Tek Damar Off-pump ve On-pump Koroner Arter Cerrahisinin Postoperatif Komplikasyonlara Etkisi
Giriş ve amaç: Günümüzde koroner bypass ameliyatları hala yaygın olarak on-pump CABG ve off-pump CABG tekniği ile yapılmaktadır. Bu retrospektif klinik çalışmada her iki cerrahi yöntemin kısa ve uzun dönem komplikasyonlarını araştırdık.
Gereç ve Yöntemler: Bu çalışmaya 2011-2015 yılları arasında kliniğimizde Syntax skorlamasına göre izole tek damar koroner arter hastalığı olan; on-pump (Grup 1) ve off-pump (Grup 2) koroner arter cerrahisi geçiren toplam 43 hasta dahil edilmiştir. Bu hastalarda postoperatif erken dönem komplikasyonlar ve bir yıllık majör advers kardiyovasküler ve serebral olaylar karşılaştırılmıştır.
Bulgular: Her iki grup arasında demografik verilerde istatistiksel olarak anlamlı fark saptanmadı. Postoperatif komplikasyonlar açısından atrial fibrilasyon off-pump cerrahi yapılan grupta anlamlı olarak daha az saptanmıştır. Yoğun bakımda ve hastanede kalış süreleri, pnömoni, sternal enfeksiyon ve postoperatif drenaj miktarları açısından anlamlı farklılık saptanmamıştır. Operasyon sonrası uzun dönemde majör adverse kardiyovasküler ve serebral olaylar (MACCE) açısından gruplar arasında farklılık saptanmamıştır.
Sonuç: Sonuç olarak koroner bypass cerrahisinde uygulanacak yöntemin hastanın risk skorlamasına göre belirlenmesini öneriyoruz.
The Effect of Single Vessel Off-pump and On-pump Coronary Artery Surgery on Postoperative Complications
Objective: Today, coronary bypass surgeries are still commonly performed with on-pump CABG and off-pump CABG techniques. In this retrospective clinical study, we investigated the short- and long-term complications of both surgical methods.
Materials and Methods: In this study, patients with isolated single-vessel coronary artery disease according to Syntax scoring in our clinic between 2011 and 2015. A total of 43 patients who underwent on-pump (Group 1) and off-pump (Group 2) coronary artery surgery were included. In these patients, early postoperative complications and one-year major adverse cardiovascular and cerebral events were compared.
Results: There were no statistically significant differences in terms of demographic values between the two groups. In terms of postoperative complications, atrial fibrillation was found to be significantly less in the off-pump surgery group. There was no significant difference in terms of length of stay in the intensive care unit and hospital, pneumonia, sternal infection and the amount of postoperative drainage. There was no difference between the groups in terms of major adverse cardiovascular and cerebral events (MACCE) in the long term after the operation.
Conclusion: In conclusion, we suggest determining the method to be applied in coronary bypass surgery according to the patient's risk scoring.
___
- Malakar, A.K, Choudhury, D, Halder, B, Paul, P, Uddin, A, Chakraborty, S. A review on coronary artery disease, its risk factors, and therapeutics, Journal of Celular Physiology, 2019, 234, 16812-16823.
- TC Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu, Türkiye Kalp ve Damar Hastalıkları Önleme ve Kontrol Programı, 2015-2020, 9-21.
- Sheikhy, A, Fallahzadeh, A, Sadeghian, S, Forouzannia, K, Bagheri, J, Salehi-Omran, A, et al., Mid‑term outcomes of off‑pump versus on‑pump coronary artery bypass graft surgery; statistical challenges in comparison, BioMed Central Cardiovascular Disorders, 2021, 21, 412-420.
- Bachar, B.J, Manna, B, Coronary artery bypass graft. Internet: StatPearls Publishing, 2021, 11, PMID: 29939613
- Shaefi, S, Mittel, A, Loberman, D, Ramakrishna, H, Off-pump versus on-pump coronary artery bypass grafting- A systematic review and analysis of clinical outcomes, Journal of Cardiothoracic and Vascular Anesthesia, 2019, 3, 232-244.
- Moller, C.H, Penninga, L, Wetterslev, J, et al., Off-pump versus on-pump coronary artery bypass grafting
for ischemic heart diseases, Cochrane Database Systematic Review, 2012, 3. CD007224.
- Ascione, R, Caputo, M, Angelini, G.D, Off-pump coronary artery bypass grafting: Not a flash pan, The Annals of Thoracic Surgery, 2003, 75, 306-313.
- Farooq, V, Head, S.J, Kappetein, A.P, Serruys, P.W, Widening clinical applications of the SYNTAX Score, Heart, 2014, 100(4), 276-87.
- Safarian, H, Alidoosti, M, Shafiee, A, Salarifar, M, Poorhosseini, H, Nematipour, E, The SYNTAX Score Can Predict Major Adverse Cardiac Events Following Percutaneous Coronary Intervention, Heart Views, 2014, 15(4), 99-105.
- Olesen, K.K.W, Madsen, M, Lip, G.Y.H, Egholm, G, Thim, T, Jensen, L.O, et al., Coronary artery disease and risk of adverse cardiac events and stroke. European Journal of Clinical Investigation, 2017, 47 (11), 819–828.
- Kilger, E, Weis, F.C, Goetz, A.E, Frey, L et al., Intensive care after minimally invasive and conventional coronary surgery: A prospective comparison, Intensive Care Medicine, 2001, 27, 534-539.
- Creswell, L.L, Postoperative atrial arrhythmias: Risk factors and associated outcomes, Seminars in Thoracic and Cardiovascular Surgery, 1999, 11, 303-307.
- Athanasiou, T, Aziz, O, Mangoush, O, Al-Ruzzeh, S, Nair, S, Malinovski, V, et al., Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited. Europen Journal of Cardiothoracic Surgery,2004, 26(4), 701-710.
- Wu, C.Y, Wang, S.H, Shang, Y.Q, Xia, JH, Incidence of atrial fibrillation after off-pump versus on-pump coronary artery bypass grafting: A meta-analysis of randomized clinical trials and propensity score matching trials. Journal of Huazhong University of Science and Technology. Medical sciences, 2017,37(6), 956-964.
- Sarak T, Karadeniz M. Akut Koroner Sendromlu Hastalarda Kronik Total Oklüzyon Sıklığı ve Risk Faktörleriyle İlişkisi. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 2019, 6(3), 194-198