CARDIO-RESPIRATORY SYSTEM IN LATE REHABILITATION PERIOD AFTER CORONARY ARTERY BYPASS GRAFT SURGERY

Aim. To identify specific features of cardio-respiratory status in the late rehabilitation period after coronary artery bypass graft surgery (CABG). Material and methods. The study included 25 men (mean age 55,7±6,1 years), who underwent CABG more than 3 years ago. Functional class (FC) of angina and heart failure (HF) was assessed. Cardiovascular status was assessed using echocardiography (EchoCG) and Holter electrocardiography (ECG) monitoring. Lung function (LF) measurement was used for the assessment of respiratory status. Results. Before CABG, most patients had FC 3 angina and Stage II HF; in the late rehabilitation period, low FC angina and Stage I HF (in >50% of the participants) were registered. Five-year incidence of recurrent angina was under 50%. Prior to CABG, FC 2 HF was the most prevalent, while the late rehabilitation period was characterised by the highest prevalence of FC 1 HF. According to EchoCG results, left ventricular (LV) myocardial contractility improved after CABG. In the late rehabilitation period, the number of supraventricular extrasystoles decreased, and the Lown grade of ventricular extrasystoles reduced. An increase in QT interval by 4,4±3,2% was observed in 8 patients. At Holter ECG, myocardial ischemia was registered in 2 patients. Mean LF parameters appeared normal; abnormal LF results were observed only in 4 participants (16%; 2 with obstructive respiratory dysfunction and 2 with restrictive respiratory dysfunction). Out of 25 examined post-CABG patients, only a small number followed the recommendations on non-pharmaceutical therapy, while administered pharmaceutical treatment was received by all participants (monotherapy by 8% (n=2) and combination therapy by 92%). Conclusion. In the late rehabilitation period after CABG, angina and HF FC decreased (in 88% and 64% of the patients, respectively), no ischemic episodes were registered at Holter ECG (92%), LV myocardial contractility improved, and respiratory function was preserved. All participants followed the recommendations on complex pharmaceutical therapy. However, 68% did not follow the nonpharmaceutical treatment recommendations.

coronary heart disease, coronary artery bypass graft surgery, cardiorespiratory system

1. Bulavin, V.V., Shchegol’kov A.M., Kowal A.M. et al. Sanatorium stage of rehabilitation of patients with coronary artery disease undergoing coronary artery bypass graft surgery.M.: OOO “Technology –3000”, 2003. Russian (Булавин В.В., Щегольков А.М., Коваль А.М. и др. Санаторный этап реабилитации больных ишемической болезнью сердца, перенесших операцию аортокоронарного шунтирование. М: ООО «Технологии –3000»; 2003).

2. Kremnev Y.A/Rehabilitation of patients after coronary artery bypass surgery. http:// www.smclinic.ru/storyshow (15 оctober 2008). Russian. (Кремнев Ю.А. Реабилитация больных после аортокоронарного шунтирования. http://www.smclinic.ru/storyshow (15 октября 2008 года)).

3. Diagnosis and treatment of stable angina. In: National clinical guidelines. M.: Cardiovascular therapy and prevention. 2008, 7 (6), Annex 4. Russian. (Диагностика и лечение стабильной стенокардии. В кН: Национальные клинические рекомендации.М.: Кардиоваскулярная терапия и профилактика. 2008; 7 (6), Приложение 4).

4. American Association of Cardiovascular and Pulmonary Rehabilitation/Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs, 3. 1999. http://www.aacvpr. org/SearchResults

5. Pogurelskaya E.P., Sledzevski I.K., Babi L.N. Clinical and hemodynamic predictors of the effectiveness of rehabilitation treatment of patients with postinfarction cardiosclerosis after coronary artery bypass grafting and aneurysmectomy. National Science Center “Institute of Cardiology. Acad. Strazhesko “AMS of Ukraine, Kiev. http://www.ukrcardio. org/journal.php (April 2009). Russian. (Погурельская Е. П., Следзевская И.К., Бабий Л.Н. Клинико-гемодинамические предикторы эффективности восстанови тельного лечения больных с постинфарктным кардиосклерозом после проведения аортокоронарного шунтирования и аневризмэктомии. Национальный научный центр «Институт кардиологии им. акад. Н.Д. Стражеско» АМН Украины, Киев. http://www. ukrcardio.org/journal.php (апрель 2009)).

6. Sledzevski IK LN Babi, SJ Sawicki etc. “The course of coronary heart disease after bypass surgery in patients with myocardial infarction (data from the two-year followup) www.banner.kiev.ua (May 15, 2003). Russian. (Следзевская И.К., Бабий Л.Н., Савицкий С.Ю. и др. «Особенности течения ишемической болезни сердца после проведения операции аортокоронарного шунтирования у больных, перенесших инфаркт миокарда (данные двухлетнего наблюдения) www.banner.kiev.ua (15 май 2003)).

7. Schneider, Y. Autoarterialnoe autovenous and coronary artery bypass for ischemic heart disease. Abstract. thesis. Dr. med. Sciences. St. Petersburg: 2003: 37. Russian. (Шнейдер Ю.А. Аутоартериальное и аутовенозное шунтирование коронарных артерий при ишемической болезни сердца. Автореф. дис. д ра мед. наук. СПб.: 2003: 37)

8. Klimko V.V., Ph.D. Optimization of staged medical rehabilitation of patients with coronary artery disease undergoing coronary artery bypass grafting.M.: 2009. p.15. Russian. (Климко В.В., автореферат «Оптимизация этапной медицинской реабилитации больных ИБС, перенесших коронарное шунтирование» М.: 2009. с. 15)

9. Bayandin NL, Vischipanov AS, Hu Chang Fu. Long-term results of multiple autoarterialnogo bypass surgery. Russ J Cardiol 2010, 3 (83): 68–73. Russian. (Баяндин Н. Л., Вищипанов А.С., Ху Чан Фу. Отдаленные результаты множественного аутоартериального шунтирования. Российский кардиологический журнал 2010, 3 (83): 68–73)