Keywords
perioperative management
acute left ventricular failure
inotropic support
metabolic therapy
How to Cite
Abstract
Introduction. Coronary heart disease is the leading cause of death and disability worldwide. For patients with three or more coronary arteries lesion, revascularization with coronary artery bypass grafting (CABG) is the best treatment. 10% of all patients require re-hospitalization within 30 days of discharge, the most common cause being heart failure. The most formidable complication after CABG surgery with cardiopulmonary bypass (CPB) is the development of acute left ventricular failure (ALVF).
The aim. To analyze the problems of correction of ALVF after CABG with CPB from the sources of modern literature to optimize the management of the perioperative period in this group of patients.
Materials and methods. Bibliosemantic, comparative and method of system analysis. The proposed recommendations are based on the analysis of modern literature, the results of randomized trials and meta-analyzes to study the problem of correction of ALVF after CABG with CPB.
Results. Inotropic support for ALVF after CABG with CPB is prescribed based on the presence of a number of factors. Adrenomimetics, phosphodiesterase inhibitors and calcium sensitizers are prescribed for the correction of ALVF. In addition to inotropics, the myocardium has a positive effect on metabolic drugs: levocarnitine and arginine. When medical treatments are exhausted, resort to the use of hardware treatments: intra-aortic balloon pump, left ventricle assist device, Impella, extracorporeal membrane oxygenation.
Conclusions. Given the variety of classes of drugs and their active components, dobutamine remains the most affordable, safe and effective drug for the treatment of ALVF after CABG with CPB. The combination of L-carnitine and arginine has a number of effects that have a stabilizing effect on the operated myocardium. For the treatment of ALVF after CABG with CPB, in order to achieve a stabilizing effect on the myocardium, it is advisable to investigate the combined use of dobutamine with L-carnitine and arginine to combine the positive effects of drugs.
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