary events (literature review). South Russian Journal of Therapeutic Practice. 2020;1(3):7-15. (In Russ.) http://doi.org/10.21886/2712-8156-2020-1-3-7-15

14. Mityaeva E.V., Kamchatnov P.R., Osmaeva Z.Kh. Cognitive impairment in patients with atrial fibrillation. S.S. Korsakov Journal of Neurology and Psychiatry = Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2023;123(8):12-20. (In Russ.) https://doi.org/10.17116/jnevro202312308112

15. Gagloeva D.A., Mironov N.Yu., Lajovich L.Yu. et al. Atrial fibrillation and chronic heart failure: interrelationship and approaches to treatment. Russian Cardiology Bulletin. 2021;16(2):5-14. (In Russ.) https://doi.org/10.17116/Cardiobulletin2021160215

16. Shkolnikova M.A., Jdanov D.A., Ildarova R.A. et al. Atrial fibrillation among Russian men and women aged 55 years and older: prevalence, mortality, and associations with biomarkers in a population-based study. Journal of Geriatric Cardiology: JGC. 2020;17(2):74-84. https://doi.org/10.11909/j.issn.1671-5411.2020.02.002