Oğuz KARAHAN, Umut Serhat SANRI, Şinasi MANDUZ, Fahri Hayri ATLI, Ahmet ÇALIŞKAN, Celal YAVUZ, Sinan DEMİRTAŞ

Coronary bypass applications in patients with low ejection fraction: investigation of preoperative, intraoperative and postoperative data

Amaç: Sol ventrikül disfonsiyonu hastane mortalitesini etkileyen önemli bir faktördür. Aynı zamanda bu hastaların cerrahisi de yüksek risklidir. Bu çalışmada kliniğimizde düşük ejeksiyon fraksiyonuna sahip hastalara uygulanan pompalı veya pompasız miyokartiyal revaskularizasyonların klinik sonuçları değerlendirmeyi amaçladık. Yöntemler: Ejeksiyon fraksiyonu (EF) %40 ve altında olan 129 hasta retrospektif olarak incelendi. Çeşitli değiş- kenler (preoperatif, intraoperatif ve postoperatif) karşılaş- tırıldı. Hastaların preoperatif, peroperatif ve postoperatif inotropik destek alıp almadıkları da değerlendirildi. Bulgular: Hastaların 84 ü (% 65,1) erkek, u bayan, yaş ortalaması 65,37 ± 8,49 olarak tespit edildi. Ortalama bazal metabolizma indeksi 26,33 ± 4,21 olarak bulundu. Hastaların EF lerinin dağılımı; 74 hastada (%57,4) EF si %40-36 arasında, 38 hastada (%29,5) EF si %35-31 arasında ve 17 hastada (%13,2) EF si ≤%30 şeklindeydi. NYHA Class ortalama 2,16 ± 1,03 olarak bulundu. Ortalama hasta başına düşen bypass sayısı 3,46 şeklinde belirlendi ve %92,2 hastada sol internal mammarian arter kullanıldı. Hastane mortalitesi 5 (%3,9) olarak tespit edildi. En önemli sebepler kardiyak faktörler ya da eşlik eden multiorgan yetmezliğiydi. Postoperatif aritmiler en sık izlenen komplikasyondu. Sonuç: Düşük sol ventrikül fonksiyonuna sahip hastalar pompalı ya da pompasız miyokartiyal revaskülarizasyondan fayda görmekle birlikte mortalite riski normal ventrikül fonksiyonuna sahip hastaların riskinden daha fazladır. Ancak, tüm risklere rağmen deneyimli deneyimli ellerde bu hastalar da başarıyla ameliyat edilebilmektedir.

Düşük ejeksiyon fraksiyonlu hastalarda koroner bypass uygulamaları: preoperatif, intraoperatif ve postoperatif verilerin incelenmesi

Objective: Left ventricle dysfunction is an important determinant that effects hospital mortality. At the same time, the surgery of these patients is also highly risky. In this study we aimed to evaluate the clinical outcomes of onpump or off-pump revascularizations in patients with low ejection fraction. Methods: One hundred and twenty-nine patients who have ≤ 40% ejection fraction (EF) was scanned retrospectively. Various variables were (preoperative, intraoperative, postoperative) were compared. It was evaluated that whether patients gets preoperative, intraoperative, postoperative support or not. Results: Eighty-four (65.1%) male and 45 (34.9%) female patient were detected with main age of 65.37 ± 8.49 years. Mean basal metabolism index was detected as 26.33 ± 4.21. The distrubution of EF of patients were as follows; EF is between %40-36 in 74 (57.4%) patients, EF is between %35-31 in 38 (29.5%) patients, and EF is ≤%30 in 17 (13.2%) patients. Mean NYHA Class was detected as 2.16 ± 1.03. Mean bypass count was determined as 3.46 per patient and left internal mammarian artery was used in 92.2% of the patients. Hospital mortality was detected as 5 (3.9%). The main important reasons were cardiac factors or concomitant multiorgan failure. Postoperatvie arrythmias were the most detected complications.Conclusion: The patients who have low left ventricular pump function are benefits myocardial revascularization, although mortality is higher than normal ventricular function. However, inspite the all risk, these patients can be sucessfully operated with experinced hands.

PDF

___

1. Cooley DA. In Memoriam: Tribute to René Favaloro, Pioneer of Coronary Bypass. Texas Heart Inst J. 2000;27:231-232.
2. Christakis GT, Weisel RD, Fremes SE, et al. Coronary artery bypass grafting in patients with poor ventricular function. J Thorac Cardiovasc Surg 1992;103:1083-1092.
3. Yamamuro M, Lytle BW, Sapp SK, et al. Risk factors and outcomes after coronary reoperation in 739 elderly patients. Ann Thorac Surg 2000;69:464-474.
4. Shapira OM, Hunter CT, Anter et al. Coronary artery bypass grafting in patients with severe left ventricular dysfunction early and mid-term outcomes. J Card Surg 2006;21:225-232.
5. Li WF, Costa LG, Furlong CE. Serum paraoxonase status: a major factor in determining resistance to organophosphates. J Toxicol Environ Health 1993;40:337-346.
6. Dinler G, Bokeria LA , Batyraliev T. Koroner arteterlein stentlenmesinin düşük sol ventrikül ejeksiyon fraksiyonlu hastalarda azalmış miyokart fonksiyonuna etkisi. Türk Girişimsel Kard. Der. 2007;11:138-145.
7. Silistreli E, Oto Ö. Son dönem kalp yetmezliğinde uygulanan cerrahi tedavi modaliteleri. TGKDCD 1999;7:161-179.
8. Topkara VK, Cheema FH, Kesavaramanujam S, et al. Coronary artery bypass grafting in patients with low ejection fraction. Circulation 2005;112;344-350.
9. Yavuz C, Ayaz F, Topal AE, et al. Changes in left ventricular functions after coronary artery by-pass surgery. J Clin Exp Invest 2010;1:108-112.
10. Hillis GS, Zehr KJ, Williams AW, et al. Williams, Hartzell V. Schaff, Thomas A. Outcome of patients with low ejection fraction undergoing coronary artery bypass grafting: renal function and mortality after 3.8 years. Circulation 2006;114;414-419.
11. Davoodi S, Karimi A, Ahmadi SH, et al. Coronary artery bypass grafting in patients with low ejection fraction: The effect of intra-aortic balloon pump insertion on early outcome. IJMS 2008;62:314-322.
12. Shrikhande GV, AHamdan AD, Monahan TS, et al. Low ejection fraction predicts shortened survival in patients undergoing infrainguinal arterial reconstruction. World J Surg 2007;31:2422-2426.