Şenol YAVUZ, Gündüz YÜMÜN, Kalp Damar Cerrahisi KLİNİĞİ, Faruk TOKTAŞ

SOL İNEN KORONER ARTER BYPASS GREFT POZİSYONUNDA SAFEN VEN VE SOL İNTERNAL MAMARİAL ARTERİN AÇIKLIKLARININ KARŞILAŞTIRILMASI

Amaç: Bizim bu çalışmadaki amacımız, koroner bypas operasyonlarında (CABG), sol anteriyor desenden koroner arterin (LAD) revaskülarizasyonunda kullanılan sol internal mamarial arter (LİMA) ile safen ven greftinin (SVG)klinik sonuçlarını ve uzun dönem açıklık oranının değerlendirilmesidir. İlave olarak safen ven greftinin diğer koroner arter pozisyonlarında ki açıklık oranını da değerlendirildi. Metot: Ocak 2012-Kasım 2014 arasında hastanemizde, daha önce koroner bypass cerrahisi geçirmiş ve iskemik semptomları olan 178 hastaya koroner angiografi yapıldı. Bu hastaların preoperatif ve postoperatif bilgilerini değerlendirildi. Hastalar LAD ye yapılan anastomozuna göre LİMA grubu ve SVG grubu olarak ikiye ayırıldı. Greftte, oklüzyon, string sign veya %80 den daha fazla darlık varsa greft yetmezliği olarak tanımlandı. Diğer koroner arterleri de subgrup analizi olarak değerlendirildi.Sonuç: Her iki grup arasında preoperatif olarak komorbidite, yaş ve acil operasyona alma açısından önemli bir fark yoktu. Hastaların ortalama takip zamanı SVG grubunda 48 ay, LİMA grubun da 60 ay oldu. LİMA greftlerinin oklüzyon oranı, SVG grubundan daha düşüktü ( (%9.9%vs. %22.2 p=0.001). subgrup analizlerinde SVG in patensi, en düşük olarak diyagonal koroner arterde bulundu(%46.9, p=0.005).Tartışma: Venöz veya arteriel konduitin seçimi, hem greft patensi için, hem de semptomsuz periyodun elde edilmesinde sol koroner desenden arter için önemlidir. Ayrıca safen ven grefti diagonal artere anastomoz edildiği zaman en düşük açıklık oranına sahiptir.

Comparison of Patency of the Saphenous Vein and Left Internal Mammary Artery in Left Descending Coronary Artery Bypass Graft Position

Objective: We aimed to evaluate long-term patency rates and clinical outcomes of the saphenous vein (SVG) and left internal mammary artery (LIMA) in left anterior descending coronary artery (LAD) position to investigate the optimum conduit for coronary artery bypass graft (CABG) operations. In addition we investigated the SVG patency in the other coronary artery positions. Methods: From January 2012 to November 2014, there were 178 patients who were previously undergone coronary artery bypass surgery and had ischemic symptoms, were restudied with coronary angiography in our hospital. We evaluated the preoperative and postoperative data of those patients. The patients were divided into two groups according to the graft anastamosed to LAD; LIMA group and SVG group. Grafts are defined as failed if there was occlusion, string sign, or greater than 80% stenosis. We analyzed also other coronary artery targets by subgroup analysis.Results: There were no significant differences between each group in preoperative comorbidity, age, or urgency. The mean follow-up time of the patients were 48 months in SVG group and 60 months in LIMA group. Occlusion rates of the LIMA grafts were lower than SVG (9.9% vs. 22.2% p=0.001). Subgroup analysis revealed that, as a target vessel diagonal coronary artery has the lowest SVG patency rates (46.9%, p=0.005).Conclusion: Selection of arterial or venous conduit for the left descending coronary artery has significantly affected both patency rate and symptom-free period. In addition, saphenous vein grafts has the lowest patency rates when anastamosed to the diagonal artery.

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