Vural ÖZCAN, Sabit SARIKAYA, Ahmet Tansel ÇÖRTELEKOĞLU, Seyfettin Hakan ALTAN, Cengiz KÖKSAL, Mustafa ZENGİN

Koroner revaskülarizasyon için kullanılan pompalı ve pompasız yöntemlerin erken dönem sonuçlarının karşılaştırılması

Koroner arter cerrahisinde çalışan kalpte koroner bypas tekniğinin (OPCAB), pompa kullanılarak yapılan cerrahiyle (CPB ile KABG) karşılaştırıldığında, üstünlüğü tartışmalıdır. Çalışmamızın amacı CPB ile KABG ve OPCAB cerrahi yöntemlerinin erken dönem sonuçlarını prospektif olarak karşılaştırmaktır. 2001-2003 yılları arasında koroner revaskülarizasyon gerektiren 100 hastaya pompalı (n: 50) ve pompasız (n: 50) teknik kullanılarak koroner bypas yapıldı. Her iki grup birbiri ile kan üre, kreatinin, SGOT, SGPT düzeyleri, (+) in-otrop ihtiyacı, ventilasyon süresi, kan ve kan ürünleri ihtiyacı, yoğun bakım ve hastanede kalış süreleri ve drenaj miktarı bakımından ameliyat sonrası erken dönemde karşılaştırıldı. OPCAB koroner bypass grubunda, diğer grupla karşılaştırıldığında, yoğun bakımda kalış süresi, karaciğer enzimleri (SGOT, SGPT) ve (+) inotrop ihtiyacı ameliyat sonrası erken dönemde anlamlı azaldığı tespit edildi. Sonuç olarak; CPB ile KABG yöntemi ile karşılaştırıldığında, OPCAB yönteminin ameliyat sonrası erken dönemde klinik olarak daha avantajlı olduğu bulunmuştur. Ancak, OPCAB yönteminin geç dönem etkinliğinin gösterilmesi için, uzun dönem takip sonuçlarına ihtiyaç vardır.

Comparison of early-term results of on-pump and off-pump technique for coronary revascularization

Background and Design.- Whether the clinical outcomes of off-pump coronary artery bypass grafting surgery is superior to on-pump coronary arter surgery is still a matter of debate. The aim of this clinical prospective study was to compare the early-term results of off-pump and on-pump techniques for myocardial revascularization. Between 2001 and 2003, 100 patients who needed myocardial revascularization was scheduled to be operated with either conventional technique (n: 50) or off-pump technique (n: 50). In the postoperative period, both groups were compared in terms of blood urea, creatinine, SGOT, SGPT levels, need for (+) inotrop agents, ventilation time, amount of blood and blood products transfusion, hospital and intensive care unit stay and amount of drainage. Results.- Statistically significant difference was found between the two groups, favoring off-pump coronary revascularization, with respect to intensive care unit stay, ventilation time, need for (+) inotropic agents, and hepatic enzyme (SGOT, SGPT) levels in the postoperative early period. Conclusion.- Off-pump coronary revascularization offers important clinical advantages in the early postoperative period compared to conventional technique. However, long-term follow-up is required to assess the future effectiveness of off-pump technique.

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