Murat DEMİRTAŞ, Gökçen ORHAN, Batuhan ÖZAY, Rafet GÜNAY, Bülend KETENCİ, Serdar ÇİMEN, Mehmet GÜNEY, Vedat ÖZKUL, Alper GÖRÜR

İskemik kardiyomiyopatide cerrahi revaskülarizasyon tekniklerinin sonuçları

İskemik kardiyomiyopati, tedavisi zor ve prognozu kötü olan bir hasta grubunu teşkil etmektedir. Son yıllarda atan kalp tekniği ile ulaşılan başarılı sonuçların, bu grup hastalarda da elde edildiği bildirilmektedir. Ancak konvansiydnel yöntemlerdeki ciddi gelişmeler, iki grubun birbirine olan üstünlükleri konusundaki tartışmaların devam etmesine neden olmuştur. Bu çalışmada, her iki grubun erken ve geç dönem sonuçları karşılaştırılmıştır. Çalışma grubu 2001-2005 yılları arasında sol ventrikül ejeksiyon fraksiyonu% 30'un altında ve sol ventrikül dilatasyonu olan toplam 25 olguyu kapsamaktadır. Grup 1 atan kalp, Grup 2 ise kardiyopulmoner by-pass uygulanarak öpere edilen olgulardan oluşturulmuştur. Hastane mortalitesi Grup 2'deki tek olgu ile % 4 idi. Hastane ve yoğun bakım kalış süreleri Grup 1 'de daha düşük bulundu. Geç dönemde her iki gruptan 1 'er olgu kaybedildi. İstatistiksel anlamlılığa erişmemesine rağmen Grup 2'deki olgular, orta dönem takipleri sırasında fonksiyonel kapasite ve angina sınıflandırması açısından daha iyi konumda idiler. İskemik kardiyomiyopatili hastaların her iki yöntemle yapılan operasyonlarının gerek erken gerekse geç dönem sonuçları tatmin edicidir. Ancak bu çalışmada, atan kalp tekniğinin erken dönem sonuçları daha iyi iken, kardiyopulmoner by-pass grubunun geç dönem morbiditesi daha düşük bulundu.

Early and late outcomes of surgical revascularization procedures in ischemic cardiomyopathy

Management of patients with ischemic cardiomyopathy is rather complicated and also has a poor prognosis. Recently, substantial success rates have also been reported with off-pump technique in these high risk patients. Nevertheless, owing to the great advances, that were achieved in traditional myocardial preservation and cardiopulmonary bypass techniques in the most recent years; a dilemma still remains regarding superiority of these techniques to each other in patients with ischemic cardiomyopathy. Thus, we have compared early and late results of these two techniques in this study. Study group included 25 operated patients who have an left ventricle ejection fraction of less than 30 % and left ventricular dilatation between 2001 and 2005. Groups 1 and 2 included patients that were operated with "off pump" and "cardiopulmonary bypass" techniques, respectively. Hospital mortality was 4% with 1 patient dying in Group 2. Durations of intensive care unit and hospital stays were shorter in Group 1. Two patients (1 from each group)died in the late postoperative period. Although midterm comparisons of both functional and angina classifications revealed better results in Group 2 patients, statistical significance wasn't present. Early and late outcomes of surgical revascularization procedures were satisfactory with both techniques in patients with ischemic cardiomyopathy. In this study, short term results seemed better in "off pump" patients, while late morbidity rate was lower for "cardiopulmonary bypass" group.

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