Anton MinaevA.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Russia
Title: Surgical tactics in congenital heart defects in elderly patients: emphasis on comorbidity
The treatment of congenital heart defects (CHD) in adult patients remains an actual problem, especially in elderly group. The goal of the study is to present the structure of CHD, the algorithm for their diagnosis, the possible stages of treatment, and the immediate results of post-operative correction in patients above 60 years old.
Materials and methods. The study included 77 patients who were operated for CHD aged between 60 to 75 years old, over the period from 2008 to 2022. The Congenital heart defects represented were, secondary atrial septal defects (51 patients, 66%), partial anomalous pulmonary venous return (12 patients, 16%), patent ductus arteriosus (7 patients, 9%), ventricular septal defect (4 patients, 5%), pulmonary artery stenosis (2 patients, 3%), corrected transposition of the great vessels with a permanent atrial flutter (1 patient, 1%). Mild or moderate pulmonary hypertension was noted in 64% of cases. In 34% of cases, various forms of atrial fibrillation were detected. Other diseases (of the gastrointestinal tract, respiratory system, kidneys, etc.) were noted in 78% of cases.
Open heart surgery was performed in 45 patients (58% of cases) with conditions needing artificial circulation, endovascular procedures - 31 patients (40% of cases), electrical cardiac stimulation implant -1 patient (1% of cases). The most commonly performed interventions were tricuspid valve repair, radiofrequency ablation, mitral valve repair, coronary artery bypass grafting.
In 7 cases CAD and CHD correction were performed percutaneously - coronary stenting as the first stage, defect closure at interval of 4 to 10 days as the second. One patient underwent coronary stenting 7 months prior to open-heart surgery. In 9 cases one-stage CAD and CHD correction was performed simultaneously.
Outcomes. There were no mortalities and no complications during the postoperative period in the general group of patients in 74% of cases. After open-heart surgery, the most common complications were heart failure, respiratory failure, and heart rhythm disturbances (in 18% of cases). After endovascular correction, 1 patient developed heart rhythm disturbances (3%).
Anton Minaev has completed his PHD at the age of 27 years from A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow. He is a senior researcher of congenital heart disease department. He has over 40 publications in Russians and International journals with the main topic about diagnosis and treatment of congenital heart disease in adults.