Respiratory system functional state in patients after the left ventricle geometric reconstruction followed by conventional respiratory rehabilitation

Abstract

Relevance. Post-infarction left ventricular aneurysm (PILVA) is the most severe complication of myocardial infarction in patients with ischemic heart disease. Systemic hemodynamic disorders in PILVA can lead to respiratory dysfunction before surgery and worsen cardiorespiratory failure in the postoperative period. Despite modern opportunities for early diagnosis and treatment of respiratory dysfunction, effective methods of postoperative respiratory function recovery have not yet been developed for patients after the left ventricle geometric reconstruction (LVGR). The aim: to investigate the cardiorespiratory status of patients before and after LVGR and to evaluate the effectiveness of conventional respiratory rehabilitation for this category of patients. Materials and Methods. The study involved 43 patients who underwent two types of surgeries: 1) coronary artery bypass grafting (CABG), and 2) CABG with LVGR. Patients were divided into two groups: group I - patients after CABG, and group II - patients after CABG with LVGR. Data collection was carried out in three stages: I - before surgery, II - on the 2nd day after surgery, and III - on the 10th day after surgery. Conventional respiratory rehabilitation was conducted in both groups. Results and Discussion. The results showed a deterioration in preoperative respiratory parameters (FVC [10.3 %, p = 0.039]; FEV1 [11.9 %, p = 0.027]) and cardiac dysfunction (EF [30.2 %, p 0.001]; EDV [56.4 %, p 0.001]) in group II compared to group I. By the time of discharge, no positive dynamics were observed in most of the examined spirometry parameters in group II. In group I, dynamics were noted in almost all analyzed parameters (p 0.05). Analysis of the desaturation index (DI) revealed the presence of pronounced sleep-disordered breathing in all groups during the second postoperative night. On the 10-12th postoperative day, DI in group I reached the preoperative level, while in group II this index remained elevated by 1.56 times (p = 0.006). Conclusion. Patients after LVGR have more pronounced oxygenation reduction, which is caused by both impaired patency at the level of the proximal and middle bronchioles and restrictive disorders associated with increased extracellular fluid volume. This largely forms the pathogenetic basis for the development of respiratory complications in the early postoperative period.