HEMOLYSIS IN ARRHYTHMIAS DEVELOPMENT AFTER CORONARY ARTERY BYPASS GRAFTING UNDER ARTIFICIAL CIRCULATION

Abstract

Introduction The operation of coronary shunting in patients with coronary heart disease leads to the development of various complications in the postoperative period, the most frequent are heart rhythm disturbances.

Purpose. To establish the connection of intraoperative hemolysis (IOH) with the development of cardiac rhythm disturbances in patients with coronary artery disease after coronary shunting in conditions of cardiopulmonary bypass (CB).

Material and research methods. The assessment of the degree of IOH was made by the level of free hemoglobin [Hb] In the blood plasma at the beginning of the operation, immediately after the patient was connected to the CB device and 15 minutes before removal from the CB, using the HemoCue Plasma / Low Hb analyzer. According to the degree of IOH, patients (n = 123) are divided into 3 groups (gr.) in accordance with free [Hb]: gr.1 – ≤0,1 g/l; gr.2 > 0.1 g/l and <0,5 g/ l; gr.3 – ≥0,5g/l. Were used the following instrumental methods of investigation: electrocardiography, 24-hour ECG monitoring. Was analyzed the frequency of heart rhythm disturbances in patients after coronary shunting with various levels of IOH in the early (up to 1 month) periods.

Results. Arrhythmias were observed in 2.3% of patients of the 1st group, in 11.9% - the 2nd group, in 52.6% - the 3rd group. Associations were noted between [Hb]. In plasma at the end of cardiopulmonary bypass and the frequency of arrhythmias (rs=0,70, p<0.001). The share of life-threatening and hemodynamically significant arrhythmias in the study period in the group with a high degree of IOH accounted for about half of all arrhythmias that occur, which is significantly more than in the group without IOH and with low IOH, p <0.001.

Conclusion The operation of coronary artery bypass surgery in conditions of artificial blood circulation leads to the development of arrhythmias in the postoperative period in 22% of patients with ischemic heart disease. A significant proportion of these are arrhythmias that pose a threat to the patient’s life and arrhythmias, causing hemodynamic disturbances and hypoperfusion of vital organs.

The largest number of patients with cardiac rhythm disturbances after coronary artery bypass grafting was observed in the group with the level of free hemoglobin in the blood plasma of 0.5 g / l or more (p <0.001), which indicates the relationship between the occurrence of arrhythmias and the degree of intraoperative hemolysis. The high risk of arrhythmias in patients with coronary heart disease after coronary artery bypass surgery is determined when the content of free hemoglobin is more than 0.85 g / l.

One of the ways to assess the risk of heart rhythm disturbances should be to determine the level of free hemoglobin in the blood plasma of patients in the intraoperative period of coronary artery bypass grafting, which is necessary for the timely prevention and correction of possible hemodynamic disorders.