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heart surgery: how to minimize the risk of complications – September 19, 2022

Russian biochemists have made a discovery. It reduces the risk of complications after heart surgery. According to statistics, every fifth patient suffers from them. The technique is based on a blood test, more precisely, on the study of a specific marker – troponin. Timely study of its level in dynamics will help doctors identify patients at high risk of postoperative complications and provide assistance in time.

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Universal marker

The relationship of the level of cardiac troponin (regulatory globular protein of the heart muscle, a specific marker of myocardial damage – approx. ed.) with the risks of complications after elective heart surgery was discovered by a team of scientists from the National Medical Research Center. V. A. Almazov and the National State University of Physical Culture, Sports and Health named after P. F. Lesgaft. Both of these institutions are part of the scientific cluster “Translational Medicine”, which is headed by an honorary citizen of St. Petersburg, General Director of the Center. V. A. Almazova Academician of the Russian Academy of Sciences Evgeny Vladimirovich Shlyakhto. The discovery aroused great interest in the scientific community. A patent for an invention of the Russian Federation, confirming the priority of domestic scientists, was received by these scientific and educational institutions at the end of 2021.

Biochemists and laboratory medicine specialists have established that the ratio between the levels of this marker in the blood of a patient, if measured twice at strictly defined hours, clearly makes it clear how much the heart suffered during the operation and how high the risks of postoperative complications are.

“At the Center. V. A. Almazov, we selected several groups of patients who underwent heart surgery of various types using cardiopulmonary bypass. They took blood every few hours for two days, – says the head of the Department of Biochemistry, Novosibirsk State University. P. F. Lesgaft, Professor of the Department of Laboratory Medicine and Genetics, N.N. V. A. Almazova, MD Vladimir Dorofeikov. – We analyzed the results of operations, the development or absence of complications, the condition of patients, data from dozens of types of laboratory tests. All patients in each group were of approximately the same age and sex, and they underwent the same type of surgery. As a result of the analysis of a large amount of data, we chose the most successful blood sampling points for performing an analysis for cardiac troponin.”

The more complex the cardiac surgery was, the higher the risk of complications
The more complex the cardiac surgery was, the higher the risk of complications
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The conducted scientific research allowed to develop a new indicator, which the St. Petersburg scientists called the “index of myocardial damage”. The results were published in leading scientific journals, reported at all-Russian and international conferences.

“We shared our developments with colleagues within the framework of Russian congresses so that they could also develop this area,” says Vladimir Dorofeikov. It is important that the new technique for assessing the state of the myocardium makes it possible to predict the risk in the early stages after surgery, without waiting for the development of complications.

The fact is that complications after heart surgery appear, according to statistics, in about 20% of cases. This is often. Some of them can be identified by instrumental expensive methods available to the world’s leading clinics – among them is the Center. V. A. Almazova. So, it is possible to detect necrosis (death) of even very small areas of the heart – two or three grams. But after cardiac surgery, other problems arise that may not appear immediately, and most importantly, begin asymptomatically.

The weight of the heart depends on the body weight and height of a person, on the level of his physical activity. But on average, this organ in an adult weighs 300 grams.

Who is at risk?

In part, notes Vladimir Dorofeikov, one can focus on the degree of technical complexity of the operation that was performed on the patient. In a person whose heart was turned off for a very short time, the risks of developing complications are significantly lower than in someone who spent several hours on the operating table with a heart-lung machine.

“Most often, after interventions, heart failure occurs, a condition in which the heart does not pump blood well, or heart rhythm disturbances – their reason is that electrical signals are not transmitted well enough in the atria or ventricles,” says Vladimir Dorofeikov. And he adds that there is another type of complications that can develop after surgery – acute myocardial infarction. Diagnosis of postoperative infarction is always a difficult task for a clinician, since after a planned heart operation all patients complain of pain, the cardiogram is often uninformative. This is where the new method, developed by scientists from St. Petersburg, will help.

One of the authors of the methodology, Professor Vladimir Dorofeikov
One of the authors of the methodology, Professor Vladimir Dorofeikov
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If doctors can identify patients at high risk of developing complications, they will have time to respond and prevent them. So timely blood tests will help to avoid complications, and sometimes save the lives of patients. What is more important, the new technique shows good results regardless of what kind of cardiac surgery was performed: coronary artery bypass grafting, valve surgery, or innovative techniques were used that increase the resistance of the heart to oxygen deficiency (myocardial preconditioning).

Surgeons sometimes have to operate on young people with coronary disease
Surgeons sometimes have to operate on young people with coronary disease
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Among the prerequisites for cardiovascular diseases, which are the main cause of death in our country, the leader is atherosclerosis, which causes coronary heart disease. Therefore, heart surgery today is not uncommon. According to Professor Dorofeykov, earlier with such a diagnosis, people over 50-60 years old were mostly admitted to hospitals, and now even 40-year-olds. Among the main reasons for this situation, the biochemist calls chronic stress, depression, malnutrition and diabetes. As well as excessive physical activity – they must also be properly organized so as not to cause harm, especially in elite sports.

So far, the method for determining the “index of myocardial damage” in cardiac surgery clinics is not widely used. Research is ongoing. The staff of the Center V. A. Almazov and the University. P. F. Lesgaft continue to study the effectiveness of the dynamic determination of troponin and other innovative blood tests. Scientists are confident that modern blood tests will help both cardiologists and sports doctors, coaches of our national teams – after all, in the end, every invention is designed to improve people’s lives.

The more complex the cardiac surgery was, the higher the risk of complications
The more complex the cardiac surgery was, the higher the risk of complications
One of the authors of the methodology, Professor Vladimir Dorofeikov
One of the authors of the methodology, Professor Vladimir Dorofeikov
Surgeons sometimes have to operate on young people with coronary disease
Surgeons sometimes have to operate on young people with coronary disease

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