Hasan UNCU, Mehmet ACIPAYAM, Tolga Onur BADAK, Habib ÇAKIR, Gür Deniz YILDIZ, Pınar DOĞAN, İbrahim ÖZSÖYLER

Atan Kalpte Bypass Deneyimlerimiz

Son yıllarda koroner arter hastalığının artmasına paralel koroner bypass operasyonlarında da artış olmuştur. Cerrahi uygulamalarçoğunlukla kardiyopulmoner bypass CPB altında yapılmasına karşın cerrahi deneyimin artması ile atan kalpte koroner arter bypasstekniği öncelikle yüksek riskli hastalarda olmak üzere günümüzde yaygın olarak kullanılmaktadır. Bu yazımızda kliniğimizdegerçekleştirdiğimiz off pump koroner arter bypass OPCAB uygulamalarımızın sonuçlarını sunmaktayız. Adana Numune Eğitim veAraştırma Hastanesi Fatma Kemal Timuçin Kalp Merkezi’nde Ocak 2004 - Şubat 2012 tarihleri arasında OPCAB uygulanan 1057 hastaçalışmaya alındı. Assendan aortada yoğun kalsifikasyonu ve bozulmuş renal fonksiyonları olan olgular öncelikle OPCAB açısındandeğerlendirildiler. Hastalar seçilirken LAD damarının intramiyokardiyal olmaması, hedef koroner arterde yoğun kalsifikasyon olmamasıve çapın 1.5 mm’nin altında olması gibi anatomik faktörler göz önünde bulunduruldu. Bu kriterlere uygun olmayan hastalar, CPB’agirilerek koroner arter bypass greft CABG operasyonu uygulandığı için çalışmaya dahil edilmedi. Olguların yaş, cinsiyet, sol ventrikülejeksiyon fraksiyonları, morbidite, mortaliteleri, yoğun bakımda kalış süreleri, kan transfüzyonu ihtiyaçları, hastanede kalış sürelerikaydedildi. Hastaların 724’ü erkek, 333’ü bayan idi. Olguların 334’ünde diyabetes mellitus DM ; 387’sinde hipertansiyon HT ;118’inde kronik obstrüktif akciğer hastalığı KOAH mevcuttu. Yaş ortalamaları 58.9±10.5; yoğun bakım ünitesinde kalış süresiortalamaları 1.2±0.5 gün, kan transfüzyonu ihtiyacı ortalama 1,3±1.0 ünite olmuştur. Beş yüz doksan hastaya tek damar, 385 hastaya 2damar, 82 hastaya 3 damar bypass uygulandı. Postoperatif erken dönemde 9 hastada mortalite gözlendi. OPCAB prosedürlerinin CPBaltında yapılan koroner bypass operasyonlarına göre mortalite ve morbiditesi daha düşüktür. Ancak uygulanabilirliği için belli bircerrahi deneyim ve uygun koroner anatomi gerektirmektedir. Seçilmiş hasta grubunda atan kalpte koroner arter bypass uygulamaları ileolguların kan transfüzyonu ihtiyacı, yoğun bakım ünitesinde ve hastanede kalma süreleri azalmaktadır. Kliniğimizde OPCABprosedürleri düşük morbidite ve mortalite oranlarıyla yapılmaktadır

Anahtar Kelimeler:

Atan kalpte bypass, kardiyopulmoner bypass, mortalitem, morbidite

Our Beating Heart Bypass Experiences

In recent years, coronary bypass operations have also been increased which parallel to the increase of coronary artery disease. Althoughsurgical applications are often performed under the cardiopulmonary bypass CPB , nowadays off pump coronary artery bypass OPCAB technique is widely used primarily high risk patient with the increase in surgical skills for it. In this lecture, we submit toresults of OPCAB cases in our clinic. In Adana Numune Education and Training Hospital Fatma Kemal Timucin Heart Centre , 1057patients that performed OPCAB between January 2004 and February 2012 were included to study. Patients with heavily calcified aortaand impaired renal function are evaluated primarly for OPCAB. While patients were selected, anatomic factors like non-intramyocardialLAD, absence of heavily calcified target coronary artery and diameter of coronary not less than 1.5 mm were taken into consideration.Patients that were not fulfilling these criteria were operated with the help of CPB so they were not included the study. Age, gender, leftventricule ejection fraction, morbidity, mortality, length of stay in intensive care unit, duration of hospitalisation and blood transfusionrequirement of cases were recorded. Seven hundered twenty four patients were male, 333 were female. Diabetes mellitus was detectedin 334 patients, hypertension was 387, chronic obstructive pulmonary disease was 118. Average of age was 58.9±10.5, average oflength of stay in intensive care unit was 1.2±0.5 and average of blood transfusion requirement was 1,3±1.0. One vessel bypass wasperformed to 590 patients, two vessels bypass were 385 and triple bypass were 82. In postoperative early period, 9 patients were died.Mortality and morbidity rate of OPCAB procedure was lower than on pump operations. However applicability of procedure is requiredsatisfactory surgical experience and appropriate coronary anatomy. Requirement of blood transfusion, hospital and intensive care unitstay decrease with OPCAB procedure for selected patient group. In our clinic, OPCAB procedure is performed low morbidity andmortality rates

Keywords:

Off pump bypass beating heart, cardiopulmonary bypass, mortality, morbidity,

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