Features of Hospital Period in Patients Who Underwent Surgical Treatment for Chronic Thromboembolic Pulmonary Hypertension in Combination With Myocardial Revascularization

AIM OF THE STUDY . To study the features of hospital period after pulmonary endarterectomy (PEA) and coronary artery bypass grafting (CABG) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and surgically significant coronary artery (CA) stenosis, and to conduct a comparative analysis with hospital period after PEA in patients with CTEPH without CA lesions. MATERIAL AND METHODS . An analysis of 141 patients with CTEPH was carried out. The average age is 53.5 (42.7-68.9) years. The 1st group (38 people) consisted of patients with CTEPH and surgically significant CA lesions, the 2nd group (103 people) — without surgically significant CA lesions. An intergroup analysis of clinical and functional data and the course of the early postoperative period was carried out. RESULTS . According to clinical data, the 1st group of patients with CTEPH was characterized by older age (p=0.003), a larger proportion of patients with concomitant type 2 diabetes (p=0.004), arterial hypertension (p<0.001), atherosclerosis of the brachiocephalic arteries ≤ 50% (p<0.001), a history of myocardial infarction (p=0.008), and a higher comorbidity index (p=0.03) compared to the 2nd group of patients. The early postoperative period was more severe in the 1st group of patients with CTEPH, where a higher proportion of patients with the development of neurological disorders (p=0.02), newly diagnosed atrial fibrillation (p=0.04), and a higher proportion of patients with prolonged artificial ventilation (p=0.03) were identified. No intergroup differences were found in hospital mortality (p=0.74). CONCLUSIONS . 1. In patients who underwent PEA in combination with myocardial revascularization, the hospital period is characterized by a more severe course in comparison with patients with CTEPH but without coronary artery disease. This is reflected in a higher incidence of neurological disorders, rhythm disturbances, and prolonged mechanical ventilation. 2. In-hospital mortality between the group of patients who underwent combined intervention and isolated PEA did not differ, despite the impact of concomitant pathology.