Kutay TAŞDEMİR, Hakan CEYRAN, Ramazan AŞIK, Hasan MERCAN, Halit ANDAÇ, Alper KUNT, Ömer Naci EMİROĞULLARI, Alptekin YASIM

Yaşlılarda koroner arter cerrahisi

1 Ağustos 1994 - 3J Aralık 1996 tarihleri arasında Erciyes Üniversitesi Tıp Fakültesi Göğüs Kalp ve Damar Cerrahisi Anabilim Dalında 65 ve üzeri 45 olguyla koroner bypass cerrahisi uygu¬lanmıştır. Onu kadın, 35'i erkek olan hastaların %28.8'inde hipertansiyon, %64.4'ünde sigara, %31.1 'inde obesite, %28.8'inde geçirilmiş myokard enfarktüsü, %22.2'sinde iabet, %31.1'inde ise aile hikayesi belirlenen risk faktörleriydi. Hastaların %11.1 'inde tek damar, %37.7'sinde iki damar, %51.2'sinde ise üç damar lezyonu mevcuttu. İki hastada mitral kapak replasmanı, 5 hastada anevriz¬ma plikasyonu, 1 hastada ise kalıcı pace maker implantasyonu koroner bypassla birlikte yapılan ek işlemlerdi. Tüm hastalarda internal mamariyal arter¬le (İMA) sol ön inen koroner artere (LAD) anastomoz yapıldı. Kırk hastada ise İMA ile birlikte safen ven grefti de kullanıldı. Ortalama distal anastomoz sayısı 2.9 olup toplam distal anastomoz sayısı 134'dür. Ortalama aortik kross klamp ve total kardiyopul-moner bypass zamanları sırasıyla 45 ve 80 dakikadır. Postoperatif dönemde düşük kalp debisi nedeniyle inotropik destek sağlanan 12 hastanın beşine ayrıca intraaortik balon (İAB) desteği uygu¬lanmış, bunlardan ikisi kaybedilmiştir. Ayrıca iki hasta nörolojik komplikasyon, bir hasta da postop¬eratif 3. gün gelişen ventriküler fibrilasyon nedeniyle exitus olmuştur. Toplam mortalitemiz 5 vaka ile %11.1'dir. Preoperatif dönemde NYHA sınıfla¬masına göre hastaların %24.4'ü II. devrede %64.5'i III. devrede ve %11.1'i IV. devrede yer almaktaydı. Taburcu edilen hastaların ise %66.6'sı devre I, %3.4'ü ise devre ll'de bulunuyordu.

Coronary bypass surgery in the elderly

Between August 1, 1994 and December 31, 1996 forty five patients aged 65 years and over underwent coronary artery bypass operations in Thoracic and Cardiovascular Surgery Department of Erciyes University Medical School. There were 35 men and 10 women. The patients' preoperative con¬ditions were characterized by hypertension (28.8%), smoking (64.4%), obesity (31.1%), recent myocar-dial infarction (28.8%), diabetes mellitus (22.2%) and family history (31.1%). 11.1% of the patients had single vessel disease, 37.7% had double vessel and 51.2% had three vessel diseases. Among them, 37 patients had isolated coronary artery bypass grafting; 2 had mitral valve replacement, 5 had ven¬tricular aneurysm plication and 1 had permanent pace maker implantation combined with coronary artery bypass grafting. While 6 patients had internal mammary artery grat alone, 39 patients had both saphenous vein and internal mammary artery grafts. The hospital mortality was 11.1% (2 low caridac output, 2 neurologic complications and 1 ventricu¬lar fibrillation). Preoperatively, 24.4% of the patients were in New York Heart Association (NYHA) func¬tional class II and 64.5% were in functional class III and 11.% were in functional class IV. Postoperatively, 66.6% of the patients were NYHA functional class 1, 33.4% functional class II.

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