vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2025-1-198-208vtio-1848Research ArticleСмежные дисциплиныRelated DisciplinesВлияние лучевой терапии органов средостения на 30-дневную летальностьEffect of mediastinal radiotherapy on 30 day mortality after cardiac surgeryhttps://orcid.org/0000-0002-7962-7273СоркомовМ. Н.SorkomovM. N.

Соркомов Максим Нюргустанович

121552, Москва, Рублевское шоссе, д. 135. Тел. (495) 414-78-49

Maxim Sorkomov

135, Rublevskoe Shosse, Moscow, 121552. Phone: (495) 414-78-49

sorcommn@gmail.comБабенкоС. И.BabenkoS. I.

Москва 

Moscow

ТитовД. А.TitovD. A.

Москва 

Moscow

СачковА. С.SachkovA. S.

Москва 

Moscow

ТереховМ. И.TerekhovM. I.

Москва 

Moscow

СеровР. А.SerovR. A.

Москва 

Moscow

МуратовР. М.MuratovR. M.

Москва 

Moscow

ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии имени А.Н. Бакулева» Минздрава РоссииРоссияBakulev National Medical Research Center for Cardiovascular SurgeryRussian Federation202526032025271198208Copyright © Соркомов М.Н., Бабенко С.И., Титов Д.А., Сачков А.С., Терехов М.И., Серов Р.А., Муратов Р.М., 20252025Соркомов М.Н., Бабенко С.И., Титов Д.А., Сачков А.С., Терехов М.И., Серов Р.А., Муратов Р.М.Sorkomov M.N., Babenko S.I., Titov D.A., Sachkov A.S., Terekhov M.I., Serov R.A., Muratov R.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1848

 Поздние осложнения, затрагивающие сердечно-сосудистую систему, зависят об обширности захвата в радиационное поле структур сердца, кумулятивной дозы воздействия и характеризуются полиморфизмом клинических проявлений. Цель: выявление предикторов, влияющих на госпитальную летальность, для оптимизации лечения пациентов с лучевым поражением сердца. Материалы и методы. Это исследование одной когорты пациентов, которое с 2004-го по 2018 год носило ретроспективный, а с 2018 года проспективный характер. Конечной точкой исследования считался летальный исход после кардиохирургического лечения клапанной патологии в условиях искусственного кровообращения в течение 30 суток с момента операции. В исследование вошли 86 пациентов (средний возраст 59 ± 13 лет, 81,4% женского пола), подверг­ шихся кардиохирургической операции клапанной патологии сердца, которые были разделены на 2 группы (обширная, тангенциальная) по этиологии онкологического заболевания. Результаты. В послеоперационном периоде в группе с обширным облучением были статистически значимые различия в необходимости проведения пролонгированной вентиляции – отношение шансов (ОШ) 5,17; ДИ 95% 1,7–15,7. Чаще встречались экссудативный плеврит ОШ 3,4 (ДИ 95% 1,1–10,8) и острая почечная недостаточность ОШ 1,2 (ДИ 95% 1,05–1,37). Независимо от послеоперационных осложнений время нахождения в стационаре в группах статистически не отличалось, медиана составила 10,5 (межквартильный интервал 7,25 : 16,75) против 11 (межквартильный интервал 9 : 15,25) дней соответственно. Общая госпитальная летальность – 14 (16,27%) пациентов. В 9 случаях причиной летального исхода была полиорганная недостаточность. В результате многофакторного анализа было выявлено, что обширное облучение при лимфогранулематозе повышает риск госпитальной летальности в 5,099 раза, а увеличение показателя шкалы EuroSCORE II на каждую единицу увеличивает риск госпитальной летальности в 1,19 раза. Выводы. Больные с постлучевым поражением клапанов сердца и коронарных артерий с перенесенным тангенциальным облучением в анамнезе могут быть успешно оперированы. Обширное облучение в анамнезе связано с высоким риском развития сердечной и полиорганной недостаточности в раннем послеоперационном периоде. 

Late complications affecting the cardiovascular system depend on the extent of the capture of cardiac structures in the radiation field and the cumulative dose of exposure. They are characterized by polymorphism in clinical manifestations. Objective: to identify the predictors influencing in-hospital mortality (IHM) in order to optimize the treatment of patients with radiation-induced heart disease. Materials and methods. This is a single-patient cohort study that was retrospective from 2004 to 2018 and prospective from 2018. Death after 30 days following heart valve surgery (HVS) under artificial circulation was taken as the end point of the study. The study included 86 patients (mean age 59 ± 13 years, 81.4% female) who underwent HVS. They were split into 2 groups (extensive, tangential) depending on the cause of cancer. Results. In the postoperative period, the group with extensive irradiation had statistically significant differences in the need for prolonged ventilation, OR 5.17 (CI 95% 1.7–15.7), more frequent exudative pleurisy OR 3.4 (CI 95% 1.1–10.8), and acute renal failure OR 1.2 (CI 95% 1.05–1.37). Regardless of postoperative complications, the length of hospital stay did not differ statistically across the groups, with a median of 10.5 (CI 7.25:16.75) vs. 11 (CI 9:15.25) days, respectively. Overall IHM was 14 (16.27%) patients. Multiple organ failure (MOF) was the cause of death in 9 cases. Multivariate analysis revealed that extensive irradiation for lymphogranulomatosis increased IHM risk by 5.099 times, and an increase in the EuroSCORE II score by every «1» increased IHM risk by 1.19 times. Conclusion. Patients with post-radiation damage to heart valves and coronary arteries with a history of tangential irradiation can be successfully operated on. Extensive irradiation in anamnesis is associated with a high risk of heart failure and MOF in the early postoperative period.

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The authors declare that there are no conflicts of interest present.