FEATURES OF THE PERIOPERATIVE PERIOD OF PATIENTS WITH HIGH-RISK CORONARY ARTERY DISEASE AND GOUT IN CARDIAC SURGERY
Summary. Objective: to study the features of the perioperative period of high-risk patients with coronary artery disease and gout in cardiac surgery. Material and methods: a retrospective analysis of 354 high-risk patients with coronary artery disease (CAD) in cardiac surgery. ECG, ECHO, coronary angiography and surgical treatment of CAD were performed for each patient. Hyperuricemia was not screened in this study, only patients with gouty arthritis were recorded. Results: among 354 high-risk patients with CAD gout was diagnosed in 30 (8.47%) patients, for whom type 2 diabetes mellitus was significantly more often diagnosed (56.6% vs 22.5% without gout, p<0, 01), chronic kidney disease (CKD) G3a-4 stage (63.3% vs 32.4% without gout, p<0.01), obesity (60% vs 35.4% without gout, p<0.01), varicose veins of lower extremities (50% vs 29.6%, p <0.05). The operative stage of patients with gout was characterized by a greater number of grafts 3.3 vs 3.04 and frequent use of internal mammary artery (IMA) (66.6% vs 55.8%). When comparing intraoperative findings of patients with and without uric acid metabolism disorders, the predominance of coronary artery intra-operative calcification (16.6% vs 6.7%), small artery diameter (16.6% and 9.5%) and intramural location of CA was noted in gout group (56.6% vs 19.7%). The postoperative period of patients with uric acid metabolism disorders was characterized by significantly more frequent development of AF in patients with gout — 43.3% vs 14.6% (p<0.01), pneumonia (6.66% vs 0.92%, p<0, 05), exacerbation of gastroduodenal ulcer (6.66% vs 0.3%, p<0.01) and sternal wound infection (6.66% vs 1.23%, p<0.01). Conclusions: considering high risk of complications in patients with gout, it is recommended to monitor uric acid levels for all patients before cardiac surgery. In order to prevent exacerbations of gouty arthritis, it is not recommended to cancel xanthine oxidase inhibitors before surgery.
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