Osman Tansel DARÇIN, Alper Sami KUNT, Mehmet Salih AYDIN, Cüneyt ŞELLİ,

Atan kalpte koroner arter bypass cerrahisi sonuçlarımız

Amaç: Kalp cerrahisinde atan kalpte koroner arter bypass KABC tekniği öncelikle yüksek riskli hastalarda olmak üzere günümüzde yaygın olarak kullanılmaktadır. Bu çalışmada koroner arter hastalığı nedeniyle kliniğimizde Euroscore > 5 olan hastalarda çalışan kalpte KABC tekniği ile ameliyat ettiğimiz olguların sonuçlarını sunmayı amaçladık. Gereç ve Yöntem: Kliniğimizde Nisan 2002-Ocak 2005 tarihleri arasındaki dönemde 86 atan kalpte KABC ameliyatı yapıldı. Tüm olguların yaş ortalaması 61.5 ± 8.9 yıl ve %89.64’ü erkek idi. Preoperatif değerlendirilmelerinde olguların risk faktörleri; sigara içimi 23 olgu %27.90 , diyabet 19 olgu %23.25 , hipertansiyon 34 olgu %40.69 , kronik obstrüktif akciğer hastalığı 6 olgu %6.97 ile sıralanmaktaydı. Bulgular: Olguların sol ventrikül ejeksiyon fraksiyonu % 34.2 ± 9.1 ve Euroscore değerleri 9.7 ± 3.1 bulundu. Ortalama distal anastomoz 1.99 ± 0.6 olarak gerçekleştirildi. Ortalama yoğun bakım kalış süresi 19 ± 5.2 saat , hastane kalış süresi 7.5 ± 1.5 gün idi. Sekiz olguda %9.19 intraaortik balon pompası kullanıldı. Beş olguya %5.74 atan kalpte KABC ve koroner endarterektomi yapıldı. Hastane mortalitesi 3 hastada % 3.4 görüldü. Sonuç: Atan kalpte KABC tekniğinin yüksek riskli hastalarda kabul edilebilir mortalite ve morbiditeyle uygulanabileceği kanaatindeyiz

Anahtar Kelimeler:

Atan kalp, koroner arter bypass cerrahisi, Euroscore

Clinical outcome off-pump coronary artery bypass grafting

Background: In the recent years, off-pump coronary artery bypass OPCAB surgery has become an established surgical technique especially in Euroscore > 5 patients. The purpose of this study is to investigate the results of on the beating heart coronary bypass surgery in patients with Euroscore > 5. Methods: Eighty-six patients operated on the beating heart between April 2002 and January 2005 were included in this study. Mean age of patients 61.5 ± 8.9 years and 89.64% were male. Preoperative patşent risk factor was; smoking 23 patient 27.90% , diabetes mellitus 19 patient 23.25% , hypertansion 34 patient 40,69% and cronic obstruktive lung disease in 6 patient. Results: Mean of left ventricular ejection fraction of all patients was 42 ± 9.1%, Euroscore was 9.7 ± 3.1. The mean number of bypassed grafts was 1.99 ± 0.6. Mean stay at intensive care unit 19 ± 5.2 hour, and at hospital 7.5 ± 1.5 days. İntra-aortic balloon pump was used in eight patients 4.6% . Five patients 5.8% received endarterectomy of at least one coronary artery. Hospital mortality was 3.4% with 3 patients. Conclusions: Off-pump CABG can be performed with low mortality and morbidity in patients with Euroscore>5

Keywords:

Beating heart, Coronary artery bypass, Euroscore,

PDF

___

Cleveland JC Jr, Shroyer AL, Chen AY, Peterson E, Grover FL. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 2001; 72: 1282–1289.
Plomondon ME, Cleveland JC Jr, Ludwig ST, et al. Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes. Ann Thorac Surg 2001; 72: 114– 119.
Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet 2002; 359: 1194–1199.
Magee MJ, Jablonski KA, Stamou SC, et al. Elimination of cardiopulmonary bypass improves early survival for multivessel coronary artery bypass patients. Ann Thorac Surg 2002; 73: 1196-1202; discussion 1202- 1203.
Nashaf Sam, Roques F, Michel P et al. . European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999; 16: 9–13.
Patel NC, Garyson AD, Jackson M, et al. The effect of offpump coronary bypass surgery on in-hospital mortality and morbidity. Eur J Cardiothorac Surg 2002; 22: 255-260.
Hart JC, Puskas JD, Sabik JF. Off-pump coronary revascularization: Current state of art. Semin Thorac Cardiovasc Surg 2002; 14: 70- 81.
Puskas JD, Wright CE, Ronson RS, et al. Clinical outcomes and angiographic patency in 125 consecutive off-pump coronary bypass patients. Heart Surg Forum 1999; 2: 216-221.
Paç M, Akçevin A, Aka SA, Büket S, Sarıoğlu T. Kalp ve Damar Cerrahisi. Ankara 2004:726- 727
Ascine C, Lloyd CT, Underwood MJ,Gomes WJ, Angelini GD. On-pomp versus Off-pomp coronary revascularization: evaluation of renal function. Ann Thorac Surg 1999; 68: 493-498.
Jerrold HL, Kenichi AT. Inflammatory response to cardiopulmonary bypass. Ann Thoracic Surg 2003; 75: 711-720.
Gerritsen WBM , van Boven WJP, Driesssen AHA, Haas FJLM, Aarts LPHJ. Off versus on- pump coronary artery bypass grafting: oksidative stress and renal function. Eur J Cardiothoracic Surg 2001; 20: 923-929.
Gu YJ, Mariani MA, van Oeveren W, Grandjean JG, Boonstra PW. Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting. Ann Thorac Surg 1998; 65: 420-424.
Brasil LA, Gomes WJ, Salomao R, Buffolo E .Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 1998; 66: 56-59
Fransen E, Maessen J, Dentener M, et al. Systemic inflammation present in patients undergoing CABG without extracorporeal circulation. Chest 1998; 113: 1290-1295.
Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): A pooled analysis of two randomised controlled trials. Lancet 2002; 359: 1194-1199.